The analgesic effect of the ultrasound-guided transverse abdominis plane block after laparoscopic cholecystectomy.

Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Korean journal of anesthesiology 04/2010; 58(4):362-8. DOI: 10.4097/kjae.2010.58.4.362
Source: PubMed

ABSTRACT Several methods are performed to control the pain after a laparoscopic cholecystectomy. Recently, the transverse abdominis plane block has been proposed to compensate for the problems developed by preexisting methods. This study was designed to evaluate the effect of the ultrasound-guided transverse abdominis plane block (US-TAP block) and compare efficacy according to the concentration of local analgesics in patients undergoing laparoscopic cholecystectomy.
Fifty-four patients undergoing laparoscopic cholecystectomy were randomized into three groups. The patients in Group Control did not receive the US-TAP block. The patients in Group B(0.25) and Group B(0.5) received the US-TAP block with 0.25% and 0.5% levobupivacaine 30 ml respectively. After the general anesthesia, a bilateral US-TAP block was performed using an in-plane technique with 15 ml levobupivacaine on each side. Intraoperative use of remifentanil and postoperative demand of rescue analgesics in PACU were recorded. The postoperative verbal numerical rating scale (VNRS) was evaluated at 20, 30, and 60 min, and 6, 12, and 24 hr. Postoperative complications, including pneumoperitoneum, bleeding, infection, and sleep disturbance, were also checked.
The intraoperative use of remifentanil, postoperative VNRS and the postoperative demand of rescue analgesics were lower in the groups receiving the US-TAP block (Group B(0.25) and Group B(0.5)) than Group Control. There were no statistically or clinically significant differences between Group B(0.25) and Group B(0.5). No complications related to the US-TAP block were observed.
The US-TAP block with 0.25% or 0.5% levobupivacaine 30 ml (15 ml on each side) significantly reduced postoperative pain in patients undergoing laparoscopic cholecystectomy.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: 391 Background and Aims: Transversus abdominis plane (TAP) block has been shown to provide postoperative pain relief following various abdominal and inguinal surgeries, but few studies have evaluated its analgesic efficacy for intraoperative analgesia. We evaluated the efficacy of TAP block in providing effective perioperative analgesia in total abdominal hysterectomy in a randomized double-blind controlled clinical trial. Materials and Methods: A total of 90 adult female patients American Society of Anesthesiologists physical status I or II were randomized to Group B (n = 45) receiving TAP block with 0.25% bupivacaine and Group N (n = 45) with normal saline followed by general anesthesia. Hemodynamic responses to surgical incision and intraoperative fentanyl consumption were noted. Visual analog scale (VAS) scores were assessed on the emergence, at 1, 2, 3, 4, 5, 6 and 24 h. Time to first rescue analgesic (when VAS ≥4 cm or on demand), duration of postoperative analgesia, incidence of postoperative nausea-vomiting were also noted. Results: Pulse rate (95.9 ± 11.2 bpm vs. 102.9 ± 8.8 bpm, P = 0.001) systolic and diastolic BP were significantly higher in Group N. Median intraoperative fentanyl requirement was significantly higher in Group N (81 mcg vs. 114 mcg, P = 0.000). VAS scores on emergence at rest (median VAS 3 mm vs 27 mm), with activity (median 8 mm vs. 35 mm) were significantly lower in Group B. Median duration of analgesia was significantly higher in Group B (290 min vs. 16 min, P = 0.000). No complication or opioid related side effect attributed to TAP block were noted in any patient. Conclusion: Preincisional TAP block decreases intraoperative fentanyl requirements, prevents hemodynamic responses to surgical stimuli and provides effective postoperative analgesia.
    07/2014; 30(3):391-396.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Abdominal pain and shoulder tip pain after laparoscopic cholecystectomy are distressing for the patient. Various causes of this pain are peritoneal stretching and diaphragmatic irritation by high intra-abdominal pressure caused by pneumoperitoneum . We designed a study to compare the post operative pain after laparoscopic cholecystectomy at low pressure (7-8 mm of Hg) and standard pressure technique (12-14 mm of Hg). Aim : To compare the effect of low pressure and standard pressure pneumoperitoneum in post laparoscopic cholecystectomy pain . Further to study the safety of low pressure pneumoperitoneum in laparoscopic cholecystectomy. Settings and Design: A prospective randomised double blind study. Materials and Methods: A prospective randomised double blind study was done in 100 ASA grade I & II patients. They were divided into two groups -50 each. Group A patients underwent laparoscopic cholecystectomy with low pressure pneumoperitoneum (7-8 mm Hg) while group B underwent laparoscopic cholecystectomy with standard pressure pneumoperitoneum (12-13 mm Hg). Both the groups were compared for pain intensity, analgesic requirement and complications. Statistical Analysis: Demographic data and intraoperative complications were analysed using chi-square test. Frequency of pain, intensity of pain and analgesics consumption was compared by applying ANOVA test. Results: Post-operative pain score was significantly less in low pressure group as compared to standard pressure group. Number of patients requiring rescue analgesic doses was more in standard pressure group . This was statistically significant. Also total analgesic consumption was more in standard pressure group. There was no difference in intraoperative complications. Conclusion: This study demonstrates the use of simple expedient of reducing the pressure of pneumoperitoneum to 8 mm results in reduction in both intensity and frequency of post-operative pain and hence early recovery and better outcome.This study also shows that low pressure technique is safe with comparable rate of intraoperative complications.
    Journal of clinical and diagnostic research : JCDR. 02/2014; 8(2):92-4.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Transversus abdominis plane (TAP) block has been used as a multimodal strategy to optimize postoperative pain outcomes; however, it remains unclear which type of surgical procedures can benefit from the administration of a TAP block. Several studies have examined the effect of the TAP block on postoperative pain outcomes after laparoscopic surgical procedures and generated conflicting results. Our main objective in the current investigation was to evaluate the effect of TAP block on postoperative analgesia outcomes for laparoscopic surgical procedures. A search was performed to identify randomized controlled trials that evaluated the effects of the TAP block compared with an inactive group (placebo or "no treatment") on postoperative pain outcomes in laparoscopic surgical procedures. Primary outcomes included early (0-4 hours) and late (24 hours) postoperative pain at rest and on movement and postoperative opioid consumption (up to 24 hours). Meta-analysis was performed using a random-effects model. Publication bias was evaluated by examining the presence of asymmetric funnel plots using Egger regression test. Meta-regression analysis was performed to establish an association between the local anesthetic dose and the evaluated outcomes. Ten randomized clinical trials with 633 subjects were included in the analysis. The weighted mean difference (99% confidence interval) of the combined effects favored TAP block over control for pain at rest (≤4 hours, -2.41 [-3.6 to -1.16]) and (at 24 hours, -1.33 [-2.19 to -0.48]) (0-10 numerical scale). Postoperative opioid consumption was decreased in the TAP block group compared with control, weighted mean difference (99% confidence interval) of -5.74 (-8.48 to -2.99) mg morphine IV equivalents. Publication bias was not present in any of the analysis. Preoperative TAP block administration resulted in greater effects on early pain and opioid consumption compared with postoperative administration. Meta-regression analysis revealed an association between local anesthetic dose and the TAP block effect on late pain at rest and postoperative opioid consumption. None of the studies reported symptoms of local anesthetic toxicity. TAP block is an effective strategy to improve early and late pain at rest and to reduce opioid consumption after laparoscopic surgical procedures. In contrast, the TAP block was not superior compared with control to reduce early and late pain during movement. Preoperative administration of a TAP block seems to result in greater effects on postoperative pain outcomes. We also detected a local anesthetic dose response on late pain and postoperative opioid consumption.
    Anesthesia and analgesia 02/2014; 118(2):454-63. · 3.08 Impact Factor


Available from