TRANSVERSUS ABDOMINIS PLANE BLOCK AFTER LAPAROSCOPIC SURGERY AND LAPAROTOMY COMPARED WITH OPIOID ANALGESIA
Actuality. Adequate postoperative analgesia is essential for successful recovery after laparoscopic surgery and laparotomy. Opioids are commonly used to treat severe postoperative pain, and their use is often associated with many dose-dependent side effects such as nausea, vomiting, constipation, ileus, and respiratory depression]. Thus, a reduction in the administration of opioids is highly desirable, and multimodal forms of postoperative anesthesia are preferred. For this reason, the blockade of the transverse plane of the abdomen has received much attention.
Aim of this study was to evaluate the effectiveness of TAP blockade after laparoscopic surgery and laparotomy and compare it with standard systemic anesthesia.
Materials and methods of research: We analyzed the results of pain relief in 120 patients who underwent laparoscopic surgery or laparotomy and were divided into two equal (n=60) groups. One group received bipolar TAP block in the early postoperative period (within the first 24 hours). In addition, patients in this group also received intravenous administration of ketonal. The second group received the standard systemic administration of the narcotic analgesic Promedol and Ketonal during the first day after the operation.
Statistical significance was determined using unpaired two-tailed Student's t-test. Statistical processing of the material was carried out using the software package Statistica v. 7.0.
Results: The assessment of pain in the first 24 hours after surgery using the visual analog scale (VAS) did not reveal significant differences between the groups, except for the assessment after 5 hours, where the difference between the groups was significant (p < 0.05). Patient satisfaction with anesthesia, assessed on the Likert scale, did not reveal significant differences between the groups. Similarly, assessments of surgeons' satisfaction with anesthesia did not reveal a significant difference between the groups. We did not find any statistical differences in heart rate, systolic and diastolic blood pressure between the two experimental groups. We also assessed the volume of systemic analgesics used in the first 24 hours after surgery. Ketonal was used in both groups at 400 mg (p>0.5). Promedol was used only in the group of narcotic analgesics 44.50 ± 7.4 mg (p<0.001).
Conclusion: Based on these results, we suggest that multimodal analgesia in the form of bipolar TAP blockade in combination with intravenous administration of ketonal provides adequate anesthesia in the postoperative period, comparable to standard systemic administration of opioids and ketonal.
Rinat Ashzhanov1, Daulet Mamyrov1, Marat Syzdykbayev2, Yoshihiro Noso3, Olga Tashtemirova4, Assem Ashzhanova4, Anton Sheinin5
1 Pavlodar branch of the JSC «Semey Medical University», Department of Emergency Medicine,
Pavlodar, the Republic of Kazakhstan;
2 JSC «Semey Medical University», Department of Hospital Surgery, Anaesthesiology and Reanimatology,
Semey, theRepublic of Kazakhstan;
3 Hiroshima International University, Department of Health Services Management, Hiroshima, Japan;
4 Pavlodar branch of the JSC «Semey Medical University», Department of Surgery, Pavlodar, the Republic of Kazakhstan;
5 Tel-Aviv University, Sagol School of Neuroscience, Tel-Aviv, Israel.
1. Alkatout I., Mechler U., Mettler L., Pape J., Maass N., Biebl M., et al. The Development of Laparoscopy-A Historical Overview // Front Surg. 2021;8:799442.
2. Beiranvand S., Moradkhani M.R. Bupivacaine Versus Liposomal Bupivacaine For Pain Control // Drug Res (Stuttg). 2018;68(7):365-9.
3. Carney J., McDonnell J.G., Ochana A., Bhinder R., Laffey J.G. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy // Anesth Analg. 2008;107(6):2056-60.
4. El-Dawlatly A.A., Turkistani A., Kettner S.C., Machata A.M., Delvi M.B., Thallaj A., et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy // Br J Anaesth. 2009;102(6):763-7.
5. Griffiths J.D., Barron F.A., Grant S., Bjorksten A.R., Hebbard P., Royse C.F. Plasma ropivacaine concentrations after ultrasound-guided transversus abdominis plane block // Br J Anaesth. 2010;105(6):853-6.
6. Guirguis M.N., Abd-Elsayed A.A., Girgis G., Soliman L.M. Ultrasound-guided transversus abdominis plane catheter for chronic abdominal pain // Pain Pract. 2013;13(3):235-8.
7. Gustafsson U.O., Scott M.J., Schwenk W., Demartines N., Roulin D., Francis N., et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations // World J Surg. 2013;37(2):259-84.
8. Hebbard P., Fujiwara Y., Shibata Y., Royse C. Ultrasound-guided transversus abdominis plane (TAP) block // Anaesth Intensive Care. 2007;35(4):616-7.
9. Ma N., Duncan J.K., Scarfe A.J., Schuhmann S., Cameron A.L. Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis // J Anesth. 2017;31(3):432-52.
10. McDermott G., Korba E., Mata U., Jaigirdar M., Narayanan N., Boylan J., et al. Should we stop doing blind transversus abdominis plane blocks? // Br J Anaesth. 2012;108(3):499-502.
11. McDonnell J.G., Curley G., Carney J., Benton A., Costello J., Maharaj C.H., et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial // Anesth Analg. 2008;106(1):186-91, table of contents.
12. McDonnell J.G., O'Donnell B., Curley G., Heffernan A., Power C., Laffey J.G. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial // Anesth Analg. 2007;104(1):193-7.
13. Mukhtar K., Singh S. Transversus abdominis plane block for laparoscopic surgery // Br J Anaesth. 2009;102(1):143-4.
14. Mukhtar K., Singh S. Ultrasound-guided transversus abdominis plane block // Br J Anaesth. 2009;103(6):900; author reply -1.
15. Nedeljkovic S.S., Kett A., Vallejo M.C., Horn J.L., Carvalho B., Bao X., et al. Transversus Abdominis Plane Block With Liposomal Bupivacaine for Pain After Cesarean Delivery in a Multicenter, Randomized, Double-Blind, Controlled Trial // Anesth Analg. 2020;131(6):1830-9.
16. Niraj G., Searle A., Mathews M., Misra V., Baban M., Kiani S., et al. Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy // Br J Anaesth. 2009;103(4):601-5.
17. O'Donnell B.D., McDonnell J.G., McShane A.J. The transversus abdominis plane (TAP) block in open retropubic prostatectomy // Reg Anesth Pain Med. 2006;31(1):91.
18. Oderda G.M., Said Q., Evans R.S., Stoddard G.J., Lloyd J., Jackson K., et al. Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay // Ann Pharmacother. 2007;41(3):400-6.
19. Petersen P.L., Hilsted K.L., Dahl J.B., Mathiesen O. Bilateral transversus abdominis plane (TAP) block with 24 hours ropivacaine infusion via TAP catheters: A randomized trial in healthy volunteers // BMC Anesthesiol. 2013;13(1):30.
20. Rafi A.N. Abdominal field block: a new approach via the lumbar triangle // Anaesthesia. 2001;56(10):1024-6.
21. Smith S.R., Draganic B., Pockney P., Holz P., Holmes R., McManus B., et al. Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blind randomized clinical trial // Int J Colorectal Dis. 2015;30(9):1237-45.
22. Tian C., Lee Y., Oparin Y., Hong D., Shanthanna H. Benefits of Transversus Abdominis Plane Block on Postoperative Analgesia after Bariatric Surgery: A Systematic Review and Meta-Analysis // Pain Physician. 2021;24(5):345-58.
Number of Views: 84
Category of articles:
Original articles
Bibliography link
Ashzhanov R., Mamyrov D., Syzdykbayev M., Noso Yo., Tashtemirova O., Ashzhanova A., Sheinin A. Transversus abdominis plane block after laparoscopic surgery and laparotomy compared with opioid analgesia // Nauka i Zdravookhranenie [Science & Healthcare]. 2023, (Vol.25) 1, pp. 100-105. doi 10.34689/SH.2023.25.1.013 Ашжанов Р., Мамыров Д., Сыздыкбаев М., Носо Йо., Таштемирова О., Ашжанова А., Шейнин А. Блокада поперечной плоскости живота после лапароскопической операции и лапаротомии в сравнении с опиоидной анальгезией // Наука и Здравоохранение. 2023. 1(Т.25). С. 100-105. doi 10.34689/SH.2023.25.1.013Related publications:
ANALYSIS OF CLINICAL AND DEMOGRAPHIC INDICATORS OF PATIENTS WITH PARKINSON'S DISEASE IN THE SOUTHERN REGION OF KAZAKHSTAN
A COMPARATIVE STUDY OF DRUG POLICY REGARDING ORPHAN DISEASES IN THE USA, THE EUROPEAN UNION, AND THE REPUBLIC OF KAZAKHSTAN
MUTATIONS IN CARDIAC ION CHANNEL GENES IN KAZAKHSTANI PATIENTS WITH LONG QT SYNDROME
GENETIC FEATURES OF CONGENITAL DYSFUNCTION OF THE ADRENAL CORTEX CAUSED BY 21-HYDROXYLASE DEFICIENCY IN PERSONS OF KAZAKH NATIONALITY
NON-MOTOR SYMPTOMS IN PARKINSON'S DISEASE USING THE EXAMPLE OF AKTOBE PATIENTS