Comparison of postoperative analgesic efficacy of ultrasound-guided lateral and posterior transversus abdominis plane blocks in lower abdominal surgeries: a prospective, parallel-group, randomized controlled trial.

Dr.Dangeti Avinash; Dr Vaddi Preethi; Dr.Sirisha Mutchi

doi:10.51168/q94bg949

Autori

Dr.Dangeti Avinash Consultant Anaesthesiologist, Pulse Hospital, Visakhapatnam, Andhra Pradesh, India
Dr Vaddi Preethi Assistant Professor, Department of Anaesthesiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
Dr.Sirisha Mutchi Assistant Professor, Department of Anaesthesiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

DOI:

https://doi.org/10.51168/q94bg949

Cuvinte cheie:

Transversus abdominis plane block, posterior TAP block, lateral TAP block, postoperative analgesia, lower abdominal surgery, ropivacaine, visual analogue scale

Rezumat

Background

Effective postoperative analgesia after lower abdominal surgery supports early mobilisation, reduces opioid exposure, and improves recovery quality. Ultrasound-guided transversus abdominis plane (TAP) block is a fascial plane technique used as part of multimodal analgesia.

Objectives

To compare the duration and quality of postoperative analgesia produced by ultrasound-guided lateral and posterior TAP blocks in adults undergoing lower abdominal surgery. The primary objective was to compare the time to first pain or rescue analgesic request; secondary objectives were to compare postoperative VAS scores, dermatomal sensory spread, haemodynamic variables, rescue analgesic timing, and adverse events during the first 24 hours.

Methods

This prospective, parallel-group, randomized controlled trial included 60 adults aged 18–65 years with ASA physical status I–II undergoing elective lower abdominal surgery under spinal anaesthesia. Participants were randomized 1:1 to lateral TAP block (Group A, n=30) or posterior TAP block (Group B, n=30). Patients and postoperative outcome assessors were blinded, whereas the block operator was not. Both groups received an identical protocol-specified volume of 0.5% ropivacaine. Pain scores, sensory blockade, haemodynamic variables, rescue analgesic requirement, and adverse events were assessed for 24 hours.

Results

Baseline characteristics were comparable between groups. Posterior TAP block produced wider sensory spread, including T9 blockade in 10 (33.3%) participants (overall p=0.002). Mean VAS scores were lower in Group B from 2–24 hours, with significant differences at 2 hours (p=0.003), 4 hours (p=0.043), and subsequent assessments (p<0.001). Mean time to first pain or rescue analgesia was significantly longer with posterior TAP block (295.66 ± 38.56 vs. 178.66 ± 22.08 minutes; p<0.001

Conclusion

Posterior TAP block provided wider sensory coverage and more prolonged postoperative analgesia than lateral TAP block, with broadly stable haemodynamic profiles.

Recommendations

Posterior TAP block may be preferred when prolonged somatic analgesia is desired after suitable lower abdominal procedures.

Biografii autori

Dr.Dangeti Avinash, Consultant Anaesthesiologist, Pulse Hospital, Visakhapatnam, Andhra Pradesh, India

is a Consultant Anaesthesiologist at Pulse Hospital, Visakhapatnam, Andhra Pradesh, India. He is actively involved in perioperative anaesthesia care, preoperative assessment, intraoperative management, postoperative pain control, and emergency anaesthesia services. His clinical interests include general anaesthesia, regional anaesthesia, airway management, perioperative patient safety, and critical care support.
Dr Vaddi Preethi, Assistant Professor, Department of Anaesthesiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

completed her MBBS from GSL Medical College, Rajahmundry, Andhra Pradesh, and obtained her MD in Anaesthesia from Great Eastern Medical School and Hospital, Srikakulam. She subsequently worked as a Senior Resident in the Department of Anaesthesia at Great Eastern Medical School and Hospital, Srikakulam, where she gained clinical and academic experience in perioperative anaesthesia care, airway management, regional anaesthesia, and critical care support. She is currently working as an Assistant Professor in the Department of Anaesthesia at Andhra Medical College, Visakhapatnam. Her areas of academic interest include clinical anaesthesia, perioperative medicine, regional anaesthesia, and patient safety. ORCID iD: https://orcid.org/0009-0008-5694-8817
Dr.Sirisha Mutchi, Assistant Professor, Department of Anaesthesiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

is an Assistant Professor in the Department of Anaesthesiology at Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. She is involved in undergraduate and postgraduate teaching, clinical anaesthesia services, perioperative care, and academic activities. Her areas of interest include regional anaesthesia, perioperative medicine, postoperative analgesia, airway management, and patient safety in anaesthesia practice.

Referințe

1. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131-157.PMID:26827847. https://doi.org/10.1016/j.jpain.2015.12.008

2. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116(2):248-273.PMID:22227789. https://doi.org/10.1097/ALN.0b013e31823c1030

3. Tsai HC, Yoshida T, Chuang TY, Yang SF, Chang CC, Yao HY, et al. Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques. Biomed Res Int. 2017;2017:8284363. doi:10.1155/2017/8284363. PMID:29226150.

https://doi.org/10.1155/2017/8284363

4. Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024-1026. doi:10.1046/j.1365-2044.2001.02279-40.x. PMID:11576144. https://doi.org/10.1046/j.1365-2044.2001.02279-40.x

5. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007;35(4):616-617. PMID:18020088.

6. McDonnell JG, O'Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg. 2007;104(1):193-197. doi:10.1213/01.ane.0000250223.49963.0f. PMID:17179269. https://doi.org/10.1213/01.ane.0000250223.49963.0f

7. McDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2008;106(1):186-191.PMID:18165577. https://doi.org/10.1213/01.ane.0000290294.64090.f3

8. Carney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg. 2008;107(6):2056-2060. PMID:19020158. https://doi.org/10.1213/ane.0b013e3181871313

9. Abdallah FW, Chan VW, Brull R. Transversus abdominis plane block: a systematic review. Reg Anesth Pain Med. 2012;37(2):193-209. doi:10.1097/AAP.0b013e3182429531. PMID:22286518. https://doi.org/10.1097/AAP.0b013e3182429531

10. Abdallah FW, Laffey JG, Halpern SH, Brull R. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis. Br J Anaesth. 2013;111(5):721-735. doi:10.1093/bja/aet214. PMID:23811424. https://doi.org/10.1093/bja/aet214

11. Carney J, Finnerty O, Rauf J, Bergin D, Laffey JG, McDonnell JG. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia. 2011;66(11):1023-1030. doi:10.1111/j.1365-2044.2011.06855.x. PMID:21851346. https://doi.org/10.1111/j.1365-2044.2011.06855.x

12. Faiz SHR, Alebouyeh MR, Derakhshan P, Imani F, Rahimzadeh P, Ashtiani MG. Comparison of ultrasound-guided posterior transversus abdominis plane block and lateral transversus abdominis plane block for postoperative pain management in patients undergoing cesarean section: a randomized double-blind clinical trial study. J Pain Res. 2018;11:5-9. doi:10.2147/JPR.S146970.PMID:29296094. https://doi.org/10.2147/JPR.S146970

13. De Oliveira GS Jr, Castro-Alves LJ, Nader A, Kendall MC, McCarthy RJ. Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials. Anesth Analg. 2014;118(2):454-463. doi:10.1213/ANE.0000000000000066. PMID:24445643. https://doi.org/10.1213/ANE.0000000000000066

14. Brogi E, Kazan R, Cyr S, Giunta F, Hemmerling TM. Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials. Can J Anaesth. 2016;63(10):1184-1196. doi:10.1007/s12630-016-0679-x. PMID:27307177. https://doi.org/10.1007/s12630-016-0679-x