Skip to main content
SpringerLink
Log in

Unilateral transversus abdominis plane block and port-site infiltration

Comparison of postoperative analgesic efficacy in laparoscopic cholecystectomy

Unilaterale Transversus-abdominis-plane-Blockade und Port-site-Infiltration

Vergleich der postoperativen analgetischen Wirksamkeit bei laparoskopischer Cholezystektomie

  • Originalien
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Abstract

Purpose

To compare the analgesic efficacy of unilateral subcostal transversus abdominis plane (TAP) block with local anesthetic infiltration, applied to the port site in patients undergoing laparoscopic cholecystectomy (LC).

Methods

Group T received a unilateral subcostal TAP block, group I received a local anesthetic infiltration at port sites, and group C was the control group. Groups T and I received 20 mL 0.25% bupivacaine. Intravenous patient-controlled analgesia with tramadol was similarly applied to all groups. Postoperative pain levels during rest and cough were evaluated using a numeric rating scale (NRS). Nausea and vomiting were evaluated using postoperative nausea vomiting scores (PONV) at 1, 3, 6, 12 and 24 h and tramadol consumption was also determined. Patient satisfaction was evaluated using a Likert-type scale.

Results

Postoperative resting NRS scores were lower in group T than the other groups at 1 h and 12 h (p = 0.007 and p = 0.016), while NRS values during cough were statistically significant at 1 h (p = 0.004). The 24‑h tramadol consumption was different: group T 229 ± 33 mg, group I 335 ± 95 mg, and group C 358 ± 66 mg (p < 0.001). The percentages of patients reporting that they would prefer the applied postoperative pain control method again were 83.3%, 62.5% and 70.8% in groups T, I and C, respectively (p = 0.118).

Conclusion

Unilateral subcostal TAP block was superior to local anesthetic infiltration at port sites after LC, in terms of low opioid consumption. Unilateral subcostal TAP block is recommended as part of a multimodal analgesic protocol.

Zusammenfassung

Ziel

Die analgetische Wirksamkeit der unilateralen subkostalen Transversus-abdominis-plane(TAP)-Blockade wurde mit der lokalen Port-site-Infiltrationsanästhesie bei laparoskopisch behandelten Patienten verglichen.

Methoden

Gruppe T erhielt eine einseitige subkostale TAP-Blockade, Gruppe I erhielt eine lokale Port-site-Infiltrationsanästhesie. Gruppe C war die Kontrollgruppe. Gruppe T und I erhielt 20 ml Bupivacain 0,25 %. Eine intravenöse patientengesteuerte Analgesie mit Tramadol wurde bei allen Gruppen angewendet. Das postoperative Schmerzniveau während Ruhe und Husten wurde mit dem numerischen Schmerzskala (NRS) bewertet: Übelkeit und Erbrechen wurden mit dem Postoperative Nausea and Vomiting Score (PONV) nach 1, 3, 6, 12 und 24 h bewertet und der kumulative Tramadolverbrauch wurde bestimmt. Die Patientenzufriedenheit wurde anhand der Likert-Skala bewertet.

Ergebnis

Die postoperativen NRS-Werte im Ruhezustand waren in Gruppe T nach der 1. und 12. Stunde niedriger als in den anderen Gruppen (p = 0,007, p = 0,016). Der NRS-Wert während des Hustens war nach der 1. Stunde statistisch signifikant (p = 0,004). Der 24-Stunden-Tramadolverbrauch der Gruppen war unterschiedlich, Gruppe T: 229 + 33 mg; Gruppe I: 335 + 95 mg und Gruppe C: 358 + 66 mg (p < 0,001). Der prozentuale Anteil der Patienten, die angaben, dass sie die angewandte postoperative Schmerzkontrollmethode wieder bevorzugen würden, betrug 83,3 %, 62,5 % und 70,8 % in den Gruppen T, I und C (p = 0,118).

Schlussfolgerung

Die unilaterale subkostale TAP-Blockade war der lokalen Port-site-Infiltrationsanästhesie an den Portstellen nach laparoskopischer Cholezystektomie in Bezug auf einen geringen Opioidverbrauch überlegen. Die Verwendung einer unilateralen subkostalen TAP-Blockade als Teil multimodaler Analgetikaprotokolle ist zu empfehlen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Boer HD, Detriche O, Forget P (2017) Opioid-related side effects: postoperative ileus, urinary retention, nausea and vomiting, and shivering. A review of the literature. Best Pract Res Clin Anaesthesiol 31(4):499–504

    Article  Google Scholar 

  2. Soliz JM, Lipski I, Hancher-Hodges S, Bryce Speer B, Popat K (2017) Subcostal transverse abdominis plane block for acute pain management: a review. Anesth Pain Med 7(5):e12923

    Article  Google Scholar 

  3. Ma N, Duncan JK, Scarfe AJ, Schuhmann S, Cameron AL (2017) Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis. J Anesth 31(3):432–452

    Article  Google Scholar 

  4. Deepanshu M, Sandeep S, Sumi S et al (2019) Anesthetic techniques: focus on transversus abdominis plane (TAP) blocks. Local Reg Anesth 12:81–88

    Article  Google Scholar 

  5. Toju K, Shiraishi K, Hakozaki T, Isosu T, Murakawa M (2015) Plasma ropivacaine concentrationfollowing ultrasound-guided subcostal transversus abdominis plane block in adults. J Anesth 29(1):146–148

    Article  Google Scholar 

  6. El-Boghdadly K, Pawa A, Chin KJ (2018) Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth 11:35–44

    Article  CAS  Google Scholar 

  7. Lancaster P, Chadwick M (2010) Liver trauma secondary to ultrasound-guided transversus abdominis plane block. Br J Anaesth 104(4):509–510

    Article  CAS  Google Scholar 

  8. Soltani Mohammadi S, Dabir A, Shoeibi G (2014) Efficacy of transversus abdominis plane block for acute postoperative pain relief in kidney recipients: a double-blinded clinical trial. Pain Med 15(3):460–464

    Article  Google Scholar 

  9. Børglum J, Gögenür I, Bendtsen TF (2016) Abdominal wall blocks in adults. Curr Opin Anaesthesiol 29(5):638–643

    Article  Google Scholar 

  10. Tanggaard K, Jensen K, Lenz K et al (2015) A randomised controlled trial of bilateral dual transversus abdominis plane blockade for laparoscopic appendicectomy. Anaesthesia 70:1395–1400

    Article  CAS  Google Scholar 

  11. Saliminia A, Azimaraghi O, Babayipour S, Ardavan K, Movafeqh A (2015) Efficacy of transverse abdominis plane block in reduction of postoperationpain in laparoscopic cholecystectomy. Acta Anaesthesiol Taiwan 53:119–122

    Article  Google Scholar 

  12. Torup H, Bøgeskov M, Hansen EG et al (2015) Transversus abdominis plane (TAP) block after robot-assisted laparoscopic hysterectomy: a randomised clinical trial. Acta Anaesthesiol Scand 59:928–935

    Article  CAS  Google Scholar 

  13. Oh TK, Yim J, Kim J et al (2017) Effects of preoperative ultrasound-guided transversus abdominis plane block on pain after laparoscopic surgery for colorectal cancer. Surg Endosc 31(1):127–134

    Article  Google Scholar 

  14. Hebbard P (2015) TAP block nomenclature. Anaesthesia 70(1):112–113

    Article  CAS  Google Scholar 

  15. Tsai HC, Yoshida T, Chuang TY, Yang SF, Chang CC, Yao HY, Tai YT, Lin JA, Chen KY (2017) Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int. https://doi.org/10.1155/2017/8284363

    Article  PubMed  PubMed Central  Google Scholar 

  16. Oksar M, Koyuncu O, Turhanoglu S, Temiz M, Oran MC (2016) Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy. J Clin Anesth 34:72–78

    Article  Google Scholar 

  17. Shin HJ, Oh AY, Baik JS, Kim JH, Han SH, Hwang JW (2014) Ultrasound-guided oblique subcostal transversus abdominis plane block for analgesia after laparoscopic cholecystectomy. Minerva Anestesiol 80:185–193

    PubMed  Google Scholar 

  18. Suseela I, Anandan K, Aravind A, Kaniyil S (2018) Comparison of ultrasound-guided bilateral subcostal transversus abdominis plane block and port-site infiltration with bupivacaine in laparoscopic cholecystectomy. Indian J Anaesth 62(7):497–501

    Article  CAS  Google Scholar 

  19. Vrsajkov V, Mančić N, Mihajlović D, Milićević ST, Uvelin A, Vrsajkov JP (2018) Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy. Rev Bras Anestesiol 68(2):149–153

    Article  Google Scholar 

  20. Ma J, Jiang Y, Tang S, Wang B, Lian Q, Xie Z, Li J (2017) Analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block. Medicine (Baltimore) 96(10):e6309

    Article  Google Scholar 

  21. Støving K, Rothe C, Rosenstock CV, Aasvang EK, Lundstrøm LH, Lange KH (2015) Cutaneous sensory block area, muscle-relaxingeffect, and block duration of the transversus abdominis plane block: a randomized, blinded, and placebo controlled study in healthy volunteers. Reg Anesth Pain Med 40(4):355–362

    Article  Google Scholar 

  22. Tolchard S, Davies R, Martindale S (2012) Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecystectomy: comparison with conventional port-site infiltration. J Anaesthesiol Clin Pharmacol 28(3):339–343

    Article  CAS  Google Scholar 

  23. Ahn SR, Kang DB, Lee C, Park WC, Lee JK (2013) Postoperative pain relief using wound infiltration with 0.5% bupivacaine in single-incision laparoscopic surgery for an appendectomy. Ann Coloproctol 29(6):238–242

    Article  Google Scholar 

  24. Bisgaard T (2006) Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology 104:835–846

    Article  Google Scholar 

  25. Moiniche S, Jorgensen H, Wetterslev J, Dahl JB (2000) Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg 90(4):899–812

    Article  CAS  Google Scholar 

  26. Ayman M, Materazzi G, Bericotti M, Rago R, Nidal Y, Miccoli P (2012) Bupivacaine 0.5 % versus ropivacaine 0.75 % wound infiltration to decrease postoperative pain in total thyroidectomy. Minerva Chir 67:511–516

    CAS  PubMed  Google Scholar 

  27. Yu N, Long X, Lujan-Hernandez JR, Succar J, Xin X, Wang X (2014) Transversus abdominis-plane block versus local anesthetic wound infiltration in lower abdominal surgery. BMC Anesthesiol 14:121

    Article  Google Scholar 

  28. Abdallah FW, Laffey JG, Halpern SH, Brull R (2013) 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 111(5):721–735

    Article  CAS  Google Scholar 

  29. Chang H, Rimel BJ, Li AJ, Cass I, Karlan BY, Walsh C (2018) Ultrasound guided transversus abdominis plane (TAP) block utilization in multimodal pain management after open gynecologic surgery. Gynecol Oncol Rep 26:75–77

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, University of Health Science, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Altındağ, Ankara, Turkey

    Emine Arık

  2. Department of Anesthesiology, Pain Clinic, University of Health Science, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

    T. Akkaya & A. Alptekin

  3. Department of Anesthesiology and Reanimation, TC Ministry of Health Hitit University Erol Olçok Training and Research Hospital, Çorum, Turkey

    S. Ozciftci

  4. Department of Surgery, University of Health Science, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

    Ş. Balas

Authors
  1. Emine Arık
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Akkaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Ozciftci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Alptekin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ş. Balas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emine Arık.

Ethics declarations

Conflict of interest

E. Arik, T. Akkaya, S. Ozciftci, A. Alptekin and Ş. Balas declare no financial or other conflicts of interest.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arık, E., Akkaya, T., Ozciftci, S. et al. Unilateral transversus abdominis plane block and port-site infiltration. Anaesthesist 69, 270–276 (2020). https://doi.org/10.1007/s00101-020-00746-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-020-00746-1

Keywords

Schlüsselwörter

Search

Navigation