TAP Block On Abdominal Surgery Patients With General Anesthesia
Condition: Post-Op Complication; Pain, Postoperative
MeSH terms: Pain, Postoperative; Postoperative Complications
Study type: Interventional

Summary: 
      INTRODUCTION: The aim of this study was to investigate the effects of tranversus abdominis
      plane (TAP) block placed postoperatively using ultrasound guidance for patients with
      caesarean section, myomectomy and hysterectomy under general anesthesia by eliminating
      additional pain caused by surgical incision.

      MATERIALS AND METHODS: The study has been planned to investigate the postoperative analgesia
      of 50 patients with TAP blocks applied and non-applied between the ages of 18-65, who will
      pass abdominal surgery. Study has been conducted in a prospective, randomized and controlled
      manner. Patients have been classified as those who have undergone TAP block (group: I) and
      those without block (group: II).
    

Detailed description: 
      The study was conducted in accordance with the Helsinki Declaration Principles (rev.2013) and
      with the approval of the local ethical board. After the written and signed approval of the
      patients, it has been planned to investigate the postoperative analgesia and comfort of a
      total of 50 patients The study examined the postoperative pain levels after abdominal surgery
      with and without TAP block. Subjects were between the ages of 18-65 who will have abdominal
      surgery with transverse incision (cesarean section, hysterectomy (benign), myomectomy) and
      American Society of Anesthesiologists Physical Status Classification System (ASA) I-II. Our
      study is planned to be prospective, randomized and controlled. The individuals to be engaged
      were divided into two groups in a randomized form. Randomization was based on a
      computer-generated code. In the first group, a total of 25 patients were admitted with 16
      cesareans, 6 myomectomies and 3 hysterectomies applied to the TAP block. In the second group,
      a total of 25 patients who did not undergo TAP block, no needle intervention, 18 cesareans, 5
      myomectomies and 2 hysterectomies were included as the control group. Those with skin
      infections, patients with organomegaly (hepatomegaly and splenomegaly), people who did not
      give consent to the method, and individuals with allergies to drugs to be used in the
      intervention area where Transversus abdominis plane is to be conducted were not included in
      the study.

      Isolyte® balanced electrolyte solution at a rate of 2 ml/kg/hour was administered to the
      individuals whose oral intake was discontinued 8 hours before the surgery. The individuals to
      be included in the study were not given any sedative agent on the morning of their surgery.
      10 cm visual analog scale (VAS) was explained in detail to all patients before the procedure.
      All individuals to be included in the study were followed up with anesthesia monitor (Drager
      Infinity Vista XL®), heart rate (CAH), electrocardiography (ECG) (lead II), systolic blood
      pressure (SKB) and diastolic blood pressure (DBP) in the preoperative and preoperative
      period. After induction of anesthesia with 1 µg/kg fentanyl (Fentanyl, Janssen-Cilag), 0.5
      mg/kg rocuronium bromide (Esmeron® vial, Schering-Plough) and 5 mg/kg thiopental sodium
      (Pental Sodium®, I.E Ulagay), 4-6% Desflurane (Suprane® Volatile Solution, Pharmacist-Head -
      Baxter) and 50% N2O in Oxygen were used to maintain anesthesia following endotracheal
      intubation. Differently in general anesthesia management at cesarean operations, 5 mg/kg
      thiopental sodium (Pental Sodium®, I.E Ulagay) and 0.5 mg/kg rocuronium bromide (Esmeron®
      vial, Schering-Plough) were administered in induction and 4-6% Desflurane (Suprane® Volatile
      Solution, Pharmaceutical-headed-Baxter), (50% N2O+50% Oxygen) and 1 µg/kg fentanyl (Fentanyl,
      Janssen-Cilag) are added as inhalation anesthesia after umbilical cord clamping in
      maintenance. The maintenance dose of rocuronium bromide was 0.15 mg/kg for all cases.
      Necessary fluid replacement was performed during the operation. At the end of the operation,
      TAP blocks were placed to the 1st group patients.

      After the necessary sterilization conditions were established, the linear ultrasound probe
      was sterilely coated and placed in the middle of the iliac crest with the end limit of the
      ribs. Starting with skin, the layers in descending order, subcutaneous adipose tissue,
      external oblique muscle, internal oblique muscle, transversus abdominis muscle and peritoneum
      were identified. As the tip of the 21Gx100 mm needle (Pajunk®-Uniplex Nanoline cannula with
      facet tip) passed through the muscular layers and fascia, a fascial click was felt and the
      needle was advanced with ultrasound in a controlled manner. After receiving the second click
      sensation (passage of the fascia of the internal oblique muscle), after a 0.5-1 ml test dose,
      the location of the needle was fixed and frequently aspirated and applied to the bilateral
      neurophysical plan so that 20 ml of 0.25% bupivacaine (Marcaine® 0.5%, Astra Zeneca) was
      applied to one side.

      The first group of patients were awakened after TAP block treatment and reversal of muscle
      relaxant with atropine sulphate and neostigmine; the control group was awakened after
      reversal of muscle relaxant with atropine sulphate and neostigmine at the end of the
      operation. When VAS>3 in the postoperative period, 1g of paracetamol was administered as an
      intravenous infusion over 10 minutes in terms of the first analgesic requirement.

      Systolic and diastolic arterial pressures, heart rate of all patients were monitored
      immediately before and postoperatively at 30th minute and 1st, 2nd, 4th, 6th, 12th and 24th
      hours after block administration. The pain levels of the patients were measured at the 30th
      minute, 1st, 2nd, 4th, 6th, 12th and 24th postoperative VAS values. The need for nausea,
      vomiting, and initial analgesia was recorded. In this study, none of the patients underwent
      any invasive procedures other than routine procedures.

      When parametric test counts were fulfilled (Kolmogorov-Simirnov) by uploading the data
      obtained from our study to SPSS (ver:22.0) program, significance test of the difference
      between the two averages, variance analysis in repeated measurements, Bonferroni test, Mann
      Whitney U test, Wilcoxon test, Freidman test and Chi-square test were used when parametric
      test assumptions were not fulfilled. When α is taken as 0.05, β: 0.10, 1-β: 0.90, 25
      individuals were included in each group and the strength of the test was p= 0.90388.

      Our data were reported as arithmetic mean, standard deviation, number of individuals and the
      level of error was taken as 0.05.
    

Intervention name(s): transversus abdominis plane (TAP) block
Intervention type(s): Procedure
Intervention description(s): The transversus abdominis plane (TAP) block is a regional anesthesia technique described in recent years that provides analgesia for the anterior portion of the abdominal wall after abdominal surgery.
Other intervention name(s): General Anesthesia
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Health Services Research
Keywords: TAP block; postoperative pain; Bupivacaine; ultra sound guided regional anesthesia