Bilateral Transversus Abdominis Plane Block versus Epidural analgesia for Postoperative Pain Relief in Lower Abdominal Surgery
Authors: Aly N M , Talaat S M , Menshawi M A , Mohammed E R 
Published: May 2020

Abstract

Background
epidural and caudal analgesia have been considered the gold-standard techniques after abdominal surgery for adults and children, respectively. The techniques consist of injecting the local anesthetic within the epidural space, between the ligamentumflavum and the dura mater. Depending on the surgical site and the level of injection, cervical, thoracic, or lumbar nerve roots are blocked after their emergence from the neural foramen. Epidural and caudal analgesia have technical drawbacks with epidural local anesthetic associated with hypotension secondary to the sympathetic blockade.In the last decade, a new abdominal truncal block, called the tranversusabdominis plane (TAP) block, was described consisting of local anesthetic injection between the internal oblique and transversusabdominis muscle. This block provides analgesia by blocking the 7th to 11th intercostal nerves (T7–T11), the subcostal nerve (T12), and the ilioinguinal nerve and iliohypogastric nerve (L1–L2).

Aim of the Work
to compare the analgesic efficacy of epidural analgesia and transverse abdominis plane (TAP) block to provide postoperative analgesia after abdominal surgery.

Methods
sixty patients undergoingLower Abdominal Surgery were randomly divided into 2 equal groups by Closed Envelope Method. patients scheduled for Lower Abdominal surgery were assessed preoperatively in the form of evaluation of their medical history, their laboratory investigations and for fulfilling the above inclusion criteria.Patients Preparation was done by 2 mg Dormicum IV injection as a sedation preoperatively. After obtaining baseline vital signs, All patients received GA; sevoflurane was used for induction and maintenance of anesthesia, IV cannula was inserted and laryngeal mask airway (LMA) to secure the airway.Patients were divided randomly into two groups, each group consists of 30 patients. Group A: Patients in this group received Epidural analgesia, patients were placed in sitting position, Epidural block was administered under sterile conditions with a 18 G Touhy needle using a standard loss of resistance technique. After negative aspiration, 1ml/kg of 0.25% bupivacaine was injected. Group B: Patients in this group received US guided TAP block on the same side of surgery, patients were placed in supine position, linear US probe (high frequency probe 10–12 MHz) connected to a portable US unit (SonoSite, USA) was placed in the mid-axillary plane midway between the lower costal margin and the highest point of iliac crest. After skin disinfection, a 23-G 50-mm needle with an injection line was inserted in plane with the probe. Once the tip of the needle was placed in the space between the internal oblique abdominal muscle and transverses abdominis muscle, and after negative aspiration, 0.5 ml/kg 0.25% bupivacaine was injected. The following parameterswas assessed and recorded Hemodynamic monitoring, Assessment of postoperative painUsing visual analogue scale score, Any case of failed block was recorded, Doses of analgesics required intraoperatively and during the first 2 hours postoperatively were recorded. In case of failed block, 1 mic/kg Fentanyl IV was given. Complications During and after the procedurewere recorded.

Results
There was no significant differences regarding Demographic data, Heart Rate, SPO2 and duration of surgerybetween both groups. There were significant difference between both group regarding systolic blood pressure, Diastolic blood pressure, visual analogue score, need of analgesic, mobilization postoperative, pain on coughing and hospital stay

Conclusion
The current study revealed that Epidural block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements compared with Ultrasound guided TAP Block in patients undergoing lower abdominal surgery. Both analgesic techniques are safe.