Query: Tap block dogs

title: Transversus abdominis plane (TAP) block for laparoscopic live donor nephrectomy: Continuous catheter infusion provides no additional analgesic benefit over single injection ropivacaine
abstract: Transversus abdominis plane (TAP) blocks are useful for adjunctive pain control following laparoscopic live donor nephrectomy (LLDN) The objective was to determine if TAP catheter provides additional analgesia compared with single injection TAP block alone for kidney donors.

title: Efficacy of transversus abdominis plane (TAP) block in pain management after laparoscopic sleeve gastrectomy (LSG) A double blind randomized controlled trial.
abstract: The aim of this randomized controlled trial was to assess the effectiveness of transversus abdominis plane (TAP) block in post operative pain management in patients undergoing laparoscopic sleeve gastrectomy (LSG)  Ninety consecutive patients undergoing LSG were randomly assigned to three groups: placebo, TAP block with 0.25% bupivacaine (40mL total) and TAP block with 0.25% bupivacaine 1/100,000 epinephrine (40mL total) Pain and nausea/vomiting scores were evaluated at varying times until discharge. Other parameters included, additional analgesia required, time to ambulation, length of stay and time required for return to work after discharge.  There was decrease in post operative pain 3 hours after surgery between the placebo group and the bupivacaine group and between the placebo group and the bupivacaine with epinephrine group, however, no difference in 1, 6, 12 and every 6 hours after. There was no significant difference in post operative analgesia requirements, nausea/vomiting scores, time to ambulation, hospital length of stay, or time to return to work after discharge.  The efficacy of TAP block is not apparent likely due to the ERAS protocol set in place for bariatric surgery, which already targets early postoperative pain control and mobility.

title: Dexamethasone added to local anesthetics in ultrasound guided transversus abdominis plain (TAP) block for analgesia after abdominal surgery: A systematic review and meta analysis of randomized controlled trials
abstract: To evaluate the analgesic efficacy of dexamethasone added to local anesthetics in ultrasound guided transversus abdominis plane (TAP) block for the patients after abdominal surgery.  PubMed, CENTRAL, EMBASE, Web of science were searched to identify eligible randomized controlled trials (RCTs) that compared dexamethasone added to local anesthetics in ultrasound guided TAP block with control for postoperative analgesia in adult patients undergoing abdominal surgery. Primary outcomes included postoperative pain intensity, the time to the first request for additional analgesics, and opioid consumption over 24 h after surgery. Secondary outcome was the incidence of postoperative nausea and vomiting. Analysis was performed by RevMan 5.3 software and the quality of evidence was rated using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.  Nine RCTs involving 575 patients were included. Compared to the control, dexamethasone added to local anesthetics in ultrasound guided TAP block significantly decreased visual analogue scale (VAS) scores at rest at 4h (mean difference [MD] 1.01; 95% confidence intervals [CI] 1.29 to 0.73; P<0.00001; moderate quality of evidence) 6h (MD 1.21; 95% CI, 1.74 to 0.69; P<0.00001; low quality of evidence) and 12h after surgery (MD 0.79; 95% CI, 0.97 to 0.60; P<0.00001; moderate quality of evidence) No difference was found at 2h (MD 0.64; 95% CI, 1.35 to 0.08; P 0.08; low quality of evidence) and 24 h (MD 0.41; 95% CI, 0.91 to 0.09; P 0.11; moderate quality of evidence) in VAS scores. The time to the first request for additional analgesics was prolonged in the dexamethasone group (MD 3.08; 95% CI, 2.37 to 3.78; P<0.00001; moderate quality of evidence) Opioid consumption over 24 h after surgery was also reduced (MD 5.42; 95% CI, 8.20 to 2.63; P 0.0001; low quality of evidence) Meanwhile, the incidence of postoperative nausea and vomiting was significantly decreased in the dexamethasone group (risk ratios [RR] 0.40; 95% CI, 0.28 to 0.58; P<0.00001; high quality of evidence) No complications were reported in all the included studies.  Dexamethasone added to local anesthetics in ultrasound guided TAP block was a safe and effective strategy for postoperative analgesia in adult patients undergoing abdominal surgery.

title: Preoperative Transversus Abdominis Plane (TAP) Block with Liposomal Bupivacaine for Bariatric Patients to Reduce the Use of Opioid Analgesics
abstract: IntroductionPostoperative pain remains the most common challenge following inpatient and outpatient surgeries, and, therefore, opioid analgesics are widely used during the perioperative period. The aim of this study is to examine the efficiency of transversus abdominis plane (TAP) block using liposomal bupivacaine in reducing the use of opioid analgesics during the perioperative period of bariatric procedures.Material and MethodsA retrospective chart review was performed on 191 patients who underwent a laparoscopic bariatric procedure between September 13, 2017, and February 26, 2018. A total of 97 patients received TAP block with liposomal bupivacaine, and 94 patients did not receive TAP block.ResultsBaseline patient characteristics were comparable between the two groups. The mean age was 43.7 and 41.1 years, and the mean preoperative body mass index (BMI) was 45.6 and 46.1 kg/m2 in TAP and non TAP groups, respectively. In the TAP group, 65 patients (69.2% received intravenous (IV) hydromorphone or morphine while 93 (95.9% did in the non TAP group (p 0.0001) In the TAP group, 44 (46.8% received oral opioid analgesic while 73 (75.3% did in the non TAP group (p 0.0001) The odds of receiving IV hydromorphone or morphine for TAP group was about 0.10 times the corresponding odds for non TAP group, and the odds of receiving oral opioid analgesic for the TAP group was about 0.29 times the corresponding odds for the non TAP group.ConclusionThe use of preoperative TAP block with liposomal bupivacaine significantly decreased the use of IV and oral opioid analgesics. A larger prospective study may be needed to further validate the results.

title: Comparison of Therapeutic Benefit of Bupivacaine HCl Transversus Abdominis Plane (TAP) Block as Part of an Enhanced Recovery Pathway versus Traditional Oral and Intravenous Pain Control after Minimally Invasive Colorectal Surgery: A Prospective, Randomized, Double Blind Trial
abstract: Enhanced recovery pathways (ERPs) when combined with transversus abdominis plane (TAP) blocks, have been proven to reduce the length of stay (LOS) and improve quality outcomes. Nonopioid pain management is an essential component of this pathway, leading to a reduction in immobility, postoperative ileus, and an increase in patient satisfaction. TAP block variations have been studied in general and gynecologic surgery. This study evaluates the effectiveness of laparoscopic TAP blocks in conjunction with the benefit of an ERP. One hundred thirty seven consecutive laparoscopic and robotic assisted Colorectal Surgery patients received TAP blocks under laparoscopic guidance while under anesthesia, randomized to a placebo, bupivacaine TAP block, or bupivacaine TAP block with an ERP arm of the trial. Patient demographics, operative techniques, and postoperative outcomes were analyzed using statistical analysis software. Our main objective was to determine short term benefits of TAP blocks on reducing total narcotic consumption. Secondary objectives included effects of TAP blocks on time to ambulation, time to bowel function, and LOS. To isolate the effect of the TAP blocks, no efforts were made to control nursing or patient education in patients managed without an ERP. Of 137 patients, 14 were withdrawn. All cases were elective, with the main diagnosis colon cancer or dysplastic polyps (47.1% The median age in each group was comparable (P 0.12) with female majority in both groups (58.5% Most procedures were segmental colon resections (74.7% Thirty one patients received a placebo, 41 bupivacaine TAP, and 51 bupivacaine TAP plus ERP. In terms of primary endpoints, the bupivacaine plus ERP arm used statistically significant less IV narcotics on postoperative day 1 and in total (P 0.001, P 0.008) All patients ambulated on average within the first 24 hours postoperatively, with the TAP plus ERP group approximately 0.5 days sooner (P 0.001) The TAP plus ERP group also had a return of bowel function and LOS approximately 24 hours early (P 0.001 and P 0.001) This study shows that a laparoscopically placed bupivacaine TAP block when used as part of an ERP can reduce LOS, postoperative narcotics, time to ambulation and bowel function, and LOS. Defined pain regimens with auxiliary staff teaching can add to the improvement in quality outcomes in laparoscopic colorectal surgery and, with the addition of the TAP block, can add to patient satisfaction and lower hospital costs.

title: Ultrasound guided bilateral subcostal TAP block for epigastric hernia repair: A case series
abstract: The transversus abdominis plane (TAP) block is a field block and it involves myocutaneous nerves supplying the anterior abdominal wall (T6 to L1) It can be performed through the classical posterior or subcostal approaches.[1] It is commonly used as an adjunct to perioperative analgesia in a wide variety of surgeries, but reports on its role as a sole anaesthetic technique are scarce.[2,3,4] We present a case series of epigastric hernia repair where subcostal TAP block was used as a sole anaesthetic technique.

title: Quality of recovery and analgesia after total abdominal hysterectomy under general anesthesia: A randomized controlled trial of TAP block vs epidural analgesia vs parenteral medications
abstract: Parenteral analgesics and epidural analgesia are two standard options to treat postoperative pain after total abdominal hysterectomy (TAH) Fascial plane blocks such as transversus abdominis plane (TAP) block have gained popularity recently. However, effect of these analgesic regimens on quality of postoperative recovery (QoR) has not been studied. Hence we aimed to assess and compare the QoR with three different postoperative analgesic regimens parenteral analgesia, epidural analgesia, and TAP block in patients undergoing TAH under general anesthesia.  Sixty female patients undergoing TAH were randomized into three groups of 20 each for postoperative analgesia. Epidural group received boluses of 0.125% bupivacaine for 24 h, parenteral group received injection diclofenac and injection tramadol alternately every 6 h for 24 h, and TAP group received bilateral TAP block with 0.25% bupivacaine at end of operation. QoR was assessed postoperatively by 40 item questionnaire QOR 40 and pain was assessed by numerical rating scale (NRS)  QOR 40 score was comparable across the three groups at 24, 48, and 72 h postoperatively. TAP block prolonged the time to first rescue analgesic (P 0.02) and reduced the total 24 h postoperative morphine consumption by 2.4 (95% CI: 1.0, 3.8) mg (P 0.002) and 7.8 (95% CI: 6.4, 9.1) mg (P 0.001) when compared with epidural and parenteral groups, respectively.  The QoR after abdominal hysterectomy is similar with either intravenous analgesics or epidural analgesia or TAP block when used with rescue analgesia to manage postoperative pain. TAP block provides superior analgesia and reduces 24 h morphine consumption when compared with parenteral and epidural analgesia.

title: Transversus abdominis plane (TAP) block with levobupivacaine versus levobupivacaine with dexmedetomidine for postoperative analgesia following cesarean delivery
abstract: Transverse abdominus plane (TAP) block provides good quality analgesia with minimal side effects. Addition of adjuvant like dexmedetomidine to the local anesthetics has been shown to prolong the action of the block in earlier studies. In this prospective randomised study TAP block with levobupivacane with or without dexmedetomidine was compared with control group for post operative analgesia following cesarean delivery.  Ninety healthy women undergoing cesarean delivery under spinal anesthesia were randomized into three groups (GroupC, GroupL and Group LD) And following this Group L received ultrasound guided bilateral TAP block with 20 ml 0.25% levobupivacaine on each side, while Group LD received TAP block with same volume of levobupivacaine with 1mg/kg of dexmedetomidine. Group C, the control group did not receive TAP block. Postoperatively, time for first request for rescue analgesia and the number of women requesting analgesia in 6 h, 12 h and 24 h were noted. Pain score was measured with the Visual Analogue Scale (VAS) at rest and on movement for the first 24 h. Patient comfort and satisfaction with analgesia was evaluated at the end of 24 h.  Time for first rescue analgesia was significantly longer and patient satisfaction scores were significantly higher in patients who received TAP block (Groups LD and L) as compared to control (Group C) Pain scores were also lower in the TAP block groups compared to control group. Among the women who received TAP block, those with dexmedetomidine group (Group LD) asked for rescue analgesia significantly later compared to group L. Patient satisfaction score was highest in the Group LD compared to Group L which in turn was better than control group. There were no significant differences in the observed side effects.  Bilateral TAP block with 0.25% levobupivacaine provides good quality analgesia for early postoperative period. Adding dexmedetomidine further improves pain control and gives higher patient satisfaction without any added side effects.

title: The TAP block in obese patients: pros cons.
abstract: The growing number of laparoscopic surgical procedures performed in obese patients has increased the need to explore suitable analgesic techniques for a prone population to postoperative complications. The morbidly obese population may particularly benefit from the opioid sparing or the opioid free anaesthesia/analgesia, which maximize the use of loco regional techniques. Transversus abdominal plane (TAP) block has been widely used as part of multimodal analgesia for abdominal and gynecological surgeries, but evidence in obese patients is still poor. The efficacy of TAP block in morbidly obese patients undergoing laparoscopic bariatric surgery is still under discussion, because ultrasound visualization of the abdominal wall muscles can be challenging due to the excessive subcutaneous fat. Inadequate needle positioning, failed regional analgesia, and possible related risks must be counterbalanced by adequate evidence of effectiveness. The present article will discuss the pros and cons of TAP block in the treatment of obese patients.

title: Application of TAP Block in Laparoscopic Urological Surgery: Current Status and Future Directions
abstract: Purpose of ReviewAmid the opioid crisis, postoperative pain management is a major challenge for practitioners. Recent pain management guidelines emphasize the importance of using regional anesthesia as part of opioid sparing multimodal analgesia. This report aims to review recent evidence regarding the utilization of transversus abdominis plane (TAP) block in minimally invasive urologic surgery.Recent FindingsTAP block has been shown to improve early and late pain at rest, and to reduce opioid consumption after minimally invasive surgery. These benefits have indirectly reduced the incidence of postoperative delirium, pneumonia, urinary retention, and falls. Compared to epidural analgesia, TAP block provides similar pain control, has a lower incidence of hypotension, and is associated with a shorter length of stay.SummaryFew studies focus specifically on the outcomes of TAP block in minimally invasive urologic surgery. TAP block decreases postoperative pain and reduces opioid consumption without increasing complications. TAP block should be integrated as an indispensable component in enhanced recovery after surgery protocols.