KUMJ | VOL. 13 | NO. 4 | ISSUE 52 | OCT-DEC, 2015
The Analgesic Effectiveness of Ipsilateral Transversus Abdominis Plane Block in Adult Patients Undergoing Appendectomy: A Prospective Randomized Controlled Trial
Ghimire A, Bhattarai B, Prasad JN, Shah SP
Abstract: Background
Transversus abdominis plane block (TAP) has been shown to produce effective pain
relief following lower abdominal surgeries but is yet to be routinized in different type
of surgeries including appendectomy. The main risk of visceral injury can be logically
avoided when the block is performed with the abdomen open using landmark
technique in the absence of ultrasound guidance.
Objective
To assess the effectiveness of TAP block with bupivacaine for postoperative analgesia
using landmark technique (performed with the abdomen open) in adult patients
undergoing appendectomy.
Method
Forty patients undergoing appendectomy were randomized to undergo ipsilateral
TAP block with bupivacaine (n=20) versus control (n=20) in addition to standard
postoperative analgesia. All patients received standard general anaesthesia. The
block was performed using the landmark technique with 20 ml of 0.5% bupivacaine
or isotonic saline on ipsilateral side just before abdominal closure. Pain severity was
measured using Visual Analogue Scale (VAS). Tramadol 50 mg was administered as
rescue analgesic intravenously when VAS was four or more postoperatively. The
duration of analgesia and the requirement of tramadol in 24 hours postoperatively
were recorded.
Result
Mean duration of analgesia in the TAP block with bupivacaine was longer as
compared with placebo (724.00±299.07 min vs 168.25±55.18 min; p< 0.01). The TAP
block with bupivacaine compared with saline significantly reduced postoperative
VAS pain scores. Mean tramadol requirement in the first 24 hours was also
reduced (42.50±37.25 mg vs 120.00±55.18 mg; p<0.01). There were no significant
complications attributable to the TAP block.
Conclusion
Ipsilateral TAP block with bupivacaine using landmark technique with the abdomen
open in appendectomy provides effective postoperative analgesia and opioids
sparing effect.
Keyword : Ipsilateral, landmark technique, postoperative analgesia, transversus abdominis plane block