Efficacy of laparoscopic transversus abdominis plane block for elective laparoscopic cholecystectomy in elderly patients
Transversus abdominis plane (TAP) block technique seems to offer one of the most efficient methods for a local pain control. Our aim is to demonstrate the effectiveness and safety of TAP block for post-operative pain control under laparoscopic vision in elderly patients during laparoscopic cholecystectomy. The patients aged more than 65 years old, who had cholecystectomy due to symptomatic cholelithiasis, were retrospectively evaluated. The patients that were operated under general anesthesia + laparoscopic TAP block and those who were operated only under only general anesthesia were compared according to their’ age and gender, comorbidities, American Society of Anesthesiologists scores, visual analog scale (VAS) for pain and length of stay in the hospital. Median (±interquartile range) values of post-operative 24th-hour-VAS for pain was found consecutively 2 (±1-3) in TAP block + group and 3 (±2-5) in TAP block - group. The median post-operative 24th-hour-VAS value in overall patients was three. Patients’ VAS values were higher in the TAP block – group with a statistically significant difference (p = 0.001). Furthermore, no statistically significant difference was found for other parameters in two groups. The laparoscopic-guided TAP block can easily be performed and has potential for lower visceral injury risk and shorter operational time. Efficacy, safety and other advantages (analgesic requirements, etc.) make it an ideal abdominal field block in elderly patients.
Kulen FT, Duman U, Bayam E, Zaim G. Laparoscopic partial cholecystectomy: A safe and effective alternative surgical technique in difficult cholecystectomies. Turkish Journal of Surgery. DOI: 10.5152/UCD.2015.3086.
Mitra S, Khandelwal P, Roberts K, Kumar S, Vadivelu N. Pain relief in laparoscopic cholecystectomy – A review of the current options. Pain Pract 2012;12(6):485-96. http://dx.doi.org/10.1111/j.1533-2500.2011.00513.x.
Ra YS, Kim CH, Lee GY, Han JI. The analgesic effect of the ultrasound-guided transverse abdominis plane block after laparoscopic cholecystectomy. Korean J Anesthesiol 2010;58(4):362-8. http://dx.doi.org/10.4097/kjae.2010.58.4.362.
Rafi AN. Abdominal field block: A new approach via the lumbar triangle. Anaesthesia 2001;56(10):1024-6. http://dx.doi.org/10.1111/j.1365-2044.2001.2279-40.x, http://dx.doi.org/10.1046/j.1365-2044.2001.02279-40.x.
Owen DJ, Harrod I, Ford J, Luckas M, Gudimetla V. The surgical transversus abdominis plane block – A novel approach for performing an established technique. BJOG 2011;118(1):24-7. http://dx.doi.org/10.1111/j.1471-0528.2010.02779.x.
Magee C, Clarke C, Lewis A. Laparoscopic TAP block for laparoscopic cholecystectomy: Description of a novel technique. Surgeon 2011;9(6):352-3. http://dx.doi.org/10.1016/j.surge.2010.11.027.
Finnerty O, McDonnell JG. Transversus abdominis plane block. Curr Opin Anaesthesiol 2012;25(5):610-4. http://dx.doi.org/10.1097/ACO.0b013e328357b165.
Jankovic ZB, du Feu FM, McConnell P. An anatomical study of the transversus abdominis plane block: Location of the lumbar triangle of Petit and adjacent nerves. Anesth Analg 2009;109(3):981-5. http://dx.doi.org/10.1213/ane.0b013e3181ae0989.
Ekmekçi P, Kazak Bengisun Z, Kazbek BK, Han S, Tüzüner F. Ultrasound guided TAP block for the treatment of postoperative prolonged pain - An alternative approach. Agri 2012;24(4):191-3. http://dx.doi.org/10.5505/agri.2012.82905.
Abdallah FW, Chan VW, Brull R. Transversus abdominis plane block: A systematic review. Reg Anesth Pain Med 2012;37:193-209. http://dx.doi.org/10.1097/AAP.0b013e3182429531.
Milan Z, Tabor D, McConnell P, Pickering J, Kocarev M, du Feu F, et al. Three different approaches to transversus abdominis plane block: A cadaveric study. Med Glas (Zenica) 2011;8(2):181-4.
Aissou M, Ghalayini M, Yazid L, Abdelhalim Z, Dufeu N, Beaussier M. Ultrasound control of local anaesthetic location after TAP block performed using landmark-based technique: A cohort study. Ann Fr Anesth Reanim 2011;30(9):641-4. http://dx.doi.org/10.1016/j.annfar.2011.03.020.
Kadam RV, Field J. Ultrasound-guided continuous transverse abdominis plane block for abdominal surgery. J Anaesthesiol Clin Pharmacol 2011;27(3):333-6. http://dx.doi.org/10.4103/0970-9185.83676.
McDermott G, Korba E, Mata U, Jaigirdar M, Narayanan N, Boylan J, et al. Should we stop doing blind transversus abdominis plane blocks? Br J Anaesth 2012;108(3):499-502. http://dx.doi.org/10.1093/bja/aer422.
Albrecht M, Hohner E, van Ackern K. The rationale of pain therapy in the aged. Z Gerontol 1987;20(1):23-30.
Donat H, Ozcan A, Ozdirenç M, Aksakoglu G, Aydinoglu S. Age-related changes in pressure pain threshold, grip strength and touch pressure threshold in upper extremities of older adults. Aging Clin Exp Res 2005;17(5):380-4. http://dx.doi.org/10.1007/BF03324626.
Huang HW, Wang WC, Lin CC. Influence of age on thermal thresholds, thermal pain thresholds, and reaction time. J Clin Neurosci 2010;17(6):722-6. http://dx.doi.org/10.1016/j.jocn.2009.10.003.
McDonnell JG, O'Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: A prospective randomized controlled trial. Anesth Analg 2007;104(1):193-7. http://dx.doi.org/10.1213/01.ane.0000250223.49963.0f.
De Oliveira GS Jr, Castro-Alves LJ, Nader A, Kendall MC, McCarthy RJ. Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: A meta-analysis of randomized controlled trials. Anesth Analg 2014;118(2):454-63. http://dx.doi.org/10.1213/ANE.0000000000000066.
Abdallah F, Laffey JG, Halpern SH, Brull R. 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 2013;111(5):721-35. http://dx.doi.org/10.1093/bja/aet214.
Petersen PL, Mathiesen O, Torup H, Dahl JB. The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical review. Acta Anaesthesiol Scand 2010;54(5):529-35. http://dx.doi.org/10.1111/j.1399-6576.2010.02215.x.
Johns N, O'Neill S, Ventham NT, Barron F, Brady RR, Daniel T, et al. Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: A systematic review and meta-analysis. Colorectal Dis 2012;14(10):e635-42. http://dx.doi.org/10.1111/j.1463-1318.2012.03104.x.
Ishida T, Sakamoto A, Tanaka H, Ide S, Ishida K, Tanaka S, et al. Transversus abdominis plane block with 0.25% levobupivacaine: a prospective, randomized, double-blinded clinical study. J Anesth 2015;29(4):557-61. http://dx.doi.org/10.1007/s00540-015-1993-0.
Fiala T. Tranversus abdominis plane block during abdominoplasty to ımprove postoperative patient comfort. Aesthet Surg J 2015;35(1):72-80. http://dx.doi.org/10.1093/asj/sju019.
Niraj G, Searle A, Mathews M, Misra V, Baban M, Kiani S, et al. Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy. Br J Anaesth 2009;103(4):601-5. http://dx.doi.org/10.1093/bja/aep175.
Ortiz J, Suliburk JW, Wu K, Bailard NS, Mason C, Minard CG, et al. Bilateral transversus abdominis plane block does not decrease postoperative pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites. Reg Anesth Pain Med 2012;37(2):188-92. http://dx.doi.org/10.1097/AAP.0b013e318244851b.
McMorrow RC, Ni Mhuircheartaigh RJ, Ahmed KA, Aslani A, Ng SC, Conrick-Martin I, et al. Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section. Br J Anaesth 2011;106(5):706-12. http://dx.doi.org/10.1093/bja/aer061.
Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care 2007;35:616-7.
El-Dawlatly AA, Turkistani A, Kettner SC, Machata AM, Delvi MB, Thallaj A, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth 2009;102(6):763-7. http://dx.doi.org/10.1093/bja/aep067.
Suresh S, Chan VW. Ultrasound guided transversus abdominis plane block in infants, children and adolescents: A simple procedural guidance for their performance. Paediatr Anaesth 2009;19(4):296-9. http://dx.doi.org/10.1111/j.1460-9592.2009.02958.x.
Tran TM, Ivanusic JJ, Hebbard P, Barrington MJ. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth 2009;102(1):123-7. http://dx.doi.org/10.1093/bja/aen344.
Chetwood A, Agrawal S, Hrouda D, Doyle P. Laparoscopic assisted transversus abdominis plane block: A novel insertion technique during laparoscopic nephrectomy. Anaesthesia 2011;66(4):317-8. http://dx.doi.org/10.1111/j.1365-2044.2011.06664.x.
Favuzza J, Delaney CP. Laparoscopic-guided transversus abdominis plane block for colorectal surgery. Dis Colon Rectum 2013;56(3):389-91. http://dx.doi.org/10.1097/DCR.0b013e318280549b.
Favuzza J, Delaney CP. Outcomes of discharge after elective laparoscopic colorectal surgery with transversus abdominis plane blocks and enhanced recovery pathway. J Am Coll Surg 2013;217(3):503-6. http://dx.doi.org/10.1016/j.jamcollsurg.2013.03.030.
Alvarez MP, Foley KE, Zebley DM, Fassler SA. Comprehensive enhanced recovery pathway significantly reduces postoperative length of stay and opioid usage in elective laparoscopic colectomy. Surg Endosc 2014;29(6):1-6.
Keller DS, Ermlich BO, Delaney CP. Demonstrating the benefits of transversus abdominis plane blocks on patient outcomes in laparoscopic colorectal surgery: Review of 200 consecutive cases. J Am Coll Surg 2014;219(6):1143-8. http://dx.doi.org/10.1016/j.jamcollsurg.2014.08.011.
Elamin G, Waters PS, Hamid H, O'Keeffe HM, Waldron RM, Duggan M, s. Efficacy of a laparoscopically delivered transversus abdominis plane block technique during elective laparoscopic cholecystectomy: A prospective, double-blind randomized trial. J Am Coll Surg 2015;221(2):335-44. http://dx.doi.org/10.1016/j.jamcollsurg.2015.03.030.
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