Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2016.07.009
Brazilian Journal of Anesthesiology
Scientific Article

Ultrasound-guided versus surgical transversus abdominis plane block in obese patients following cesarean section: a prospective randomised study

Bloqueio cirúrgico do plano transverso abdominal versus guiado por ultrassom em pacientes obesas após cesárea: estudo prospectivo e randomizado

Aykut Urfalı; ; lu; Murat Bakacak; Ömer Faruk Boran; Fatih Mehmet Yazar; Mahmut Arslan; Hafize Öksüz

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Abstract

Abstract Background and objectives Ultrasound-guided transversus abdominis plane block demonstrated efficacy in providing post-operative analgesia by prolonging the time to first analgesic requirement and reducing the total analgesic consumption. The surgical transversus abdominis plane block, a novel technique, can be performed safely in obese patients in whom muscle layers cannot be sufficiently exposed. Here, we compared applicability, efficacy and complications of surgical transversus abdominis plane and ultrasound-guided transversus abdominis plane blocks in obese pregnant women following cesarean section under general anesthesia. Methods Seventy-five pregnant women with pre- and post-pregnancy body mass index > 30 were randomized and allocated into two groups: Ultrasound-guided transversus abdominis plane block (UT group; n = 38) and surgical TAP block (ST group; n = 37). Visual analogue scale scores at post-operative 0, 2, 6, 12 and 24 hours (h), time to first analgesic requirement, total analgesic consumption amount in 24 h, post-operative side effects, complications and patient satisfaction were recorded. Results and conclusions Age, American Society of Anesthesiologist score, operative duration, body mass index, mean time to first analgesic requirement and total analgesic consumption in 24 h were similar between groups, while significant differences in pre- and post-pregnancy body mass index were observed between groups. Block procedure durations were 7 and 10 minutes in ST and UT groups, respectively. No significant differences in visual analogue scale scores were observed between the groups at all times; itching and nausea was observed in one (UT group) and four (UT and ST groups) patients, respectively. Surgical transversus abdominis plane block was safe in obese pregnant patients and provided similar post-operative analgesia to ultrasound-guided transversus abdominis plane block.

Keywords

Transversus abdominis plane block, Cesarean section, Pregnant women, Visual analogue scale, Analgesia

Resumo

Resumo Justificativa e objetivos O bloqueio do plano transverso abdominal (TAP) guiado por ultrassom (US) demonstrou eficácia no fornecimento de analgesia no pós-operatório ao prolongar o tempo até a primeira necessidade de analgésico e reduzir o consumo total de analgésico. O bloqueio TAP cirúrgico (uma nova técnica) pode ser realizado com segurança em pacientes obesas nas quais as camadas musculares não podem ser suficientemente expostas. Comparamos a aplicabilidade, a eficácia e as complicações do bloqueio TAP cirúrgico e do bloqueio TAP-US em gestantes obesas submetidas à cesárea sob anestesia geral. Método Setenta e cinco mulheres grávidas com índice de massa corporal (IMC) pré e pós-gravidez > 30 foram randomicamente alocadas em dois grupos: bloqueio TAP-US (Grupo TAP-US, n = 38) e bloqueio TAP cirúrgico (Grupo TAP-C, n = 37). Os escores da escala visual analógica (VAS) nos tempos 0, 2, 6, 12 e 24 horas de pós-operatório, o tempo até a primeira necessidade de analgésico, o consumo total de analgésico em 24 horas, os efeitos colaterais no pós-operatório, as complicações e a satisfação do paciente foram registrados. Resultados e conclusões Idade, estado físico ASA, tempo cirúrgico, IMC, média de tempo até a primeira necessidade de analgésico e consumo total de analgésico em 24 horas foram semelhantes entre os grupos, enquanto diferenças significativas foram observadas entre os grupos em relação ao IMC pré- e pós-gravidez. As durações dos procedimentos de bloqueio foram de 7 e 10 minutos nos grupos TAP-US e TAP-C, respectivamente. Não houve diferença significativa nos escores VAS entre os grupos em todos os momentos; prurido e náusea foram observados em um paciente (Grupo TAP-US) e em quatro (Grupo TAP-C), respectivamente. O bloqueio TAP cirúrgico foi seguro nas pacientes grávidas obesas e forneceu analgesia similar à do bloqueio TAP-US no pós-operatório.

Palavras-chave

Bloqueio do plano transverso abdominal, Cesariana, Grávidas, Escala visual analógica, Analgesia

References

Tan TT, Teoh WH, Woo DC. A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia. Eur J Anaesthesiol. 2012;29:88-94.

Patel SA, Gotkin J, Huang R. Transversus abdominis plane block for postoperative analgesia after cesarean delivery. J Matern Fetal Neonatal Med. 2012;25:2270-3.

Kwok S, Wang H, Sng BJ. Post-caesarean analgesia. J Trends Anaesth Crit Care. 2014;4:189-94.

Schyns-van den Berg AM, Huisjes A, Stolker RJ. Postcaesarean section analgesia: are opioids still required?. Curr Opin Anaesthesiol. 2015;28:267-74.

Chandon M, Bonnet A, Burg Y. Ultrasound-guided transversus abdominis plane block versus continuous wound infusion for post-caesarean analgesia: a randomised trial. PLOS ONE. 2014;9:e103971.

Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56:1024-6.

Farooq M, Carey M. A case of liver trauma with a blunt regional anesthesia needle while performing transversus abdominis plane block. Reg Anesth Pain Med. 2008;33:274-5.

Hebbard P, Fujiwara Y, Shibata Y. Ultrasound-guided transversus abdominis plane block. Anaesth Intensive Care. 2007;35:616-7.

Lancaster P, Chadwick M. Liver trauma secondary to ultrasound-guided transversus plane block. Br J Anaesth. 2010;104:509-10.

Weiss E, Jolly C, Dumoulin JL. Convulsions in 2 patients after bilateral ultrasound-guided transversus abdominis plane blocks for cesarean analgesia. Reg Anesth Pain Med. 2014;39:248-51.

Canovas L, Lopez C, Castro M. Contribution to post-caesarean analgesia of ultrasound-guided transversus abdominis plane block. Rev Esp Anestesiol Reanim. 2013;60:124-8.

Zhao X, Tong Y, Ren H. Transversus abdominis plane block for postoperative analgesia after laparascopic surgery: a systematic review and meta-analysis. Int J Clin Exp Med. 2014;7:2966-75.

Owen DJ, Harrod I, Ford J. The surgical transversus abdominis plane block-a novel approach for performing an established technique. BJOG. 2011;118:24-7.

Elamin G, Waters PS, Hamid H. Efficacy of a laparascopically delivered transversus abdominis plane block technique during elective laparascopic cholecystectomy: a prospective double-blind randomised trial. J Am Coll Surg. 2015;221:335-44.

El Hachem L, Small E, Chung P. Randomized controlled double-blind trial of transversus abdominis plane block versus trocar site infiltration in gynecologic laparoscopy. Am J Obstet Gynecol. 2015;212.

El-Dawlatly A, Al-Dohayan A. İnside-out transversus abdominis plane block. Saudi J Anaesth. 2014;8:315-6.

Eslamian L, Jalili Z, Jamal A. Transversus abdominis plane block reduces postoperative pain intensity and analgesic consumption in elective cesarean delivery under general anesthesia. J Anesth. 2012;26:334-8.

Wittels B, Scott DT, Sinatra RS. Exogenous opioids in human breast milk and acute neonatal neurobehavior: a preliminary study. Anesthesiology. 1990;73:864-9.

McKeen DM, George RB, Boyd JC. Transversus abdominis plane block does not improve early or late pain outcomes after cesarean delivery: a randomized controlled trial. Can J Anesth. 2014;61:631-40.

Fusco P, Scimia P, Paladini G. Transversus abdominis plane block for analgesia after cesarean delivery. A systematic review. Minerva Anestesiol. 2015;81:195-204.

Yu N, Long X, Lujan-Hernandez JR. Transversus abdominis-plane block versus local anesthetic wound infiltration in lower abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. BMC Aneshesiol. 2014;14:121.

Walter CJ, Maxwell-Armstrong C, Pinkney TD. A randomised controlled trial of the efficacy of ultrasound-guided transversus abdominis plane (TAP) block in laparoscopic colorectal surgery. Surg Endosc. 2013;27:2366-72.

Rao DP, Rao VA. Morbidly obese parturitient challenges for the anaesthesiologist, including managing the diffucult airway in obstetrics. What is new?. Indian J Anaesth. 2010;54:508-21.

Belavy D, Cowlishaw PJ, Howes M. Ultrasound-guided transversus abdominis plane block for analgesia after caesarean delivery. Br J Anaesth. 2009;103:726-30.

Bollag L, Richebe P, Ortner C. Transversus abdominis plane catheters for post-cesarean delivery analgesia: a series of five cases. Int J Obstet Anesth. 2012;21:176-80.

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