J Korean Surg Soc.  2013 Sep;85(3):128-133. 10.4174/jkss.2013.85.3.128.

Postoperative analgesic effects of ultrasound-guided transversus abdominis plane block for open appendectomy

• Cho S
• Kim YJ
• Kim DY
• Chung SS

• KMID: 1426345
• DOI: http://doi.org/10.4174/jkss.2013.85.3.128

Abstract

PURPOSE
Transversus abdominis plane (TAP) block is a newly developed and effective peripheral block involving the nerves of the anterior abdominal wall for lower abdominal surgery. We evaluated the postoperative analgesic efficacy of ultrasound-guided TAP block using 20 mL of 0.5% levobupivacaine in patients undergoing open appendectomy.
METHODS
Forty-four patients undergoing appendectomy were assigned either to undergo a right sided-TAP block (group I, n = 22), or to receive standard care (group II, n = 22). All patients received standard anesthetics, and the TAP block group received ultrasound-guided right side TAP block using 20 mL of 0.5% levobupivacaine after induction of anesthesia. All patients received acetaminophen, and nonsteroidal anti-inflammatory drug as required during the 48 postoperative hours. Each patients was assessed for time to first rescue analgesia, verbal numerical rating pain scores (VNRS), number of rescue analgesic demands, nausea, vomiting, pruritus, and drowsiness by a blinded investigator at 0, 1, 3, 6, 12, 24 and 48 hours postoperatively.
RESULTS
The TAP block group with levobupivacaine compared to the control group reduced VNRS significantly up to 12 hours postoperatively. There were no significant differences in time to first analgesia, number of rescue analgesics demands, nausea, vomiting, pruritus and drowsiness between the groups. There were no complications attributable to the TAP block.
CONCLUSION
Ultrasound-guided TAP block using 20 mL of 0.5% levobupivacaine provided effective postoperative analgesia during the 12 postoperative hours after an open appendectomy.

Keyword

Appendectomy; Postoperative pain; Nerve block; Ultrasonography

MeSH Terms

Abdominal Wall
Acetaminophen
Analgesia
Analgesics
Anesthesia
Anesthetics
Appendectomy
Bupivacaine
Humans
Nausea
Nerve Block
Pain, Postoperative
Pruritus
Research Personnel
Sleep Stages
Vomiting
Acetaminophen
Analgesics
Anesthetics
Bupivacaine

Figure

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  Fig. 1 (A) Abdominal muscles and fascia before injection. (B) Abdominal muscles and fascia after 20 mL injection of local anesthetics to transversus abdominis plane.

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  Fig. 2 VNRSr (A) and VNRSc (B) change according to the time. Control group received ultrasound transversus abdominis plane block with 20 mL of 0.9% normal saline. TAP block received ultrasound transversus abdominis plane block with 20 mL of 0.5% levobupivacaine. VNRSr, verbal numerical rating scale at resting state; VNRSc, verbal numerical rating scale at coughing; TAP, transversus abdominis plane. *P < 0.05 compared with the control group.

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  Fig. 3 A Kaplan-Meier graph of the time to first rescue analgesia. Control group received ultrasound transversus abdominis plane block with 20 mL of 0.9% normal saline. Transversus abdominis plane (TAP) block received ultrasound transversus abdominis plane block with 20 mL of 0.5% levobupivacaine.

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