Bilateral Ultrasound-Guided TAP Block Effects Before and After Laparoscopic Cholecystectomy Surgery on Postoperative Pain Reduction: A Randomized Double-Blind Controlled Trial
-
Nafiseh Faghani Makrani
,
Alieh Zamani Kiasari
,
Goli Aezzi Pashakollaei
,
Ramin Rouhani
,
Farshad Hassanzadeh Kiabi
,
Negar Shirvani Ghadikolaee
,
Keihan Shabankhani
Abstract
Background: The goal of this study is to compare the effects of the TAP (transversus abdominis plane) block, guided by ultrasound, before the commencement of surgery and after its completion, on reducing postoperative pain in patients undergoing laparoscopic cholecystectomy.
Methods: The present study was conducted as a randomized, double-blind clinical trial. The study population included patients scheduled for laparoscopic cholecystectomy at Imam Khomeini Hospital in Sari, Mazandaran, Iran. Patients were randomly assigned to two groups: TAP block before the operation and after the operation. The pain intensity and consciousness level at 0, 2, 4, 6, 8, 12, and 24 hours post-surgery, as well as the time of the first analgesic request, time of first pain expression after surgery, and the amount of morphine consumption within 24 hours for each patient, were documented.
Results: 120 patients were included in this study; 60 of them were in the pre-op group and 60 in the post-op group. There was no statistically significant difference in terms of duration of surgery and total morphine consumed between the study groups. The time of the first analgesic request and the time of the first pain expression were significantly longer in the post-op group. Pain intensity was significantly lower in the post-op group.
Conclusion: Bilateral ultrasound-guided TAP block after surgery in patients undergoing laparoscopic cholecystectomy leads to a reduction in pain intensity and incidence of vomiting and an increase in the time of analgesic request and pain expression after surgery.
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[9] Jensen K, Kehlet H, Lund C. Post‐operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime. Acta Anaesthesiol Scand. 2007;51(4):464-71.
[10] Rafi A. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024-6.
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[12] Petersen PL, Mathiesen O, Torup H, Dahl J. The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical review. Acta Anaesthesiol Scand. 2010;54(5):529-35.
[13] El-Dawlatly A, Turkistani A, Kettner S, Machata A-M, Delvi M, 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.
[14] 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.
[15] 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.
[16] 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.
[17] McDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2008;106(1):186-91.
[18] Carney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg. 2008;107(6):2056-60.
[19] Belavy D, Cowlishaw P, Howes M, Phillips F. Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery. Br J Anaesth. 2009;103(5):726-30.
[20] Costello JF, Moore AR, Wieczorek PM, Macarthur AJ, Balki M, Carvalho JC. The transversus abdominis plane block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve analgesia after cesarean delivery. Reg Anesth Pain Med. 2009;34(6):586-9--9.
[21] Piaggio G, Elbourne DR, Pocock SJ, Evans SJ, Altman DG, CONSORT Group ft. Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. JAMA. 2012;308(24):2594-604.
[22] Faiz SHR, Alebouyeh MR, Derakhshan P, Imani F, Rahimzadeh P, Ghaderi Ashtiani M. Comparison of ultrasound-guided posterior transversus abdominis plane block and lateral transversus abdominis plane block for postoperative pain management in patients undergoing cesarean section: a randomized double-blind clinical trial study. J Pain Res. 2017:5-9.
[23] Zhou H, Ma X, Pan J, Shuai H, Liu S, Luo X, et al. Effects of transversus abdominis plane blocks after hysterectomy: a meta-analysis of randomized controlled trials. J Pain Res. 2018:2477-89.
[24] De Oliveira Jr GS, 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.
[25] Rashid A, Gorissen K, Ris F, Gosselink M, Shorthouse J, Smith A, et al. No benefit of ultrasound‐guided transversus abdominis plane blocks over wound infiltration with local anaesthetic in elective laparoscopic colonic surgery: results of a double‐blind randomized controlled trial. Colorectal Dis. 2017;19(7):681-9.
[26] Kalu R, Boateng P, Carrier L, Garzon J, Tang A, Reickert C, et al. Preoperative Versus Postoperative Use of Transversus Abdominis Plane Block With Nonliposomal Bupivacaine on Postoperative Narcotic Use: A Retrospective Study. BMC Anesthesiol. 2021; 21(1):114.
[27] Tikuisis R, Miliauskas P, Lukoseviciene V, Samalavicius N, Dulskas A, Zabuliene L, et al. Transversus abdominis plane block for postoperative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial. Tech Coloproctol. 2016; 20:835-44.
[28] Wills V, Hunt D. Pain after laparoscopic cholecystectomy. Br J Surg. 2000;87(3):273-84.
[29] O'Donnell BD. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med. 2006;31(1):91.
[2] Bucher P, Pugin F, Buchs N, Ostermann S, Morel P. Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. J Br Surg. 2011;98(12):1695-702.
[3] Barczyński M, Herman R. A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc. 2003;17(4):533-8.
[4] Bisgaard T, Warltier DC. Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology. 2006;104(4):835-46.
[5] Rozen WM, Tran T, Ashton M, Barrington M, Ivanusic J, Taylor G. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat. 2008;21(4):325-33.
[6] Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001;92(1-2):147-57.
[7] Mukhtar K, Singh S. Transversus abdominis plane block for laparoscopic surgery. Br J Anaesth. 2009;102(1):143-4.
[8] Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain. 2001;90(3):261-9.
[9] Jensen K, Kehlet H, Lund C. Post‐operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime. Acta Anaesthesiol Scand. 2007;51(4):464-71.
[10] Rafi A. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024-6.
[11] Jeng CL, Rosenblatt MA, Maniker R, Crowley M. Overview of peripheral nerve blocks [Internet]. UpToDate; 2019 [cited 2025 Feb 10]. Available from: https://doctorabad.com/app/uptodate/d/topic.htm?path=overview-of-peripheral-nerve-blocks
[12] Petersen PL, Mathiesen O, Torup H, Dahl J. The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical review. Acta Anaesthesiol Scand. 2010;54(5):529-35.
[13] El-Dawlatly A, Turkistani A, Kettner S, Machata A-M, Delvi M, 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.
[14] 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.
[15] 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.
[16] 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.
[17] McDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2008;106(1):186-91.
[18] Carney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg. 2008;107(6):2056-60.
[19] Belavy D, Cowlishaw P, Howes M, Phillips F. Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery. Br J Anaesth. 2009;103(5):726-30.
[20] Costello JF, Moore AR, Wieczorek PM, Macarthur AJ, Balki M, Carvalho JC. The transversus abdominis plane block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve analgesia after cesarean delivery. Reg Anesth Pain Med. 2009;34(6):586-9--9.
[21] Piaggio G, Elbourne DR, Pocock SJ, Evans SJ, Altman DG, CONSORT Group ft. Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. JAMA. 2012;308(24):2594-604.
[22] Faiz SHR, Alebouyeh MR, Derakhshan P, Imani F, Rahimzadeh P, Ghaderi Ashtiani M. Comparison of ultrasound-guided posterior transversus abdominis plane block and lateral transversus abdominis plane block for postoperative pain management in patients undergoing cesarean section: a randomized double-blind clinical trial study. J Pain Res. 2017:5-9.
[23] Zhou H, Ma X, Pan J, Shuai H, Liu S, Luo X, et al. Effects of transversus abdominis plane blocks after hysterectomy: a meta-analysis of randomized controlled trials. J Pain Res. 2018:2477-89.
[24] De Oliveira Jr GS, 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.
[25] Rashid A, Gorissen K, Ris F, Gosselink M, Shorthouse J, Smith A, et al. No benefit of ultrasound‐guided transversus abdominis plane blocks over wound infiltration with local anaesthetic in elective laparoscopic colonic surgery: results of a double‐blind randomized controlled trial. Colorectal Dis. 2017;19(7):681-9.
[26] Kalu R, Boateng P, Carrier L, Garzon J, Tang A, Reickert C, et al. Preoperative Versus Postoperative Use of Transversus Abdominis Plane Block With Nonliposomal Bupivacaine on Postoperative Narcotic Use: A Retrospective Study. BMC Anesthesiol. 2021; 21(1):114.
[27] Tikuisis R, Miliauskas P, Lukoseviciene V, Samalavicius N, Dulskas A, Zabuliene L, et al. Transversus abdominis plane block for postoperative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial. Tech Coloproctol. 2016; 20:835-44.
[28] Wills V, Hunt D. Pain after laparoscopic cholecystectomy. Br J Surg. 2000;87(3):273-84.
[29] O'Donnell BD. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med. 2006;31(1):91.
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How to Cite
1.
Faghani Makrani N, Zamani Kiasari A, Aezzi Pashakollaei G, Rouhani R, Hassanzadeh Kiabi F, Shirvani Ghadikolaee N, Shabankhani K. Bilateral Ultrasound-Guided TAP Block Effects Before and After Laparoscopic Cholecystectomy Surgery on Postoperative Pain Reduction: A Randomized Double-Blind Controlled Trial. Arch Anesth & Crit Care. 2025;.
