Ultrasound Guided Oblique Subcostal Transversus Abdominis Plane Block (TAP) versus both Subcostal and Posterior TAP Block as Postoperative Analgesia in Hepatectomy
-
Ahmed Wagih Ezzat
,
Fahmy Saad Lateef
,
Mona Refaat Hosny
,
Rana Ayman Mohamed Abdelhalim
,
Rasha K. Ali
Abstract
Background: Poorly controlled acute pain after abdominal surgery originates from somatic pain in the abdominal wall and is associated with multiple adverse postoperative outcomes, including psychological distress, cardiopulmonary complications, prolonged hospitalization, delayed bowel recovery, increased analgesic requirements, and a higher risk of chronic pain. The objective is the evaluation of the postoperative analgesic effectiveness of oblique subcostal and posterior techniques for ultrasound-guided Transversus Abdominis Plane (TAP) block in hepatectomy.
Methods: Forty patients aged 40–60 years (ASA class II–III) scheduled for hepatectomy at Ain Shams University Hospitals were randomly assigned to two groups of 20. One group received general anesthesia plus an ultrasound-guided oblique subcostal TAP block with 30 ml of a solution containing bupivacaine 0.25%, lidocaine, magnesium, and dexamethasone. The second group received general anesthesia and combined subcostal and posterior TAP blocks using the same solution via both routes, totaling 60 ml without exceeding safe dose limits.
Results: Patients who received only the subcostal TAP blocks experienced significantly lower pain scores during the first 24 hours after surgery and required fewer analgesics than those who received combined subcostal and posterior TAP blocks.
Conclusion: Compared with the subcostal TAP block alone, the combined oblique subcostal and posterior TAP block provided better postoperative pain control and reduced analgesic requirements after hepatectomy under general anesthesia.
[1] Pirie K, Traer E, Finniss D, Myles PS, Riedel B. Current approaches to acute postoperative pain management after major abdominal surgery: a narrative review and future directions. Br J Anaesth. 2022; 129(3):378-93.
[2] Sellam S, Nguyen AT, Pogu M, Kianmanesh R, Malinovsky JM, Renard Y. Transversus abdominis plane block in the treatment of chronic postsurgical abdominal wall pain improves patient quality of life: a retrospective study and literature review. Pain Physician. 2023; 26(2):E91-e100.
[3] Knaak C, Spies C, Schneider A, Jara M, Vorderwülbecke G, Kuhlmann AD, et al. Epidural anesthesia in liver surgery—a propensity score–matched analysis. Pain Med. 2020; 21(11):2650-60.
[4] Ghosh A, Ninave S. Navigating pain relief: a comprehensive review of transversus abdominis plane block. Cureus. 2023; 15(12):e51119.
[5] Jin S, Fu Q, Wuyun G, Wuyun T. Management of post-hepatectomy complications. World J Gastroenterol. 2013; 19(44):7983-91.
[6] Kamarajah SK, Gujjuri RR, Hilal MdA, Manas DM, White SA. Does minimally invasive liver resection improve long-term survival compared to open resection for hepatocellular carcinoma? A systematic review and meta-analysis. Scand J Surg. 2022; 111(1):14574969211042455.
[7] 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. 2018; 11:5-9.
[8] Ma N, Duncan JK, Scarfe AJ, Schuhmann S, Cameron AL. Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis. J Anesth. 2017; 31(3):432-52.
[9] Padhi S, Ratha S, Raj KA, Nanda AK. Post-operative analgesic efficacy of transversus abdominis plane block as compared to local anaesthetic infiltration at the surgical site in lower abdominal surgeries: a randomized controlled trial. Int J Health Sci. 2022; 6(S2):13107-14.
[10] Bhatia P, Bihani P, Chhabra S, Sharma V, Jaju R. Ultrasound-guided bilateral subcostal TAP block for epigastric hernia repair: a case series. Indian J Anaesth. 2019; 63(1):60-3.
[11] Bhatia N, Arora S, Jyotsna W, Kaur G. Comparison of posterior and subcostal approaches to ultrasound-guided transverse abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy. J Clin Anesth. 2014; 26(4):294-9.
[12] Paladini A, Rawal N, Coca Martinez M, Trifa M, Montero A, Pergolizzi J Jr, et al. Advances in the management of acute postsurgical pain: a review. Cureus. 2023; 15(8):e42974.
[13] Joshi G, Ogunnaike B. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North America. 2005; 23(1):21-36.
[14] Kuppuvelumani P, Jaradi H, Delilkan A. Abdominal nerve blockade for postoperative analgesia after caesarean section. Asia Oceania J Obstet Gynaecol. 1993; 19(2):165-9.
[15] Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001; 56(10):1024-6.
[16] Macías AA, Finneran JJ. Regional anesthesia techniques for pain management for laparoscopic surgery: a review of the current literature. Curr Pain Headache Rep. 2022; 26(1):33-42.
[17] Siam EM, Alia DMA, Fathy RM, Elshahaly MA. Efficacy of magnesium sulfate added to bupivacaine in transversus abdominis plane block for postoperative analgesia after inguinal herniorrhaphy. Res Opin Anesth Intensive Care. 2021; 8(4):189-97.
[18] Ireland KC, Lalkhen AG. Postoperative analgesia. Anaesth Intensive Care Med. 2022; 23(1):29-36.
[19] Rawal N. Epidural analgesia for postoperative pain: improving outcomes or adding risks? Best Pract Res Clin Anaesthesiol. 2021; 35(1):53-65.
[20] Bohringer C, Astorga C, Liu H. The benefits of opioid free anesthesia and the precautions necessary when employing it. Transl Perioper Pain Med. 2020; 7(1):152-7.
[21] Tsai HC, Yoshida T, Chuang TY, Yang SF, Chang CC, Yao HY, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int. 2017; 2017(1):8284363.
[22] Zeng J, Hong A, Gu Z, Jian J, Liang X. Efficacy of transversus abdominis plane block on postoperative nausea and vomiting: a meta-analysis of randomized controlled trial. BMC Anesthesiol. 2024; 24(1):87.
[23] Alsharari AF, Abuadas FH, Alnassrallah YS, Salihu D. Transversus abdominis plane block as a strategy for effective pain management in patients with pain during laparoscopic cholecystectomy: a systematic review. J Clin Med. 2022; 11(23):6896.
[24] Mishriky BM, George RB, Habib AS. Transversus abdominis plane block for analgesia after cesarean delivery: a systematic review and meta-analysis. Can J Anaesth. 2012; 59(8):766-78.
[25] Hamid HK, Ahmed AY, Saber AA, Emile SH, Ibrahim M, Ruiz-Tovar J. Transversus abdominis plane block using a short-acting local anesthetic reduces pain and opioid consumption after laparoscopic bariatric surgery: a meta-analysis. Surg Obes Relat Dis. 2020; 16(9):1349-57.
[26] Nessim FMM, Hassan AEM, Eskander FSL, Nady RFG. The effect of combined ultrasound-guided transverse thoracic muscle plane block and rectus sheath plane block on the peri-operative consumption of opioids in open heart surgeries with median sternotomy. Egypt J Anaesth. 2023; 39(1):488-95.
[27] Serag Eldin M, Mahmoud F, El Hassan R, Abdel Raouf M, Afifi MH, Yassen K, et al. Intravenous patient-controlled fentanyl with and without transversus abdominis plane block in cirrhotic patients post liver resection. Local Reg Anesth. 2014; 7:27-37.
[2] Sellam S, Nguyen AT, Pogu M, Kianmanesh R, Malinovsky JM, Renard Y. Transversus abdominis plane block in the treatment of chronic postsurgical abdominal wall pain improves patient quality of life: a retrospective study and literature review. Pain Physician. 2023; 26(2):E91-e100.
[3] Knaak C, Spies C, Schneider A, Jara M, Vorderwülbecke G, Kuhlmann AD, et al. Epidural anesthesia in liver surgery—a propensity score–matched analysis. Pain Med. 2020; 21(11):2650-60.
[4] Ghosh A, Ninave S. Navigating pain relief: a comprehensive review of transversus abdominis plane block. Cureus. 2023; 15(12):e51119.
[5] Jin S, Fu Q, Wuyun G, Wuyun T. Management of post-hepatectomy complications. World J Gastroenterol. 2013; 19(44):7983-91.
[6] Kamarajah SK, Gujjuri RR, Hilal MdA, Manas DM, White SA. Does minimally invasive liver resection improve long-term survival compared to open resection for hepatocellular carcinoma? A systematic review and meta-analysis. Scand J Surg. 2022; 111(1):14574969211042455.
[7] 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. 2018; 11:5-9.
[8] Ma N, Duncan JK, Scarfe AJ, Schuhmann S, Cameron AL. Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis. J Anesth. 2017; 31(3):432-52.
[9] Padhi S, Ratha S, Raj KA, Nanda AK. Post-operative analgesic efficacy of transversus abdominis plane block as compared to local anaesthetic infiltration at the surgical site in lower abdominal surgeries: a randomized controlled trial. Int J Health Sci. 2022; 6(S2):13107-14.
[10] Bhatia P, Bihani P, Chhabra S, Sharma V, Jaju R. Ultrasound-guided bilateral subcostal TAP block for epigastric hernia repair: a case series. Indian J Anaesth. 2019; 63(1):60-3.
[11] Bhatia N, Arora S, Jyotsna W, Kaur G. Comparison of posterior and subcostal approaches to ultrasound-guided transverse abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy. J Clin Anesth. 2014; 26(4):294-9.
[12] Paladini A, Rawal N, Coca Martinez M, Trifa M, Montero A, Pergolizzi J Jr, et al. Advances in the management of acute postsurgical pain: a review. Cureus. 2023; 15(8):e42974.
[13] Joshi G, Ogunnaike B. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North America. 2005; 23(1):21-36.
[14] Kuppuvelumani P, Jaradi H, Delilkan A. Abdominal nerve blockade for postoperative analgesia after caesarean section. Asia Oceania J Obstet Gynaecol. 1993; 19(2):165-9.
[15] Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001; 56(10):1024-6.
[16] Macías AA, Finneran JJ. Regional anesthesia techniques for pain management for laparoscopic surgery: a review of the current literature. Curr Pain Headache Rep. 2022; 26(1):33-42.
[17] Siam EM, Alia DMA, Fathy RM, Elshahaly MA. Efficacy of magnesium sulfate added to bupivacaine in transversus abdominis plane block for postoperative analgesia after inguinal herniorrhaphy. Res Opin Anesth Intensive Care. 2021; 8(4):189-97.
[18] Ireland KC, Lalkhen AG. Postoperative analgesia. Anaesth Intensive Care Med. 2022; 23(1):29-36.
[19] Rawal N. Epidural analgesia for postoperative pain: improving outcomes or adding risks? Best Pract Res Clin Anaesthesiol. 2021; 35(1):53-65.
[20] Bohringer C, Astorga C, Liu H. The benefits of opioid free anesthesia and the precautions necessary when employing it. Transl Perioper Pain Med. 2020; 7(1):152-7.
[21] Tsai HC, Yoshida T, Chuang TY, Yang SF, Chang CC, Yao HY, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int. 2017; 2017(1):8284363.
[22] Zeng J, Hong A, Gu Z, Jian J, Liang X. Efficacy of transversus abdominis plane block on postoperative nausea and vomiting: a meta-analysis of randomized controlled trial. BMC Anesthesiol. 2024; 24(1):87.
[23] Alsharari AF, Abuadas FH, Alnassrallah YS, Salihu D. Transversus abdominis plane block as a strategy for effective pain management in patients with pain during laparoscopic cholecystectomy: a systematic review. J Clin Med. 2022; 11(23):6896.
[24] Mishriky BM, George RB, Habib AS. Transversus abdominis plane block for analgesia after cesarean delivery: a systematic review and meta-analysis. Can J Anaesth. 2012; 59(8):766-78.
[25] Hamid HK, Ahmed AY, Saber AA, Emile SH, Ibrahim M, Ruiz-Tovar J. Transversus abdominis plane block using a short-acting local anesthetic reduces pain and opioid consumption after laparoscopic bariatric surgery: a meta-analysis. Surg Obes Relat Dis. 2020; 16(9):1349-57.
[26] Nessim FMM, Hassan AEM, Eskander FSL, Nady RFG. The effect of combined ultrasound-guided transverse thoracic muscle plane block and rectus sheath plane block on the peri-operative consumption of opioids in open heart surgeries with median sternotomy. Egypt J Anaesth. 2023; 39(1):488-95.
[27] Serag Eldin M, Mahmoud F, El Hassan R, Abdel Raouf M, Afifi MH, Yassen K, et al. Intravenous patient-controlled fentanyl with and without transversus abdominis plane block in cirrhotic patients post liver resection. Local Reg Anesth. 2014; 7:27-37.
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| Section | Research Article(s) | |
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| Hepatectomy Oblique Subcostal Transversus Abdominis Plane Block Subcostal Postoperative Analgesia | ||
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How to Cite
1.
Ezzat A, Lateef F, Hosny M, Abdelhalim R, Ali R. Ultrasound Guided Oblique Subcostal Transversus Abdominis Plane Block (TAP) versus both Subcostal and Posterior TAP Block as Postoperative Analgesia in Hepatectomy. Arch Anesth & Crit Care. 2026;.
