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Four quadrant transversus abdominis plane block and continuous transversus abdominis plane analgesia: a 3-year prospective audit in 124 patients - 02/10/15

Doi : 10.1016/j.jclinane.2015.07.005 
G. Niraj, MD, FRCA, FFPMRCA  : Consultant in Anaesthesia, Aditi Kelkar, MD, FRCA : Consultant in Anaesthesia, Elaine Hart, FRCA : Consultant in Anaesthesia, Vipul Kaushik, FRCA : Specialist Trainee in Anaesthesia, Danny Fleet, MB, ChB : Specialist Trainee in Anaesthesia, John Jameson : Consultant in Colorectal Surgery
 Department of Anaesthesia and Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK 

Corresponding author at: Department of Anaesthesia & Pain Management, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW. Tel./fax: +44 116 258 4661.Department of Anaesthesia & Pain Management, Leicester General Hospital, University Hospitals of Leicester NHS TrustGwendolen RoadLeicesterLE5 4PW

Abstract

Study Objective

Transversus abdominis plane (TAP) blocks have been reported to be an effective method of providing analgesia after abdominal surgery. To perform a prospective audit on the effectiveness of a novel technique of providing continuous transversus abdominis plane (TAP) analgesia in patients undergoing emergency and elective abdominal surgery.

Design

Prospective single center audit over a 3-year period.

Setting

University hospital.

Patients

One hundred twenty-four American Society of Anesthesiologists I to IV adult patients presenting for elective as well as emergency abdominal surgery in whom epidural analgesia was contraindicated or refused.

Interventions

Four quadrant TAP blocks and continuous TAP analgesia.

Measurements

Numerical rating scale pain scores at rest and on coughing, nausea scores, satisfaction scores, complications, frequency of analgesia failure, therapeutic failure with continuous TAP analgesia and opioid consumption.

Results

One hundred twenty-four patients who received continuous TAP analgesia were audited. This included 34 patients for elective open surgery, 36 patients for emergency laparotomy, and 54 patients who underwent elective laparoscopic colorectal surgery. Surgical incision was within the dermatomal limit of the block in 70% of the patients (88/124). Therapeutic failure with the technique was 10%. Frequency of analgesic failure over the 48-hour period was none in 39% and below 5 episodes in 57%.

Conclusion

Four quadrant transversus abdominis plane blocks and continuous TAP analgesia is an effective technique for providing postoperative analgesia after abdominal surgery. It has the potential to be used as a sole analgesic technique when the surgical incision is within its dermatomal limit.

Il testo completo di questo articolo è disponibile in PDF.

Highlights

We present a 3-year prospective audit of a new technique “Four quadrant TAP block and Continuous TAP analgesia.”
We included patients undergoing elective open and laparoscopic abdominal surgery as well as emergency laparotomy.
We conclude that continuous TAP analgesia is an effective analgesic technique following abdominal surgery with a favourable risk benefit profile.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Continuous TAP analgesia, Four quadrant TAP analgesia


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Vol 27 - N° 7

P. 579-584 - novembre 2015 Ritorno al numero
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