Preemptive analgesia of ultrasound-guided transversus abdominis plane block compared with deep wound infiltration in patients undergoing urological surgery
Ain Shams Journal of Anesthesiology
Introduction Pain after urologic surgeries is common and expected so it should be treated adequately to avoid postoperative complications and the development of chronic pain  . The most common approach to postoperative pain relief for urologic surgeries is multimodel using non-steroidal antiinflammatory drugs, opoids and local infiltration of anesthetic. Opioids are effective for treatment of postoperative pain but can cause adverse effects such as nausea, vomiting, decreased
... sed gastrointestinal motility, respiratory depression and sedation which further increase the morbidity of the patients. Local infiltration does not relieve deep muscular pain and NSAIDS are nephrotoxic . In the last decade, a novel approach to block the abdominal wall neural afferents via the lumbar triangle of petit has been described by Ref., in (2001). Known as transverses abdominus plane block (TAP) . However, landmark technique is associated with difficulties like anatomical variation of triangle of petit , difficulty in palpation of angle in obese patients and complications like liver injury, nerve injury and un predictable spread of local anesthetic . Hebbard et al. (2007) have subsequently described the ultrasound guided approach to the TAP block [6,7]. Real time ultrasound provides reliable imaging of urea muscular layers of anterolateral abdominal wall and assessment of correct needle placement and local anesthetic injection thus increasing the success rate and safety of TAP block compared to the landmark technique . The aim of our study was to evaluate the analgesic efficacy of ultrasound guided TAP block by comparing it with bupivacaine wound infiltration in patients undergoing urologic surgeries. Patients and Methods Following approval of the medical ethical committee of Ain Shams University, 40 patients ASA I-II physical status that were scheduled for elective urologic surgeries via abdominal wall incision under general anesthesia were included in this prospective study. All patients provided written informed consent. Patients with known allergy to any of the study medications, receiving medical therapies producing tolerance to opoids, with coagulapolly, and psychiatric problems were excluded. A preoperative evaluation was performed the day before surgery. Patients were divided into two groups: The TAP group (n=20) received Abstract Background: Transversus abdominus plane (TAP) block is suitable for unilateral urologic surgeries. Blind TAP block has many complications and uncertainty of its effects. Use of ultrasonography increases the safety and efficacy. This study was conducted to evaluate the analgesic efficacy of ultrasound (USG) guided TAP block compared with wound infiltration with bupivacaine (0.25%) in patients undergoing urologic surgeries.