Evaluation of usg guided transversus abdominis plane (tap) block with ropivacaine as post - operative analgesic technique for laparoscopic or robotic pelvic surgeries

Research Article
*Parth Shah, Ronak Shah, Alka Mandke and Harshal Wagh
Transversus Abdominis Plane block, Visual Analogue Scale, Multimodal analgesia

Background: Ultrasound guided (USG) approach to the TAP (Transversus Abdominis Plane) block provides reliable imaging of the three muscular layers of the anterolateral abdominal wall and assessment of correct needle placement and local anaesthetic injection thus potentially increasing the success rate and safety of the TAP block compared to the landmark technique. So we conducted this study to evaluate the efficacy of TAP block for post -operative pain relief after laparoscopic or robotic pelvic surgeries, assessment of the duration of analgesia as measured by time requirement of first dose of rescue analgesia, assessment of the quality of analgesia as measured by VAS score and any adverse effects or complications. Methodology A prospective, observational study was conducted at department of Anesthesiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai over 9 months.68 patients of either sex undergoing laparoscopic or robotic pelvic surgeries in hospital complying with eligibility criteria, undergoing general anesthesia with endotracheal intubation using standard anaesthesia protocol were selected.. Patients underwent a routine pre - anaesthetic check-up and pre-operative investigations as per protocol. Demographic data like age, sex, height, weight, BMI were obtained in pre - operative period. Patients were explained about the procedure and VAS score, TAP block pre operatively and written informed consent was taken. Pre operative heart rate, SPO2, blood pressure, respiratory rate were recorded in Operation Theater. All patients had general anaesthesia with intermittent positive pressure ventilation. At the end of the surgery, ultrasound guided TAP block was performed with 20ml 0.2% ropivacaine on each side of the abdomen. After completion of the block procedure patients were reversed and extubated as per extubation criteria. In the post operative period, the time of the first request for analgesia was recorded as duration of post operative analgesia by TAP block. Vital signs (heart rate, SPO2, blood pressure, respiratory rate), VAS pain scores at immediate post operative period (0 min) in post anaesthesia care unit (PACU), 2, 6, 12, and 24 hours post operatively recorded. Complication/ side effects if any were noted. Results: Out of 68 patients, total 18 patients did not receive any rescue analgesia for 24 hours post - operatively. Whereas duration of analgesia as assessed by time of request for 1st dose of rescue analgesic in other patients was 218.70 minutes (mean) with SD of 171.73. Comparison of VAS score at different time intervals in post operative period was found statistically significant (p <0.01) where VAS score at 0 min and at 2 hours post operatively was similar with mean VAS was 1.65. At 6, 12, 24 hours post operatively mean VAS score was 1.47, 1.09, 1.03 respectively. Thus in immediate post operative period (0min) till 2 hours no change was seen in VAS score after which at different intervals mean VAS score was decreased. Total 3 patients (4.4%) found to have nausea- vomiting in post operative period but TAP block was not associated with any symptoms of local anesthetic toxicity or organ injury. Hemodynamic parameters like heart rate, blood pressure, SPO2 and respiratory rate were clinically stable. Conclusion: addition of TAP block as a part of multimodal analgesia regime for laparoscopic or robotic pelvic surgeries is better option to obtain longer duration of analgesia, lower pain scores with no major side effects or complications.