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BJA Advance Access originally published online on June 26, 2009
British Journal of Anaesthesia 2009 103(4):601-605; doi:10.1093/bja/aep175
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy{dagger}

G. Niraj1,*, A. Searle2, M. Mathews3, V. Misra2, M. Baban2, S. Kiani2 and M. Wong3

1 Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
2 Department of Anaesthesia, Derby Hospitals NHS Foundation Trust, Derby DE22 3NE, UK.
3 Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK

* Corresponding author. E-mail: nirajgopinath{at}yahoo.co.uk

Background: Transversus abdominis plane (TAP) block is a new regional anaesthetic technique that blocks abdominal neural afferents by introducing local anaesthetic into the neuro-fascial plane between the internal oblique and the transversus abdominis muscles. We evaluated its analgesic efficacy in patients undergoing open appendicectomy in a randomized controlled double-blinded clinical trial.

Methods: Fifty-two adult patients undergoing open appendicectomy were randomized to undergo standard care (n=26) or to undergo a right-sided TAP block with bupivacaine (n=26). In addition, all patients received patient-controlled i.v. morphine analgesia, regular acetaminophen, and non-steroidal anti-inflammatory drug, as required, in the postoperative period. All patients received standard anaesthetic, and after induction of anaesthesia, the TAP group received an ultrasound-guided unilateral TAP block. Each patient was assessed after operation by a blinded investigator at 30 min and 24 h after surgery.

Results: Ultrasound-guided TAP block significantly reduced postoperative morphine consumption in the first 24 h [mean (SD) 28 (18) vs 50 (19) mg, P<0.002]. Postoperative visual analogue scale pain scores were also reduced in the TAP block group soon after surgery [median (IQR) 4.5 (3–5.3) vs 8.5 (7.5–10), P<0.001] and at 24 h [5.2 (4–6.2) vs 8 (7–8.5), P<0.001]. There were no complications attributable to the TAP block.

Conclusions: Ultrasound-guided TAP block holds considerable promise as a part of a balanced postoperative analgesic regimen for patients undergoing open appendicectomy.

Keywords: anaesthetic techniques, regional; equipment, ultrasound; surgery, appendicectomy

{dagger} This article is accompanied by Editorial II.


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F. Bonnet, J. Berger, and C. Aveline
Transversus abdominis plane block: what is its role in postoperative analgesia?
Br. J. Anaesth., October 1, 2009; 103(4): 468 - 470.
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