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BJA Advance Access published online on April 17, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep067
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 BJA: June 2009
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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

Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy{dagger}

A. A. El-Dawlatly1, A. Turkistani1, S. C. Kettner2, A.-M. Machata2, M. B. Delvi1, A. Thallaj1, S. Kapral2 and P. Marhofer2,*

1 Department of Anaesthesia and Intensive Care Medicine, King Saud University, College of Medicine, Riyadh, Saudi Arabia
2 Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria

* Corresponding author. E-mail: peter.marhofer{at}meduniwien.ac.at

Background: The transversus abdominis plane (TAP) block is usually performed by landmark-based methods. This prospective, randomized, and double-blinded study was designed to describe a method of ultrasound-guided TAP block and to evaluate the intra- and postoperative analgesic efficacy in patients undergoing laparoscopic cholecystectomy under general anaesthesia with or without TAP block.

Methods: Forty-two patients undergoing laparoscopic cholecystectomy were randomized to receive standard general anaesthetic either with (Group A, n=21) or without TAP block (Group B, n=21). Ultrasound-guided bilateral TAP block was performed with a high frequent linear ultrasound probe and an in-plane needle guidance technique with 15 ml bupivacaine 5 mg ml–1 on each side. Intraoperative use of sufentanil and postoperative demand of morphine using a patient-controlled analgesia device were recorded.

Results: Ultrasonographic visualization of the relevant anatomy, detection of the shaft and tip of the needle, and the spread of local anaesthetic were possible in all cases where a TAP block was performed. Patients in Group A received significantly more intraoperative sufentanil and postoperative morphine compared with those in Group B [mean (SD) 8.6 (3.5) vs 23.0 (4.8) µg, P<0.01, and 10.5 (7.7) vs 22.8 (4.3) mg, P<0.05].

Conclusions: Ultrasonographic guidance enables exact placement of the local anaesthetic for TAP blocks. In patients undergoing laparoscopic cholecystectomy under standard general anaesthetic, ultrasound-guided TAP block substantially reduced the perioperative opioid consumption.

Keywords: anaesthetic techniques, regional; equipment, ultrasound machines; surgery, laparoscopy

{dagger} The study was performed at the Department of Anaesthesia and Intensive Care Medicine, King Saud University, College of Medicine, Riyadh, Saudi Arabia.


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This article has been cited by other articles:


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E-letters:

Read all E-letters

Ultrasound-guided transversus abdominis plane block... is it still a new technique?
Karim MUKHTAR, et al.
British Journal of Anaesthesia, 7 May 2009 [Full text]
Transversus abdominis plane blocks: a correction and a suggestion
Rachel K Perry
British Journal of Anaesthesia, 16 Jul 2009 [Full text]
Ultrsound guided TAP block -continous catheter technique in abdominal surgery.
vasanth rao kadam
British Journal of Anaesthesia, 27 Jul 2009 [Full text]
Re: Ultrasound-guided transversus abdominis plane block... is it still a new technique?
Abdelazeem Eldawlatly
British Journal of Anaesthesia, 28 Sep 2009 [Full text]
Re: Ultrsound guided TAP block -continous catheter technique in abdominal surgery.
Abdelazeem Eldawlatly
British Journal of Anaesthesia, 2 Oct 2009 [Full text]
Re: Transversus abdominis plane blocks: a correction and a suggestion
Abdelazeem Eldawlatly
British Journal of Anaesthesia, 12 Oct 2009 [Full text]

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