Perioperative analgesic effects of preemptive ultrasound-guided subcostal transversus abdominis plane (TAP) block for percutaneous nephrolithotomy: a prospective, randomized trial.

Backgroud and Objectives: Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for removing kidney stones but patients still suffer from moderate postoperative pain. The aim of this study is to evaluate the perioperative analgesic effect of ultrasound-guided subcostal transversus abdominis plane (TAP) block performed prior to PCNL procedure. METHODS Patients scheduled for elective percutaneous nephrolithotomy were randomized into two groups: Group TAP and Group IV. General anesthesia was induced with propofol, fentanyl and rocuronium and maintained with sevoflurane, fentanyl and rocuronium. Unilateral ultrasound-guided transversus abdominis plane block was performed with total of 30ml volume of local anesthetic solution (20ml Bupivacaine 0.125% plus 10ml Lidocaine 1%) after intubation but before surgery to the Group TAP patients. Paracetamol 1gr was given to the Group IV. Tramadol 100mg and morphine iv-patient-controlled analgesia was applied to both groups. Perioperative fentanyl consumption; postoperative Verbal Analog Scale, morphine consumption and additional analgesic drug requirement were assessed. Chi square with Yates correction and Mann Whitney U tests were used for statistical analysis. RESULTS Eighty patients were assessed for enrollment. One patient developed septicemia at the recovery room so data of 79 patients were collected for statistical analysis. Total morphine consumption at 48th hour after the surgery was lower at Group TAP (p=0.022). Perioperative fentanyl consumption was lower at Group TAP (p<0.001). Additional analgesic requirement and VAS were comparable between groups. CONCLUSIONS Preemptive unilateral ultrasound-guided subcostal transversus abdominis plane block decreases perioperative fentanyl and postoperative total morphine consumption in percutaneous nephrolithotomy patients compared to iv analgesic management.

[1]  E. Mueller,et al.  Paravertebral block for percutaneous nephrolithotomy: a prospective, randomized, double-blind placebo-controlled study , 2020, World Journal of Urology.

[2]  A. Erdoğan,et al.  Evaluation of the Efficacy of the Erector Spinae Plane Block for Postoperative Pain in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Controlled Trial. , 2019, Journal of endourology.

[3]  A. Elnabtity,et al.  Analgesic efficacy of erector spinae plane block in percutaneous nephrolithotomy , 2019, Der Anaesthesist.

[4]  B. Ökmen,et al.  Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial , 2019, Korean journal of anesthesiology.

[5]  V. Chan,et al.  Transmuscular quadratus lumborum block for percutaneous nephrolithotomy reduces opioid consumption and speeds ambulation and discharge from hospital: a single centre randomised controlled trial. , 2019, British journal of anaesthesia.

[6]  David I. Lee,et al.  Application of TAP Block in Laparoscopic Urological Surgery: Current Status and Future Directions , 2019, Current Urology Reports.

[7]  E. Tekin,et al.  Relief of refractory renal colic in emergency department: A novel indication for ultrasound guided erector spinae plane block. , 2018, The American journal of emergency medicine.

[8]  S. Bang,et al.  The Erector Spinae Plane Block for Postoperative Analgesia after Percutaneous Nephrolithotomy , 2018, Chinese medical journal.

[9]  S. Shin,et al.  Postoperative analgesic efficacy of single-shot and continuous transversus abdominis plane block after laparoscopic cholecystectomy: A randomized controlled clinical trial. , 2017, Journal of clinical anesthesia.

[10]  Y. Demiraran,et al.  Analgesic effects of ultrasound-guided transverse abdominis plane block using different volumes and concentrations of local analgesics after laparoscopic cholecystectomy , 2017, The Journal of international medical research.

[11]  O. Koyuncu,et al.  Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy. , 2016, Journal of clinical anesthesia.

[12]  Jean de la Rosette,et al.  Percutaneous Nephrolithotomy: Update, Trends, and Future Directions. , 2016, European urology.

[13]  T. Knoll,et al.  EAU Guidelines on Interventional Treatment for Urolithiasis. , 2016, European Urology.

[14]  A. Seth,et al.  Analgesic efficacy of paravertebral bupivacaine during percutaneous nephrolithotomy: an observer blinded, randomized controlled trial. , 2014, Journal of endourology.

[15]  N. Bhatia,et al.  Comparison of posterior and subcostal approaches to ultrasound-guided transverse abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy. , 2014, Journal of clinical anesthesia.

[16]  P. Tan,et al.  A comparison of analgesic efficacy between oblique subcostal transversus abdominis plane block and intravenous morphine for laparascopic cholecystectomy. A prospective randomized controlled trial , 2013, Korean journal of anesthesiology.

[17]  V. Chan,et al.  Ultrasound-Guided Transversus Abdominis Plane (TAP) Block for Laparoscopic Gastric-Bypass Surgery:a Prospective Randomized Controlled Double-Blinded Trial , 2013, Obesity Surgery.

[18]  J. Laffey,et al.  Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks * , 2011, Anaesthesia.

[19]  G. Niraj,et al.  Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery , 2011, Anaesthesia.

[20]  Y. Amr,et al.  Comparative study between effect of pre- versus post-incisional transversus abdominis plane block on acute and chronic post-abdominal hysterectomy pain , 2011, Anesthesia, essays and researches.

[21]  M. Melekos,et al.  Percutaneous nephrolithotomy under a multimodal analgesia regime. , 2009, Journal of endourology.

[22]  P. Hebbard.  Subcostal transversus abdominis plane block under ultrasound guidance. , 2008, Anesthesia and analgesia.

[23]  A. Rafi.  Abdominal field block: a new approach via the lumbar triangle: Correspondence , 2008 .