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Background: Laparoscopic radical gastrectomy has been reported to be associated with substantial trauma and pain. This study compared the impact of ultrasound-(US)-guided, bilateral, double-injection intertransverse process block (ITPB) on postoperative analgesia with subcostal transversus abdominis plane block (TAPB) in patients who were undergoing laparoscopic radical gastrectomy. Methods: Sixty-two patients who were undergoing laparoscopic radical gastrectomy surgery under general anesthesia were included. These patients were randomized to either the ITPB group or the TAPB group. Patients in the ITPB group received a double-shot US-guided bilateral ITPB at the thoracic level T6/7 and T9/10 level using ropivacaine (0.3%, 15 mL). Patients in the TAPB group received bilateral subcostal TAPB one injection per side using ropivacaine (0.3%, 30 mL). All patients used a BIS-guided combined intravenous and inhalation anesthesia. The primary outcome was defined as postoperative morphine-equivalent consumption during the first 24 h. Results: The study recruited 62 patients (31 in each group) for the analysis. A comparatively less postoperative opioid consumption was observed in the ITPB group compared with the subcostal TAPB group within the first 24 h postoperatively (mean [standard deviation-(SD)] morphine-equivalent dose): 27.8 (5.7) mg vs 31.2 (4.4) mg, P < 0.001. The ITPB group showed lower intraoperative opioid use, and statistical significantly lower scores at rest and coughing at 6, 24 h postoperatively. The time to first requiring rescue analgesia was longer in the ITPB group than the subcostal TAPB group (median [IQR]): 8.0 [8.0] vs 6.0 [6.0] h, P = 0.009. The patients in the ITPB group exhibited earlier independent movement, lower incidence of postoperative complications and higher levels of satisfaction (P = 0.021). Conclusion: This study showed that the double-shot bilateral ITPB could reduce opioids consumption and achieve longer and better pain relief. Additionally, it promoted early postoperative activity and improved patient satisfaction. Trial registration: ChiCTR2300072986. Registered 29 June 2023. [ABSTRACT FROM AUTHOR]

Background: Patients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery. Methods: Sixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay. Results: At 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p < 0.05) compared to those in the TAPB group. The sufentanil consumption median (interquartile range) in the ESPB group at 24 h postoperatively was lower (62, 61–65 μg) compared to the TAPB group (66, 63–70 μg) (p < 0.001). Hospital stay median was 7 (6–9) days for the ESPB group and 8 (7–10) days for the TAPB group (p = 0.037). Conclusions: Patients who received ESPB showed better recovery quality, improved analgesic effects, and higher postoperative satisfaction compared to those who underwent preoperative TAPB. Trial registration: https://www.chictr.org.cn (ChiCTR2400081157); date of registration: February 24, 2024. The first participant was enrolled on February 27, 2024. [ABSTRACT FROM AUTHOR]

Background: The current study compared the effect of ultrasound-guided quadratus lumborum block (QLB) to transversus abdominis plane block (TAPB) on post-operative pain in children undergoing lower abdominal laparoscopy. Methods: Ninety male and female patients (ASA I to II), ages (1–7), performing elective laparoscopic lower abdomen surgery randomly allocated into three equal groups of 30 patients each. Group (C) received conventional analgesics. In addition to conventional analgesics, 0.5 ml/kg of bupivacaine 0.25% was injected under US-guidance on both abdominal sides, into transversal plane at subcostal level in group (TAP) or into the facial plane between the PM and QL muscles in group (QL). Our primary outcome was the measuring FLACC scale immediately following surgery, every 30 minutes in the PACU, and then at 4, 6, 8, 10, 12, 18, and 24 hours after surgery. Our secondary outcomes were the first analgesic request, the dosage of analgesics, the postoperative complications, and parents' satisfaction during the first 24 hours. Results: When comparing the FLACC pain scores, the QL group showed a significant reduction in pain for the whole postoperative period in comparison to C group (p < 0.001) and up to 12 h in TAP group (p < 0.001). Patients in QL group got the longest time to the first analgesic requirement (p < 0.001). The C group required more analgesics overall than the other groups. Conclusions: Ultrasound-guided QLB after induction of general anesthesia in comparison to TAP block provides better postoperative pain, prolonged analgesia, and less postoperative analgesic consumption after lower abdominal laparoscopic surgery in pediatrics. [ABSTRACT FROM AUTHOR]

Objective: The transversus abdominis plane (TAP) block and local anaesthetic infiltration (LAI) of port sites provide adequate analgesia after laparoscopic cholecystectomy (LC). Little is known if the two techniques affect the day-case (DC) rate of LC. We tested the appropriateness of the research design in view of a larger randomised controlled trial (RCT) – laparoscopic-assisted right subcostal TAP block plus local anaesthetic wound infiltration (STALA) versus LAI. Subjects and Methods: Sixty patients having DC LC were randomised into STALA and LAI. Participants received bupivacaine 0.5% 30 mL. Pain scores were evaluated with the Visual Analogue Scale (VAS) score, at 1 h post-surgery and at discharge. Need of postoperative intravenous (IV) opioids, DC rate, and Quality of Recovery-15 questionnaires were compared between groups and were considered as measures of efficacy of the interventions and follow-up in a definitive trial. Results: Twenty-nine participants were randomised to STALA, and 31 to LAI. Subjects in LAI group were all women (p = 0.0007) and younger (43.8 vs. 37.7 years, p = 0.023). Median VAS scores were 0 versus 1 at 1 h (p = 0.60), 0 versus 1.5 at discharge (p = 0.55). The need of IV opioids was 15/29 (51.7%) versus 13/31 (41.9%; p = 0.60). The DC rate was 93.1% versus 93.5% (p = 0.39). Fifty (83.3%) participants responded the questionnaires. Conclusions: The laparoscopically guided right subcostal TAP block provided no additional benefit to LAI on pain control after LC and DC rate. Despite the appropriate design, our findings do not support a larger RCT. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to assess the impact of intraperitoneal local anesthetic infiltration and ultrasonography-guided transversus abdominis plane (TAP) block on postoperative pain intensity and opioid usage within the first 24 hours after laparoscopic cholecystectomy. Methods: Sixty patients classified under the American Society of Anesthesiologists 1-2-3 risk groups participated in this prospective, controlled, and randomized study and were divided. into three groups. The TAP group (n=20) underwent bilateral TAP blocks with 20 mL of 0.25% bupivacaine. prior to surgical incision. The following gallbladder removal by the surgical team, the intraperitoneal group (n=20) received 10 mL of 0.5% bupivacaine infiltration into the bladder bed. The control group (n=20) did not receive local anesthesia via TAP block or intraperitoneally. Postoperative pain scores on the Numeric Rating Scale [(NRS) 0-10] were recorded at 1, 2, 4, 8, and 24 hours. Additionally, the total tramadol dosage (mg) consumed at the 24th postoperative hour and the frequency of additional analgesic use were documented in the case report form. Results: The postoperative NRS scores of both the TAP block and intraperitoneal groups were significantly lower than those of the control group (p<0.05). Moreover, there was no notable difference between the TAP block and intraperitoneal groups concerning NRS scores (p>0.05). Similarly, no significant variance was observed in the total tramadol dosage among the TAP block, intraperitoneal, and control groups (p>0.05). Conclusion: The analgesic efficiencies of TAP block and intraperitoneal local anesthesia infiltration were similar, and both groups provided more effective analgesia than the control group. [ABSTRACT FROM AUTHOR]

Background: Multimodal pain management program is needed to control severe pain after abdominal hysterectomy which is considered as one of the major abdominal surgeries. This study aimed to improve pain quality using ultrasound guided transversus abdominis plane block versus quadratus lumborum block in elective total abdominal hysterectomy under general anesthesia. Methods: This prospective, randomized controlled, doubleblinded trial was carried out in Zagazig University Hospitals, anesthesia, Intensive care and Pain management department. The participants were randomly allocated into three equal groups, each group consist of 21 patients. Group C served as the control group, where each patient received only general anesthesia. In Group Transversus abdominis plane (TAP), each patient was administered general anesthesia plus bilateral TAP block. Group Quadratus lumborum (QL) involved patients receiving general anesthesia along with a bilateral QL block. Results: The number of patients needed rescue analgesia was significantly lower in group QL compared to both groups (C&TAP). The time of first rescue analgesia (nalbuphine) was significantly early in group TAP compared to group QL. Performance time of block was shorter in TAP group compared to QL group. Visual analogue scale (VAS) score at 30 min ,2 ,4 and 8 hours post-operative was significantly lower in (TAP&QL) groups compared to group C. Conclusions: This study demonstrated that both transversus abdominis plane block and quadratus lumborum block are effective and safe for enhancing postoperative analgesia in patients undergoing total abdominal hysterectomy, with superiority of quadratus lumborum block affirming it effectiveness in pain management. [ABSTRACT FROM AUTHOR]

Objective: The impact of a transversus abdominis plane (TAP) block in patients undergoing cesarean section requires further evaluation. The aim of this study was to compare postoperative pain scores and opioid use in cesarean surgery patients undergoing either a TAP block and scheduled multimodal pain management (SMPM) or SMPM alone. Methods: In this retrospective, dual cohort study, cesarean surgery patients underwent neuraxial anesthesia and a TAP block (SMPM/TAP) or SMPM; the TAP block incorporated ropivacaine (20–30 mL) administered bilaterally. The group analyses involved a comparison of postoperative pain scores using the visual analog scale and opioid consumption at 24 and 24–48 h. Results: There were 94 (52.8%) patients in the SMPM/TAP group and 84 (47.2%) subjects in the SMPM alone group. At 24 h postoperatively, the SMPM/TAP group exhibited significantly lower pain scores (4.07 vs 4.54) than the SMPM group (P < 0.001) and reduced opioid consumption (2.29 vs 3.28 mg; P < 0.001). However, at 24–48 h, the SMPM group demonstrated lower pain scores (5.46 vs 5.98) compared to the SMPM/TAP group (P < 0.001) and reduced opioid consumption (8.75 vs 10.21 mg; P < 0.001); overall opioid consumption was higher (12.50 vs 12.02 mg) in the SMPM/TAP group (P < 0.001). Conclusion: The TAP block improved cesarean surgery patients' pain scores and reduced opioid consumption at 24 h postoperatively but the effect of the TAP block was ephemeral as the SMPM/TAP group exhibited inferior pain scores and greater opioid consumption compared to the SMPM group at 24–48 h postoperatively. Synopsis: A TAP block is potentially an effective adjunct to neuraxial anesthesia in endeavoring to reduce postoperative pain and opioid consumption for patients undergoing cesarean section. [ABSTRACT FROM AUTHOR]

Jie Pu,1 Chendong Guo,1 Yue Xiao,2 Yanan Cao,1 Zhenhua Liu,3 Yuzhong Jin,3 Yimin Hu4 1Department of Anesthesiology, The Second People’s Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, People’s Republic of China; 2Department of Anesthesiology, Sichuan Cancer Hospital, Chengdu, 100062, People’s Republic of China; 3Changzhou Wujin Hospital of Traditional Chinese Medicine, Changzhou, 213161, People’s Republic of China; 4Department of Anesthesiology, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, People’s Republic of ChinaCorrespondence: Yimin Hu, Department of Anesthesiology, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, People’s Republic of China, Tel +86 18951767577, Email guyueym@njmu.edu.cnPurpose: The aim of this study was to investigate the effect of general anesthesia combined with transversus abdominis plane block on postoperative sleep disorders in elderly patients undergoing gastrointestinal tumor surgery.Methods: For elderly patients with gastrointestinal malignant tumors, we recruited 94 patients, aged 65– 80, who were scheduled for radical laparoscopic surgery. Using the random number table method, the patients were randomly divided into two groups, the general anesthesia group (group GA) and the general anesthesia combined with transversus abdominis plane block group (group GT). The group GA received the sedation-aspiration complex general anesthesia regimen, while the group GT underwent bilateral transversus abdominis plane blocks (TAPB) after the same induction of anesthesia. Group GA was injected bilaterally with equal amounts of saline in the same way. Sleep was monitored using wearable devices on the first day before surgery (P1) and the first and third day after surgery (D1 and D3). The Pittsburgh Sleep Quality Index(PSQI) scale was used to assess sleepiness and the occurrence of postoperative sleep disorders (POSD) on P1, D1 and D3 nights, respectively.Results: Compared to the group GA, the group GT showed a significant decrease in remifentanil use during surgery (P< 0.05). At D1, the group GT showed an increase in the ratio of deep sleep to rapid eye movement sleep (REM), along with a significant decrease in the number of wakefulness (P< 0.05). At D3, the proportion of REM continued to increase and PSQI scores were significantly lower at both D1 and D3 (P< 0.05). In addition, the incidence of POSD and the visual analog scores (VAS) at 0.5h and 6h postoperative activity in D1 showed a decreasing trend (P< 0.05). However, no significant differences were observed between the two groups in general condition, intraoperative condition, remedial analgesia and number of analgesic pump presses (P> 0.05).Conclusion: General anesthesia combined with transversus abdominis plane block reduces the dosage of opioids in abdominal surgery, especially gastrointestinal surgery, alleviates postoperative pain in elderly gastrointestinal oncology patients, improves sleep quality, and reduces the incidence of sleep disorders.Keywords: transversus abdominis plane block, sleep disorders, elderly, gastrointestinal tumors, Pittsburgh sleep quality index

Abstract Background Laparoscopic radical gastrectomy has been reported to be associated with substantial trauma and pain. This study compared the impact of ultrasound-(US)-guided, bilateral, double-injection intertransverse process block (ITPB) on postoperative analgesia with subcostal transversus abdominis plane block (TAPB) in patients who were undergoing laparoscopic radical gastrectomy. Methods Sixty-two patients who were undergoing laparoscopic radical gastrectomy surgery under general anesthesia were included. These patients were randomized to either the ITPB group or the TAPB group. Patients in the ITPB group received a double-shot US-guided bilateral ITPB at the thoracic level T6/7 and T9/10 level using ropivacaine (0.3%, 15 mL). Patients in the TAPB group received bilateral subcostal TAPB one injection per side using ropivacaine (0.3%, 30 mL). All patients used a BIS-guided combined intravenous and inhalation anesthesia. The primary outcome was defined as postoperative morphine-equivalent consumption during the first 24 h. Results The study recruited 62 patients (31 in each group) for the analysis. A comparatively less postoperative opioid consumption was observed in the ITPB group compared with the subcostal TAPB group within the first 24 h postoperatively (mean [standard deviation-(SD)] morphine-equivalent dose): 27.8 (5.7) mg vs 31.2 (4.4) mg, P

Abstract Background Patients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery. Methods Sixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay. Results At 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p

Introduction: This study aimed to assess the impact of intraperitoneal local anesthetic infiltration and ultrasonography-guided transversus abdominis plane (TAP) block on postoperative pain intensity and opioid usage within the first 24 hours after laparoscopic cholecystectomy. Methods: Sixty patients classified under the American Society of Anesthesiologists 1-2-3 risk groups participated in this prospective, controlled, and randomized study and were divided. into three groups. The TAP group (n=20) underwent bilateral TAP blocks with 20 mL of 0.25% bupivacaine. prior to surgical incision. The following gallbladder removal by the surgical team, the intraperitoneal group (n=20) received 10 mL of 0.5% bupivacaine infiltration into the bladder bed. The control group (n=20) did not receive local anesthesia via TAP block or intraperitoneally. Postoperative pain scores on the Numeric Rating Scale [(NRS) 0-10] were recorded at 1, 2, 4, 8, and 24 hours. Additionally, the total tramadol dosage (mg) consumed at the 24th postoperative hour and the frequency of additional analgesic use were documented in the case report form. Results: The postoperative NRS scores of both the TAP block and intraperitoneal groups were significantly lower than those of the control group (p0.05). Similarly, no significant variance was observed in the total tramadol dosage among the TAP block, intraperitoneal, and control groups (p>0.05). Conclusion: The analgesic efficiencies of TAP block and intraperitoneal local anesthesia infiltration were similar, and both groups provided more effective analgesia than the control group.

The purpose of this study was to compare and evaluate the analgesic effectiveness of quadratus lumborum block (QLB) and transversus abdominis plane bloc block (TAPB) after laparoscopic robot-assisted total hysterectomy. Materials and methods. A prospective study of female patients (n=101), with physical status ASA I-II, who underwent laparoscopic robot-assisted total hysterectomy under multicomponent general anesthesia. In random order, patients were randomized into three groups: the first group (CON, n=40) - control, where no blocks were performed, the second group (TAPB, n=30) - a blockade of the transverse abdominis muscle, the third group (QLB, n= 31) – blockade of the quadratus lumborum muscle was performed. After surgery, pain was assessed using a 10-point digital visual analogue scale, and postoperative nausea and vomiting were assessed. (PONV) Average arterial pressure and heart rate were recorded. Additionally, the next morning, a survey was conducted to assess the well-being and satisfaction of patients. Results. There were no differences between the groups in terms of demographic characteristics, duration of surgery, and analgesic consumption during the intraoperative period. The severity of postoperative pain was higher (p0.05). More patients from the QLB group (p

Background and Aims Inguinal hernia is a commonly performed surgical procedure globally, which is often accompanied by significant post-operative pain that peaks on the day of the surgery. The transversus abdominis plane block (TAP) offers better postoperative pain relief for lower abdominal procedures. However, the duration of TAP block is restricted by the effects of given local anaesthetic drugs, necessitating the use of an adjuvant, such as buprenorphine, to improve the quality and duration of analgesia. Hence, we designed the present study to analyse the effect of a TAP block with buprenorphine on the relief of pain after inguinal hernia repair surgery. Methods A prospective, randomized, double-blinded study was conducted on fifty American Society of Anaesthesiologists Physical Status I and II patients posted for elective unilateral inguinal hernia repair under spinal anaesthesia. At the end of the surgery, group B patients received 20 ml of 0.25% bupivacaine and group BB patients received 20 ml of 0.25% bupivacaine along with 300 mg of buprenorphine for ultrasound-guided transversus abdominis plane block. The duration of analgesia, postoperative analgesic consumption and pain scores at rest and during sitting up to 24 h were recorded. Results Patients who received perineural buprenorphine experienced prolonged duration of analgesia (870.32 ± 27.86 vs. 385.64 ± 27.86 minutes), lower tramadol consumption (135.08 ± 23.05 vs. 246.72 ± 38.8 mg), and decreased pain scores both at rest and during sitting for up to 24 hours post-surgery. Conclusion The present study shows that the addition of buprenorphine to bupivacaine in TAP block after inguinal hernia repair produces superior postoperative analgesia compared with the control group without any significant side effects.

Background The transversus abdominis plane block (TAPB) is frequently used for postoperative analgesia in abdominal surgery. However, it remains insufficient for analgesia during upper abdominal surgeries. Therefore, we compared the efficacy of the subcostal transversus abdominis plane block (STAPB) or rectus sheath block (RSB), in addition to the posterior transversus abdominis plane block (PTAPB), for postoperative analgesia in major gynecologic cancer surgeries. Methods This prospective randomized study included 50 patients aged > 18 years (American Society of Anesthesiologists physical status II or III), who underwent gynecologic cancer surgery through a midline incision. All patients underwent PTAPB, STAPB, or RSB according to the randomization. The following parameters were recorded and compared: demographic data; intraoperative hemodynamic parameters; numeric rating scale (NRS) pain levels at the 1st, 6th, 12th, and 24th postoperative hours; opioid consumption; number of requests and boluses; adverse effects; surgical complications within 24 h. Results Forty-seven patients were included in this study. In the STAPB group, postoperative 1, 12 and 24 h NRS values were lower; opioid consumption, opioid demand, and bolus numbers were lower during the postoperative 24 h as compared to RSB (P < 0.05). The intraoperative opioid and hemodynamic values were similar in both groups. Conclusions STAPB in addition to PTAPB provides more effective analgesia than RSB for postoperative pain management in open gynecologic cancer surgeries.

Abstract Background Currently, the prevalence of obesity is on the rise annually. Bariatric surgery stands out as the most efficacious approach for addressing obesity. Obese patients are more prone to experience moderate to severe pain after surgery due to lower pain thresholds. Regional block, as an important component of multimodal analgesia in bariatric surgery, is crucial in reducing opioid consumption and alleviating postoperative pain in patients undergoing bariatric surgery. Transversus abdominis plane block (TAPB) has gained widespread utilization in bariatric surgery; however, its limitation of inadequate reduction of visceral pain in obese patients remains a significant concern. Therefore, it is imperative to explore new and more efficient strategies for analgesia. Quadratus lumborum block (QLB) has emerged as a popular nerve block in recent years, frequently utilized in conjunction with general anesthesia for abdominal surgery. In the cadaver study of QLB, it was confirmed that the dye level could reach up to T6 when using the subcostal anterior quadratus lumborum muscle approach, which could effectively reduce the incision pain and visceral pain of bariatric surgery patients during the perioperative period. However, there is currently a lack of research on the use of subcostal anterior QLB in patients undergoing bariatric surgery. Our study aims to investigate whether subcostal anterior QLB can provide superior perioperative analgesic efficacy for bariatric surgery under general anesthesia compared to TAPB, leading to reduced postoperative opioid consumption and a lower incidence of postoperative nausea and vomiting (PONV). Methods and design This study is a prospective, randomized controlled trial aiming to recruit 66 patients undergoing bariatric surgery. The participants will be randomly allocated into two groups in a 1:1 ratio: subcostal anterior QLB group (n = 33) and TAPB group (n = 33). The study aims to investigate the efficacy of subcostal anterior QLB and TAPB in obese patients who are scheduled to undergo bariatric surgery. Our primary outcome is to observe the amount of opioids used in the two groups 24 h after operation. The secondary outcomes included VAS of pain during rest/activity after operation, the type and dose of additional analgesics, the occurrence and severity of PONV, the type and dose of additional antiemetic drugs, postoperative anesthesia care unit (PACU) time, time of first postoperative exhaust, time to first out of bed activity, time to first liquid diet and postoperative admission days. Discussion Opioid analgesics are prone to causing adverse reactions such as nausea, vomiting, and respiratory depression, especially in obese patients. Multimodal analgesia, including nerve block, can effectively reduce the dose of opioids and alleviate their adverse effects. Currently, TAPB is the most prevalent nerve block analgesia method for abdominal surgery. Recent studies have indicated that subcostal anterior QLB offers advantages over TAPB, including a wider block plane, faster onset, and longer maintenance time. It is not clear which of the two nerve block analgesia techniques is better for postoperative analgesia in patients undergoing bariatric surgery. Our objective in this investigation is to elucidate the superior method between TAPB and subcostal anterior QLB for postoperative pain management in bariatric surgery. Trial registration ChiCTR ChiCTR2300070556. Registered on 17 April 2023.

Background and Aims: Multimodal analgesia regimens for optimizing the postoperative pain following abdominal surgeries are a crucial component of enhanced recovery after surgery (ERAS), as it reduces postoperative opioid consumption along with their adverse effects. We compared the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) versus posterior transversus abdominis plane block (TAPB) with respect to duration of analgesia, modified Defense and Veterans Pain Rating Scale (DVPRS) scores for pain, activity, sleep, stress, and mood, respectively, the total amount of rescue analgesic consumption, hemodynamics parameters and side effects, in patients undergoing total abdominal hysterectomy under general anesthesia. Materials and Methods: In this study, which was prospective, randomized, and double-blind, 60 patients of the American Society of Anesthesiologists Physical Status I and II, aged 18–65 years, undergoing abdominal hysterectomy, were randomized into two groups. Group QLB (n = 30) and Group TAPB (n = 30) received bilateral QLB and TAPB with 40 ml of 0.375% ropivacaine, respectively. The data were compared using standard qualitative and quantitative tests. Results: The duration of pain relief was longer in Group QLB compared to Group TAPB (981.83 ± 138.62 min vs. 637 ± 127.02 min, P < 0.0001). The DVPRS score for pain, activity, sleep, stress, and mood, respectively, were significantly lower in Group QLB (P < 0.05). The total rescue analgesic consumption was significantly lesser in Group QLB (103.33 ± 18.26 mg) compared to Group TAPB (150.00 ± 50.85 mg) (P < 0.0001). No significant hemodynamic changes or side effects were observed (P > 0.05). Conclusion: Bilateral QLB significantly prolonged the duration of analgesia with reduced rescue analgesic requirement compared with bilateral TAPB in patients undergoing total abdominal hysterectomy.

Background: Abdominal surgery is a common surgical procedure that is frequently associated with substantial postoperative pain. However, rescue analgesia using opioids is associated with several adverse effects. The transversus abdominis plane block (TAPB) has been demonstrated to be effective as part of multimodal analgesia. This study aims to evaluate the effects of rescue analgesia using the TAPB following abdominal surgery. Methods: Ninety patients undergoing abdominal surgery and reporting a numeric rating scale (NRS) score of cough pain ≥4 on the first postoperative day were randomized to receive either sufentanil or TAPB for rescue analgesia. Pain scores and arterial oxygen pressure (PaO2) were evaluated before and after the administration of rescue analgesia. Sleep quality and gastrointestinal function were assessed postoperatively. The primary outcome was the degree of pain relief on coughing 30 min after the administration of rescue analgesia. Results: Patients of both groups reported a significantly reduced NRS score on coughing 30 min after receiving rescue analgesia (Ppaired < 0.001 for both groups). Notably, the degree of pain relief was significantly higher in the TAPB group than in the sufentanil group [median (interquartile range), −3 (−4 to −2) vs. −2 (−2 to −1), median difference = −1; 95% confidence interval, −2 to −1; P < 0.001]. Moreover, patients in the TAPB group experienced less pain than those in the sufentanil group during the following 24 h. When evaluated, PaO2 increased significantly after rescue analgesia was administered in the TAPB group (Ppaired < 0.001); however, there were no significant intragroup differences in the sufentanil group (Ppaired = 0.129). Patients receiving the TAPB experienced better quality of sleep than those receiving sufentanil (P = 0.008), while no statistical differences in gastrointestinal function were observed between the two groups. Conclusion: Rescue analgesia with the TAPB on the first postoperative day alleviated pain, enhanced oxygenation, and improved sleep quality in patients undergoing abdominal surgery; however, its effect on gastrointestinal function requires further research. [ABSTRACT FROM AUTHOR]

Objective To observe the application effect of bupivacaine liposome transversus abdominis plane block (TAPB) on postoperative pain and stress response in patients undergoing laparoscopic gynecological surgery. Methods Totally 120 patients undergoing laparoscopic gynecological surgery were randomly divided into two groups： the bupivacaine liposome group (LB group) and the ropivacaine group (L group) . Patients in the LB group received bupivacaine liposome TAPB before the start of the surgery, while patients in the L group received an equivalent dose of ropivacaine TAPB. Postoperative pain was assessed by using the Numerical Rating Scale (NRS) at 6 h (T1), 24 h (T2), 48 h (T3), 60 h (T4), and 72 h (T5) for 72 consecutive h after surgery, with the number of analgesic pump button presses and rescue analgesia requirements recorded. Additionally, venous blood was drawn from patients before operation (D0) and on the 1st (D1), 3rd (D3), and 7th (D7) days after surgery, and the serum levels of cortisol, interleukin-6(IL-6), and tumor necrosis factorα(TNF-α) were measured. The Quality of Recovery-40(QoR-40) scale was used to assess the quality of recovery at 24, 48, and 72 h postoperatively, and we recorded the postoperative nausea and vomiting (PONV), urinary retention, pruritus and incision infection in the two groups. Results NRS scores significantly decreased over time in both groups (all P< 0.05) . The NRS scores at T2 to T4 in the LB group were lower than those of the L group (all P<0.05) . The number of postoperative remedial analgesia and the number of analgesic pump button presses in the LB group were smaller than those in the L group (all P<0.05) . The levels of serum cortisol, IL-6, and TNF-α in both groups showed a trend of first increasing and then decreasing after surgery. The levels of serum cortisol, IL-6, and TNF-α on the 3rd day after surgery in the LB group were lower than those in the L group (all P<0.05) . The QoR-40 scores increased over time in both groups, with a more significant increase in the LB group (P<0.05) . The incidence of PONV was lower in the LB group than in the L group (P<0.05), while there were no significant differences in the occurrence of urinary retention, pruritus, or incision infection between the two groups (all P>0.05) . Conclusion Bupivacaine liposome TAPB showed a long-lasting analgesic effects in laparoscopic gynecological surgery and could reduced postoperative stress response, improve the quality of postoperative recovery and had high safety. [ABSTRACT FROM AUTHOR]

Background: The transversus abdominis plane block (TAPB) is frequently used for postoperative analgesia in abdominal surgery. However, it remains insufficient for analgesia during upper abdominal surgeries. Therefore, we compared the efficacy of the subcostal transversus abdominis plane block (STAPB) or rectus sheath block (RSB), in addition to the posterior transversus abdominis plane block (PTAPB), for postoperative analgesia in major gynecologic cancer surgeries. Methods: This prospective randomized study included 50 patients aged > 18 years (American Society of Anesthesiologists physical status II or III), who underwent gynecologic cancer surgery through a midline incision. All patients underwent PTAPB, STAPB, or RSB according to the randomization. The following parameters were recorded and compared: demographic data; intraoperative hemodynamic parameters; numeric rating scale (NRS) pain levels at the 1st, 6th, 12th, and 24th postoperative hours; opioid consumption; number of requests and boluses; adverse effects; surgical complications within 24 h. Results: Forty-seven patients were included in this study. In the STAPB group, postoperative 1, 12 and 24 h NRS values were lower; opioid consumption, opioid demand, and bolus numbers were lower during the postoperative 24 h as compared to RSB (P < 0.05). The intraoperative opioid and hemodynamic values were similar in both groups. Conclusions: STAPB in addition to PTAPB provides more effective analgesia than RSB for postoperative pain management in open gynecologic cancer surgeries. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the in vivo spread of iodinated contrast following injections in the transversus abdominis plane (TAP) and rectus sheath in anesthetized dogs via computed tomography. Secondarily, the time of performing each block was compared. ANIMALS 6 adult, purpose-bred Beagles. METHODS In a prospective crossover study, dogs were administered injections either in the rectus sheath or transversus abdominis fascial plane in the same manner as a rectus sheath block (RSB) or TAP block using dilute iodinated contrast. Computed tomography scans were performed immediately following injection (time [T]-0) and at 3, 9, 18, and 30 minutes postinjection. Data regarding the spread in the cranial-caudal and lateral directions and time to perform the injections were compared between the 2 techniques using paired or 2-sample t tests. RESULTS There was significantly greater spread in the cranial-caudal direction in the RSB group (62.9 ± 6.4 mm vs 54.8 ± 6.8 mm at T30; P = .009), whereas spread in the lateral direction was greater in the TAP group (37.3 ± 3.0 mm vs 48.6 ± 6.1 mm at T30; P < .0001). The RSB injection was performed in a more time-efficient manner than TAP injection (48.2 ± 3.2 seconds vs 82.3 ± 8.7 seconds; P = .03). CONCLUSIONS In living subjects, RSB injections resulted in greater cranial-caudal spread while TAP injections resulted in greater lateral spread. Rectus sheath block injections were performed in a more time efficient manner compared to a single point TAP injection in anesthetized dogs. CLINICAL RELEVANCE The RSB was performed in a more time-efficient manner and would likely result in greater coverage of the ventral midline. The TAP block would likely result in more significant regional anesthetic coverage of the lateral abdominal wall. Further studies are required to determine the degree of the clinical significance of these results. [ABSTRACT FROM AUTHOR]

Background: Local anesthetics are commonly used in interfascial plane blocks these days. Quadratus lumborum block (QLB) and transversus abdominis plane block (TAPB) have emerged as an indispensable part of multimodal analgesia for post-operative pain management in abdominal procedures. Ultrasound (US)-guided QLB is a good option to be considered in multimodal analgesia for abdominal surgeries. Aims and Objectives: Our aim was to compare the efficacy of TAPB and QLB in mitigating post-operative pain. The study's objectives were to evaluate the extent of use of other analgesics in the post-operative period between TAPB and QLB and to compare the duration of action of TAPB and QLB. Materials and Methods: Sixty patients aged 18-75 years of American Society of Anesthesiologists physical statuses 1-2 were selected and divided randomly into two groups of 30 each, Group Q and Group T who were administered QLB and TAPB, respectively. Before starting this randomized, double-blinded study, ethics committee sanction, and detailed informed written consent were obtained. US-guided QLB and TAPB were performed on either side in patients planned for lower abdominal procedures under sub-arachnoid block and 20 mL of 0.25% bupivacaine was used. Both groups were compared for hemodynamic parameters. Post-operative pain was assessed using the visual analog scale (VAS) and compared between the two groups. The time to initial rescue analgesic requested and the total amount of rescue analgesic requested were compared between the two groups. Results: Demographic data of Group Q and Group T were similar. The VAS score was much less in Group Q in comparison with Group T at 12, 24, and 48 h. The time at which the first analgesic demanded was much earlier in Group T compared with Group Q (mean: 40.2 vs. 30.57, P = 0.004). Patients in Group T demanded analgesics much more than patients in Group Q. Conclusion: The posterior QLB represents a much more efficient regional block as part of multi-modal analgesia in comparison to the posterior TAPB in patients undergoing lower abdominal surgeries. We require more studies to decide the ideal dose and the volume of the drug to be administered. [ABSTRACT FROM AUTHOR]

Background: The Transversus Abdominis Plane (TAP) block is the most common peripheral nerve block that provides acceptable postoperative analgesia for a variety of abdominal surgeries. A long-acting local anesthetic called ropivacaine is used to relieve pain following surgery. The duration of analgesia may be extended by the adjuvant administration of dexmedetomidine. Aim: The current study aimed to evaluate the effects of dexmedetomidine combined with Ropivacaine in ultrasound-guided Transversus Abdominis plane block on post-operative analgesia following cesarean section. Materials and Method: A total of 70 patients scheduled for CS were divided randomly into two groups: $ (Ropivacaine) group, which received 3 mg/kg of Ropivacaine diluted to 40 mL in normal saline with 20 mL on each side, and B (dexmedetomidine) group, which received 3 mg/kg of Ropivacaine plus 0.5 µg/kg of dexmedetomidine diluted to 40 mL in normal saline with 20 mL on each side. The primary outcome was pain-free duration, with secondary outcomes included heart rate (HR) and mean blood pressure (MBP) readings, visual analogue scale (VAS) pain scores, number of patients requiring rescue analgesia, time to first seek analgesia, and patient satisfaction. Results were analysed using SPSS 20.0 version and the association was tested using the Student's t-test, Fisher's exact test or Pearson's χ² test. Results: As compared to group A, group B experienced a significantly longer period of sensory block and analgesia (p<0.05). In comparison to Group A, group B showed longer pain-free duration (6.25±1.47 vs. 9.74±1.31 hours; p<0.05), a longer mean time to initial reporting of postoperative pain (5.12±1.23 vs. 7.07±1.48; p<0.05), a lower number of patients requiring rescue analgesic (27(77.14%) vs. 8(22.86%); p<0.05), a longer time to first request for analgesia (5.76±1.87 vs. 7.63±2.07 hours; p<0.05), and better patient satisfaction (3.5 vs. 4.5; p<0.05). Postoperative VAS pain scores in group B were considerably lower at 6, 8, and 10 hours than in group A. Bradycardia was noted in 1 (2.86%) and 3 (8.57%) of the patients in Groups A and B, respectively. Conclusion: Extending the duration and improving the quality of analgesia without causing any notable side effects is possible with the adjuvant addition of dexmedetomidine to Ropivacaine for TAP block. [ABSTRACT FROM AUTHOR]

The procedure with the highest rate of opioid prescription in plastic surgery is abdominoplasty. Additionally, plastic surgery patients are at a particularly elevated risk of becoming opioid-dependent. The main objective of this study was to perform a systematic review and create an algorithm for a multimodal pain regimen specific to patients undergoing abdominoplasty. A systematic search of the research literature was performed to summarize the prevailing understanding of multimodal pain control in the management of abdominoplasty. The initial search yielded 448 articles. Sixty-eight manuscripts were identified for full-text review. The effectiveness of current strategies was evaluated by way of pain scores, opioid usage, and length of stay, as well as other measures of physical function such as time to early mobilization. In 32 studies involving 2451 patients, the efficacy of different pain regimens during abdominoplasty was evaluated. Among nontraditional, opioid-sparing analgesia, efficacy of treatment interventions for improved pain and decreased opioid usage was found inall studies. Among local infusion studies, efficacy of treatment interventions for improved pain and decreased opioid usage was found in 78% of studies. Last, among regional block studies, efficacy of treatment interventions for improved pain was found in 87%, with 73% efficacy for decreased opioid usage. Multimodal pain regimens in abdominoplasty have the potential to play an important role in opioid-sparing practices in medicine by incorporating nonopioid pain adjuvants such as nonsteroidal anti-inflammatory drugs and transversus abdominis plane blocks in the preoperative, perioperative, and postoperative periods. Level of Evidence: 2 [ABSTRACT FROM AUTHOR]

Background: Currently, the prevalence of obesity is on the rise annually. Bariatric surgery stands out as the most efficacious approach for addressing obesity. Obese patients are more prone to experience moderate to severe pain after surgery due to lower pain thresholds. Regional block, as an important component of multimodal analgesia in bariatric surgery, is crucial in reducing opioid consumption and alleviating postoperative pain in patients undergoing bariatric surgery. Transversus abdominis plane block (TAPB) has gained widespread utilization in bariatric surgery; however, its limitation of inadequate reduction of visceral pain in obese patients remains a significant concern. Therefore, it is imperative to explore new and more efficient strategies for analgesia. Quadratus lumborum block (QLB) has emerged as a popular nerve block in recent years, frequently utilized in conjunction with general anesthesia for abdominal surgery. In the cadaver study of QLB, it was confirmed that the dye level could reach up to T6 when using the subcostal anterior quadratus lumborum muscle approach, which could effectively reduce the incision pain and visceral pain of bariatric surgery patients during the perioperative period. However, there is currently a lack of research on the use of subcostal anterior QLB in patients undergoing bariatric surgery. Our study aims to investigate whether subcostal anterior QLB can provide superior perioperative analgesic efficacy for bariatric surgery under general anesthesia compared to TAPB, leading to reduced postoperative opioid consumption and a lower incidence of postoperative nausea and vomiting (PONV). Methods and design: This study is a prospective, randomized controlled trial aiming to recruit 66 patients undergoing bariatric surgery. The participants will be randomly allocated into two groups in a 1:1 ratio: subcostal anterior QLB group (n = 33) and TAPB group (n = 33). The study aims to investigate the efficacy of subcostal anterior QLB and TAPB in obese patients who are scheduled to undergo bariatric surgery. Our primary outcome is to observe the amount of opioids used in the two groups 24 h after operation. The secondary outcomes included VAS of pain during rest/activity after operation, the type and dose of additional analgesics, the occurrence and severity of PONV, the type and dose of additional antiemetic drugs, postoperative anesthesia care unit (PACU) time, time of first postoperative exhaust, time to first out of bed activity, time to first liquid diet and postoperative admission days. Discussion: Opioid analgesics are prone to causing adverse reactions such as nausea, vomiting, and respiratory depression, especially in obese patients. Multimodal analgesia, including nerve block, can effectively reduce the dose of opioids and alleviate their adverse effects. Currently, TAPB is the most prevalent nerve block analgesia method for abdominal surgery. Recent studies have indicated that subcostal anterior QLB offers advantages over TAPB, including a wider block plane, faster onset, and longer maintenance time. It is not clear which of the two nerve block analgesia techniques is better for postoperative analgesia in patients undergoing bariatric surgery. Our objective in this investigation is to elucidate the superior method between TAPB and subcostal anterior QLB for postoperative pain management in bariatric surgery. Trial registration: ChiCTR ChiCTR2300070556. Registered on 17 April 2023. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of Transversus Abdominis Plane (TAP) block vs Local Infiltration for pain management techniques in patients undergoing laparoscopic lower abdominal surgeries. Methodology: This cross-sectional study was conducted at the Department of Surgery, Lahore General Hospital, from March to May, 2024. It involved a total of 110 patients, divided into two groups of 55 each, between the ages of 20 to 60 years, diagnosed with indirect inguinal hernia by ultrasound. Chronic smokers, drug addicts, intravenous drug abusers, patients with a history of previous surgeries, with known drug allergies and with complicated hernia were excluded from this cross-sectional study. The Numerical Rating Scale (NRS) was used to see the pain variation and effectiveness of both techniques at 6, 12, 18 and 24 hours. Results: The mean age in the TAP Block Group was 32.0 ± 9.92 years, and the mean age in the Local Wound Infiltration Group was 34.21 ± 10.01 years. There were 108 (98.18%) male and 2(1.81%) female cases with a higher male-to-female ratio. The results indicated that the TAP Block group consistently required fewer rescue analgesic doses than the local wound Infiltration group at all postoperative time points. At 6 hours, 23.63% of patients in the TAP Block group needed additional analgesia, compared to 38.18% in the Wound Infiltration group, though this difference was not statistically significant. However, at 12, 18, and 24 hours, the TAP Block group showed a significantly lower need for rescue analgesia, with p-values of 0.002, and 0.008, respectively. Conclusion: In managing postoperative pain of Inguinal Hernia Repair, TAP Block is superior to Wound Infiltration of local anesthetic agent. After TAP Block NRS remains fewer and a smaller number of rescue doses are needed as compared to Wound infiltration.

Yi Zhang,&ast; Yiqing Guo,&ast; Chao Gong, Junzuo Fu, Lianhua Chen Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, 200080, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Junzuo Fu; Lianhua Chen, Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Shanghai, 200080, People’s Republic of China, Tel +86-21-63240090, Email Fujunzuo021@163.com; emily19941010@126.comBackground: The positive roles of deep muscle relaxation in abdominal surgeries and transversus abdominis plane block (TAPB) in the postoperative analgesia. This study aimed to discuss the effects of TAPB on abdominal muscle relaxation, the intraoperative diaphragmatic, and the respiratory functions.Methods: The patients were randomly divided into the TAPB group who received single-shot TAPB bilaterally (n=30), and the control group who did not receive TAPB (n=30). Both groups keep the same steps for other procedures in the surgeries and anesthesia. Four time points for monitoring were defined: The moment when pneumoperitoneum pressure stabilized following endotracheal intubation and anesthetic induction (T0), appearance of the first incisure in the pressure-volume (P-V) loop (T1), appearance of the second incisure in the P-V loop (T2), and the moment with single stimulation (SS) =20% (T3). Primary observation parameters were SS1 measured by muscle relaxation monitoring at T1, and SS2 at T2. Secondary observation parameters included surgeon’s satisfaction with surgical field and respiratory dynamics at the four time points.Results: The two groups were comparable in age, gender, BMI, ASA grade, and operation time. The TAPB group had a dramatic reduction in the total dose of intraoperative sufentanil (0.73± 0.21 ug/kg) compared with the control group (0.87± 0.18 ug/kg) (P=0.023); Other use of drug did not differ between the two groups. The two groups did not differ significantly in SS at either T1 (SS1) or T2 (SS2). In either group, surgeon’s satisfaction with surgical field at T1 and T2 decreased dramatically compared with T0 and T3 (all P< 0.05). At each time point, the respiratory dynamics and the surgeon’s satisfaction with surgical field did not differ significantly between the two groups.Conclusion: TAPB reduced the use of intraoperative analgesics without altering the degree of abdominal relaxation, or affecting surgeon’s satisfaction with surgical field in the patients receiving laparoscopic colorectal surgery.Keywords: Transversus abdominis plane block, deep muscle relaxation, analgesia, laparoscopic colorectal surgery

Abstract Background Ultrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists, affecting patient recovery and sleep quality on the day of surgery. We compared the analgesic effect of ultrasound-guided TAP block with or without rectus sheath (RS) block in patients undergoing laparoscopic cholecystectomy using the visual analog scale (VAS) scores. Methods The study was registered before patient enrollment at the Clinical Research Information Service (registration number: KCT0006468, 19/08/2021). 88 American Society of Anesthesiologist physical status I-III patients undergoing laparoscopic cholecystectomy were divided into two groups. RS-TAP group received right lateral and right subcostal TAP block, and RS block with 0.2% ropivacaine (30 mL); Bi-TAP group received bilateral and right subcostal TAP block with same amount of ropivacaine. The primary outcome was visual analogue scale (VAS) for 48 h postoperatively. Secondary outcomes included the use of rescue analgesics, cumulative intravenous patient-controlled analgesia (IV-PCA) consumption, patient satisfaction, sleep quality, and incidence of adverse events. Results There was no significant difference in VAS score between two groups for 48 h postoperatively. We found no difference between the groups in any of the secondary outcomes: the use of rescue analgesics, consumption of IV-PCA, patient satisfaction with postoperative pain control, sleep quality, and the incidence of postoperative adverse events. Conclusion Both RS-TAP and Bi-TAP blocks provided clinically acceptable pain control in patients undergoing laparoscopic cholecystectomy, although there was no significant difference between two combination blocks in postoperative analgesia or sleep quality.

Suwarman,1 Osmond Muftilov Pison,1 Mohammad Fikry Maulana,1 Prapanca Nugraha2 1Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, IndonesiaCorrespondence: Suwarman; Mohammad Fikry Maulana, Email suwarman@unpad.ac.id; mohammad19029@mail.unpad.ac.idObjective: Acute postoperative pain is one of the major clinical problems that occurs in patients undergoing cesarean section with a prevalence of 89.8%. Postoperative pain causes discomfort and various complications for the mother. In addition, postoperative pain that is not handled properly can increase the risk of becoming chronic pain by 2.5 times. One of the methods recommended in the Enhanced Recovery After Caesarean Section (ERACS) protocol to prevent acute postoperative pain is the use of intrathecal long-acting opioids, with intrathecal morphine as the gold standard and Transversus Abdominis Plane (TAP) block. This study aims to assess the comparison of opioid needs as analgesic rescue between the administration of 0.1mg spinal morphine and TAP block with bupivacaine 0.2% 10mg in patients undergoing cesarean section.Methods: This study is an observational study in a single Tertiary Hospital in West Java – Indonesia. Patients were given patient-controlled anesthesia (PCA) with fentanyl as analgesic rescue. Statistical analysis of the numerical data used the unpaired t-test and Chi-Square test for categorical data.Results: In the group that was given spinal morphine, the duration of additional opioids was longer (p < 0.05), and the total dose of additional opioids was less than the TAP block group (p < 0.05).Conclusion: The spinal morphine requires fewer additional opioids than the TAP block.Plain Language Summary: Sectio caesarea (SC) is one of the most commonly performed surgeries in health care. One of the most common risks of SC is the occurrence of postoperative pain that can interfere with mothers’ physical and mental health. Therefore, the anesthesia technique used must have an optimal effect both in relieving pain during surgery and postoperatively. In addition, the side effects of the anesthesia technique used must also be minimized. This is an observational study comparing the pain relief and side effects between two anesthesia techniques that are often mentioned in the literature, namely the use of morphine in spinal anesthesia and bupivacaine in the Transversus Abdominis Plane (TAP) Block. A total of 44 pregnant women who were indicated to undergo SC were divided into two groups. Pain and side effects subjectively reported by the women were monitored and documented for up to 24 hours postoperatively. Moderate-to-severe pain was an indication of additional pain relief. The results showed that the spinal anesthesia technique with morphine had a better postoperative pain relief effect, characterized by the need for less additional pain relief and a longer time interval to the first additional pain relief. Morphine-treated women experienced more mild side effects such as skin itching, nausea, and vomiting. However, this was not significant. Further research with a larger sample and consideration of other factors that may affect the mother’s subjective pain perception such as histories of previous surgery, medication use, and previous pregnancy will provide more accurate comparative results.Keywords: cesarean section, duration of analgesia, pain scale, spinal analgesia, transversus abdominis plane block

Background/Objectives: Different analgesic techniques have been used in the clinical management of chronic post-hernioplasty pain (CPHP), with variable results. This study aimed to investigate clinical factors associated with long-term outcome of the transversus abdominal plane (TAP) block for CPHP. Methods: We retrospectively analyzed 26 patients with CPHP who were treated with single or multiple TAP blocks with local anesthetic and steroid. Patients were evaluated for pain and neuropathic pain intensity by a Numerical Rating Scale (NRS) and the painDETECT questionnaire (PDQ), for anxiety and depression by the Hospital Anxiety and Depression Scale, and for quality of life by the 12-item Short Form Health Survey (SF12). Results: At 6 months post-treatment, 20 patients (77%) presented substantial (>50%) or moderate (30–50%) CPHP relief and were considered responders. In responders, the 24-h average and maximum NRS pain significantly declined (p < 0.01) from 7.3 ± 1.3 to 2.6 ± 2.1 and from 8.8 ± 1.5 to 5.1 ± 2.0, and the neuropathic PDQ score from 9.1 ± 3.2 to 6.1 ± 1.3; the physical SF12 score improved from 36.5 ± 5.8 to 44.3 ± 7.5 (p < 0.01). Six patients failed to achieve a significant CPHP improvement and were considered non-responders. Non-responders presented a significantly (p < 0.05) longer CPHP, higher body mass index and neuropathic symptoms, and more frequent anxiety, depression, diabetes, and fibromyalgia. Conclusions: The TAP block with local anesthetic and steroid should be considered as a therapeutic option for CPHP. However, medical and psychiatric comorbidities negatively impact the TAP block effectiveness for CPHP. [ABSTRACT FROM AUTHOR]

Background: Robot-assisted laparoscopic partial nephrectomy (RAPN) for renal tumor treatment provides ergonomic advantages to surgeons and improves surgical outcomes. However, moderate-to-severe pain is unavoidable even after minimally invasive surgery. Despite the growing interest in multimodal analgesia, few studies have directly compared its efficacy with intrathecal morphine, a traditional opioid-based analgesic. Methods: We retrospectively investigated the efficacy of multimodal analgesia compared with that of intrathecal analgesia and intravenous patient-controlled analgesia (IV-PCA) in patients who underwent transperitoneal RAPN at our institute between 2020 and 2022. Among the 334 patients who met the inclusion criteria, intrathecal analgesia using morphine 200 µg was performed in 131 patients, and multimodal analgesia, including transversus abdominis plane block and intraoperative infusion of paracetamol 1 g and nefopam 20 mg, was administered to 105 patients. The remaining 98 patients received postoperative IV-PCA alone. Results: As the primary outcome, the area under the curve of pain scores over 24 h was significantly lower in the intrathecal analgesia and multimodal analgesia groups than in the IV-PCA group (89 [62–108] vs. 86 [65–115] vs. 108 [87–126] h, p < 0.001). Cumulative opioid requirements were also significantly lower in the intrathecal analgesia and multimodal analgesia groups at 24 h after surgery (p < 0.001). However, postoperative nausea and vomiting were significantly increased in the intrathecal analgesia group (27.5% vs. 13.3% vs. 13.3%, p = 0.005). Conclusions: Multimodal analgesia with a transversus abdominis plane block is an efficient analgesic method with fewer adverse effects compared to other analgesic methods. Our findings suggest the efficacy and safety of a multimodal approach for opioid-sparing analgesia after RAPN in the current opioid epidemic. [ABSTRACT FROM AUTHOR]

The utilization of transversus abdominis plane (TAP) block for postoperative pain management has proven to be efficacious. The purpose of this inquiry is to evaluate the effectiveness of right-sided TAP blockade guided by ultrasonography (USG) in managing pain subsequent to laparoscopic cholecystectomy. A total of 60 patients were equallydistributed into two groups. The control group was comprised of patients who did not receive a TAP block, whereas the TAP block group consisted of patients who underwent an ultrasound-guided, right-sided unilateral subcostal TAP block with 20 mL of 0.25% bupivacaine. A Verbal Numerical Rating Scale was administered to all participants for pain assessment at postoperative intervals of 0th, 6th, 12th and 24th hours. Additionally, the overall amount of supplementary analgesic used after surgery, age distribution among each gender classification and body mass index range categories as well as operation time duration; use or non-use of drain; and incidence rate for postoperative complications were recorded for each patient individually. The mean age of participants was 47.72 ± 13.80 years, with a female-to-male ratio of 41/19. The control group exhibited significantly higher pain scale measurements than the block group at the postoperative 0th and the postoperative 24th hour. Drain replacement yielded notably higher pain scores for both TAP and control groups at the postoperative 0th hour. Neither BMI nor operation duration had significant effects on postsurgical pain in either patient group--whether or not they received a TAP block treatment. Our research shows that the implementation of a TAP block and exclusion of surgical area drainage placement yield favorable results in mitigating postoperative pain. Notably, BMI and procedure duration do not exhibit any discernible impact on postoperative pain management. [ABSTRACT FROM AUTHOR]

Background: Ultrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists, affecting patient recovery and sleep quality on the day of surgery. We compared the analgesic effect of ultrasound-guided TAP block with or without rectus sheath (RS) block in patients undergoing laparoscopic cholecystectomy using the visual analog scale (VAS) scores. Methods: The study was registered before patient enrollment at the Clinical Research Information Service (registration number: KCT0006468, 19/08/2021). 88 American Society of Anesthesiologist physical status I-III patients undergoing laparoscopic cholecystectomy were divided into two groups. RS-TAP group received right lateral and right subcostal TAP block, and RS block with 0.2% ropivacaine (30 mL); Bi-TAP group received bilateral and right subcostal TAP block with same amount of ropivacaine. The primary outcome was visual analogue scale (VAS) for 48 h postoperatively. Secondary outcomes included the use of rescue analgesics, cumulative intravenous patient-controlled analgesia (IV-PCA) consumption, patient satisfaction, sleep quality, and incidence of adverse events. Results: There was no significant difference in VAS score between two groups for 48 h postoperatively. We found no difference between the groups in any of the secondary outcomes: the use of rescue analgesics, consumption of IV-PCA, patient satisfaction with postoperative pain control, sleep quality, and the incidence of postoperative adverse events. Conclusion: Both RS-TAP and Bi-TAP blocks provided clinically acceptable pain control in patients undergoing laparoscopic cholecystectomy, although there was no significant difference between two combination blocks in postoperative analgesia or sleep quality. [ABSTRACT FROM AUTHOR]

Background and aim: Pain following surgery contributes to significant morbidity if not properly managed. The present study was aimed at comparing the efficacy of ultrasound guided ilioinguinal and iliohypogastric nerve (IIIHN) block versus transversus abdominis plane (TAP) block Methodology: 60 male patients undergoing unilateral open inguinal hernia repair under spinal anaesthesia were randomized into two groups, IIIHN group (n=30) and TAP group (n=30). IIIHN block/TAP block was performed after completion of surgery with 25 ml of 0.375% ropivacaine and 4 mg dexamethasone as per the group allocation. Postoperative pain was assessed using visual analogue scale (VAS) score and haemodynamic parameters were recorded at 0,2,4,6,8,12,16,20 and 24 hours. Time for first rescue analgesia, doses of rescue analgesia (IV diclofenac aqueous) was noted. Results: Patients in IIIHN group had lower VAS score at 6,8 and 12 hrs. Duration of analgesia was significantly prolonged in IIIHN group than TAP group. The number of rescue analgesia doses required was significantly less in IIIHN group. Conclusion: IIIHN block is superior to TAP block for postoperative analgesia in patients undergoing open inguinal hernia repair as it decreases VAS score, delays the need for first rescue analgesia and decreases the need for rescue analgesia. [ABSTRACT FROM AUTHOR]

Background and Aims: Multimodal analgesia regimens for optimizing the postoperative pain following abdominal surgeries are a crucial component of enhanced recovery after surgery (ERAS), as it reduces postoperative opioid consumption along with their adverse effects. We compared the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) versus posterior transversus abdominis plane block (TAPB) with respect to duration of analgesia, modified Defense and Veterans Pain Rating Scale (DVPRS) scores for pain, activity, sleep, stress, and mood, respectively, the total amount of rescue analgesic consumption, hemodynamics parameters and side effects, in patients undergoing total abdominal hysterectomy under general anesthesia. Materials and Methods: In this study, which was prospective, randomized, and double-blind, 60 patients of the American Society of Anesthesiologists Physical Status I and II, aged 18–65 years, undergoing abdominal hysterectomy, were randomized into two groups. Group QLB (n = 30) and Group TAPB (n = 30) received bilateral QLB and TAPB with 40 ml of 0.375% ropivacaine, respectively. The data were compared using standard qualitative and quantitative tests. Results: The duration of pain relief was longer in Group QLB compared to Group TAPB (981.83 ± 138.62 min vs. 637 ± 127.02 min, P < 0.0001). The DVPRS score for pain, activity, sleep, stress, and mood, respectively, were significantly lower in Group QLB (P < 0.05). The total rescue analgesic consumption was significantly lesser in Group QLB (103.33 ± 18.26 mg) compared to Group TAPB (150.00 ± 50.85 mg) (P < 0.0001). No significant hemodynamic changes or side effects were observed (P > 0.05). Conclusion: Bilateral QLB significantly prolonged the duration of analgesia with reduced rescue analgesic requirement compared with bilateral TAPB in patients undergoing total abdominal hysterectomy. [ABSTRACT FROM AUTHOR]

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Aim. To evaluate the safety and efficacy of the transversus abdominis plane block in kidney transplantation from deceased donor.Material and methods. The first stage included a retrospective comparative analysis of the results using the transversus abdominis plane block in renal transplantation. Group I (n=30) included patients who underwent transversus abdominis plane block after kidney transplantation; in comparative group II (n=58) the TAP-block wasn’t performed. We assessed the daily requirement for trimeperidine on the first day after kidney transplantation. The second stage was a prospective randomized placebo-controlled study. The patients were randomly divided into 2 groups with respect to whether the transversus abdominis plane block was provided with an active drug, or placebo was used; so the sodium chloride 0.9% was injected into the transversus abdominis plane in the intermuscular fascial plane between the internal oblique and transversus abdominis muscle in patients of Group III (n=31), and a local anesthetic was injected in patients of Group IV (n=34).) The daily requirements for trimeperidine, tramadol were assessed as well as the pain severity according to visual analogue scale at 1, 6, 12, 24 hours after surgery, the incidence of adverse events in the gastrointestinal tract; and several laboratory parameters (cortisol, interleukin-1, interleukin-6) related to pain syndrome were analyzed.Results. As a result of pseudorandomization, 17 cases were included in each of two retrospective stage, which were comparable in terms of patients' main characteristics (p>0.05). The daily requirement for trimeperidine in the transversus abdominis plane block group (Group I) was lower than in the comparison group with a trend toward statistical significance (p=0.07). The median daily dose of trimeperidine in Group III (placebo control) was 59.5 mg (interquartile range: 51.5–72.0), which was higher than in Group IV (45.5 mg; interquartile range: 38.5–62.0) (p=0.039). The postoperative pain severety assessed by visual analogue scale was also statistically significantly higher in group III at the timepoint of 12 hours after surgery, making 4.0 points (interquartile range: 2.5–5.0) versus 1.5 points (interquartile range: 0.5–2.5) in group VI (p=0.015). There were no differences between the groups in pain severity at 1, 6, and 24 hours after surgery. The daily requirement for tramadol was also statistically significantly higher in Group III, amounting to 50 mg (interquartile range: 0–100) versus 0 (interquartile range: 0–55 mg) in the active drug Group IV (p=0.045).Conclusion. Our study showed that the use of the transversus abdominis plain block was safe and effective, yielding encouraging results, which demonstrated a clinically significant reduction in the need for opioid analgesics and in the incidence of adverse events in the postoperative period after transversus abdominis plane block which contributes to the early activation of patients. Therefore, further studies are needed to improve the package of multimodal perioperative analgesia after kidney transplantation.

Background. Postoperative analgesia in kidney transplant recipients is challenging due to potential nephrotoxicity of nonsteroidal anti-inflammatory drugs and the reduced clearance of opioid metabolites during transient renal impairment. Opioid-sparing multimodal postoperative analgesia using regional analgesia methods could provide better pain control and early activation after kidney transplantation.Aim. To evaluate the clinical results of treatment using regional pain management methods in kidney transplant recipients.Material and methods. A single-center study was conducted at Republican Research Center of Emergency Medicine from 2020 to 2022. The study included 97 patients who underwent heterotopic kidney transplantation from a living related donor. Patients were divided into 3 groups. In group 1 (31 patients), general anesthesia was used. For postoperative analgesia opioid analgesics in combination with metamizole 1000 mg were used. In group 2 (33 recipient patients), a combination of general anesthesia and open transversus abdominis plane block was used. In group 3 (33 recipient patients), a combination of general anesthesia and erector spine plane block was performed. Opioid analgesics were used as a "rescue analgesia" when necessary. The primary study end points were the pain intensity assessed by a visual analogue scale and opioid consumption on the first day after surgery. Secondary endpoints were the time of intestinal motility recovery, the presence of nausea and vomiting, the Intensive Care Unit length of stay and the hospital length of stay.Results. Pain intensity 6 hours after surgery in patients of group 1 was 13.5% and 24.6% higher than in patients of group 2 and 3, respectively. In group 2, pain intensity was 12.8% higher compared to group 3 (p=0.0017). At 12 hours after surgery, the pain intensity was 42% higher in group 1 compared to group 2 and group 3 (p

Abstract Background Rectus sheath block (RSB) and transversus abdominis plane block (TAPB) have been shown to reduce opioid consumption and decrease postoperative pain scores in abdominal surgeries. However, there are no reports about the one-puncture technique of RSB combined with TAPB for perioperative pain management during laparoscopic upper abdominal surgery. Methods A total of 58 patients were randomly assigned to the control group (C), the TAP group (T), and the one-puncture technique of RSB combined with TAPB group (RT). The patients in group C did not receive any regional block. The patients in group T received ultrasound-guided subcostal TAPB with 30 mL of 0.33% ropivacaine on each side. The patients in the RT group received a combination of RSB and TAPB with 15 mL of 0.33% ropivacaine in each plane by one puncture technique. All patients received postoperative patient-controlled intravenous analgesia (PCIA) after surgeries. The range of blocks was recorded 20 min after the completion of the regional block. The postoperative opioid consumption, pain scores, and recovery data were recorded, including the incidence of emergence agitation (EA), the times of first exhaust and off-bed activity, the incidence of postoperative nausea and vomiting, dizziness. Results The range of the one-puncture technique in group RT covered all areas of surgical incisions. The visual analogue scale (VAS) score of the RT group is significantly lower at rest and during coughing compared to groups T and C at 4, 8, 12, and 24 h after surgery, respectively (P

Background: Our study aims to the compare the duration of post-operative analgesia, times of post-operative opioid consumption, post-operative sedation score, and haemodynamic changes between the groups on using 8mg Dexamethasone and 75 µgm clonidine as an adjuvant to 0.25% Ropivacaine in ultrasound-guided bilateral TAP block in patients undergoing total abdominal hysterectomy. Study design: Prospective, randomized, double blinded study with 56 patients were included and allocated using a -generated randomization code into: Group A (n=28 patients): Received USG guided bilateral TAP block with Injection Ropivacaine (0.5%) 20ml + Dexamethasone (8 mg) 2ml + Normal Saline 18 ml and Group B (n=28 patients) Received USG guided bilateral TAP block with Injection Ropivacaine (0.5%) 20ml + clonidine (75mcgs) 0.5 ml + Normal Saline 19.5 ml. Results: The duration of pain relief was highest (14.3 ± 4.7 hours) in group B patients compared to group A (11.1 ± 5.1 hours). The duration of analgesia provided by 75 mcg clonidine was statistically significant (p<0.001). Post-operative opioid consumption was higher in group A compared to group B which is statistically not significant. (P>0.05). There was also no significant difference in between the study groups for sedation scoring and haemodynamic changes. Conclusion: The addition of dexamethasone 8mg or clonidine 75 mcgs to 0.25% ropivacaine significantly prolongs the duration of analgesia and reduces postoperative opioids requirement, thereby facilitating early recovery and ambulation. On comparing, clonidine appears to be superior adjunct, in terms of pain relief. [ABSTRACT FROM AUTHOR]

Investigate the analgesic efficacy of quadratus lumborum (QL) block versus transversus abdominis plane (TAP) block in postoperative pain management in nonemergent cesarean section. Systematic review with meta-analysis. PubMed, Cochrane, CINAHL, Google Scholar, and gray literature were searched for evidence. Only randomized controlled trials examining the effects of QL and TAP block for nonemergent cesarean delivery were included. Mean difference (MD) was used to estimate continuous outcomes with appropriate effect models. The quality of evidence was rated using the Risk of Bias and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Six studies involving 543 parturients were included. Compared to the TAP block, the cumulative 24-hour pain score at rest (MD, −0.60; 95% CI, −1.03 to −0.17; P =.007) and during activity (MD, −1.05; 95% CI, −1.54 to −0.56; P <.0001) were significantly lower in QL block. Time to the first analgesic rescue (MD, 21.67; 95% CI, −18.58 to 61.91; P =.29) and opioid consumption (MD, −1.96; 95% CI, −4.59 to 0.66; P =.14) were similar in both groups. No difference was found in the incidence of postoperative nausea and vomiting and sedation. However, patients treated with QL block reported higher patient satisfaction scores. There is limited evidence to suggest that QL block is superior to TAP block for postoperative pain management in nonemergent cesarean delivery. The study limitations must be considered when extrapolating the review's findings to clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative pain management is crucial for patient recovery with Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) emerging as potential techniques. We aimed to compare the analgesic efficacy of QLB and TAPB in patients undergoing inguinal hernia repair. Methods: We performed a systematic review of Cochrane, EMBASE, and MEDLINE databases to identify randomized controlled trials comparing QLB and TAPB in patients undergoing inguinal hernia repair. Outcomes included postoperative pain and opioid consumption. Statistical analysis was performed using RevMan 5.4. The review protocol was registered at PROSPERO (CRD42023445513). Results: We included five RCTs encompassing 255 patients. QLB was associated with a significant decrease in postoperative pain (MD −0.45; 95% CI −0.75 to −0.14; and p = 0.004; I2 = 94%). However, we found no difference in 24‐h opioid consumption between QLB and TAPB groups. Conclusion: QLB may offer superior pain reduction. However, its effect on opioid consumption remains unclear. [ABSTRACT FROM AUTHOR]

The application effect of transversus abdominis plane block (TAPB) combined with thoracic paravertebral block (TPVB) or erector spinae plane block (ESP) under ultrasound guidance in endoscopic radical resection of esophageal cancer under general anesthesia was studied. From March 2021 to February 2022, patients who underwent endoscopic radical resection of esophageal cancer in our hospital were selected as the research object, and 90 patients were selected as the samples. Patients were divided into group A and group B according to the difference of blocking schemes. Group A received ESP and Group B received TPVB. The dosage of sufentanil, nerve block time, awakening time and extubation time of the two groups were counted. The postoperative pain, sedation effect, sleep satisfaction and analgesia satisfaction of the two groups were compared, and the complications of the two groups were observed. The nerve block time and extubation time in group A were shorter than those in group B (P<0.05), but there was no statistical difference in the dosage of sufentanil and the awakening time between the two groups (P>0.05). At T2, T3 and T4, the visual analogue scale (VAS) scores of group A at rest and cough were significantly lower than those of group B (P<0.05). At T1, T2 and T3, the Ramsay score of group A was lower than that of group B (P<0.05), and there was no significant difference between the two groups at T4 (P>0.05). The satisfaction of sleep and analgesia in group A was higher than that in group B (P<0.05). There was no significant difference in the incidence of adverse reactions between group A and group B (P>0.05). The analgesic effect of ultrasound-guided TAPB combined with ESP is better than that of ultrasound-guided TAPB combined with TPVB, and it can shorten the time of nerve block and extubation, which is worth popularizing. [ABSTRACT FROM AUTHOR]

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This study aims to evaluate the effect of the transversus abdominis plane (TAP) block on the blood cells and the inflammatory markers neutrophil– to– lymphocyte ratio (NLR), platelet– to– lymphocyte ratio (PLR), and systemic immune– inflammation index (SII) after the laparoscopic ovariectomy (LapOV) in dogs. 72 healthy bitches undergoing LapOV were randomly allocated to the no– TAP group of dogs under inhaled anesthesia (IA), the TAP– S group (IA and TAP with saline), and the TAP– B group (IA and TAP with bupivacaine). The NLR, PLR, and SII were calculated 1 h before ovariectomy (T0) and at 2−3 h (T1), 6−8 h (T2), and 20−24 h (T3) post– surgery. The number of dogs requiring postoperative analgesic rescue with buprenorphine and the doses administered in each group were recorded. Significant changes were observed in all groups' postoperative NLR, PLR, and SII over time. Between groups, no differences were observed in any of the ratios at any control point (NLR at T0−T3: p = 0.17, 0.36, 0.80, and 0.95; PLR at T0−T3: p = 0.70, 0.62, 0.21, 0.87; SII at T0−T3: p = 0.29, 0.65, 0.09, and 0.34). A significantly lower number of dogs required analgesic rescue in the TAP-B group (p = 0.0001) and a lower number of doses were administered (p = 0.001). There is no difference in the inflammatory response measured through the complete blood– derived inflammatory markers after the LapOV in dogs when the postoperative pain is managed entirely with opioids or with the TAP block with bupivacaine. The hydrodissection associated with the TAP block technique does not increase the inflammatory response. [ABSTRACT FROM AUTHOR]

BackgroundAlthough laparoscopic cholecystectomy (LC) is a minimally invasive surgery, it can cause moderate to severe postoperative pain. Erector spinae plane (ESP) and transversus abdominis plane (TAP) blocks are considered effective means for pain management in such cases; however, there is inconclusive evidence regarding their analgesic efficacy. This meta-analysis aimed to compare the efficacy of ESP block and TAP block for pain control in LC.MethodsWe systematically searched Medline, PubMed, Scopus, Embase, and Google Scholar until 26 January 2024. All randomized clinical trials compared the efficacy of erector spinae plane block (ESPB) and transversus abdominis plane block (TAPB) for postoperative pain relief after LC. The primary outcomes were pain scores at rest and on movement at 1, 2, 6, 12, and 24 h postoperatively. The secondary outcomes were total opioid consumption, first analgesia request time, and rates of postoperative nausea and vomiting. We analyzed all the data using RevMan 5.4.ResultsA total of 8 RCTs, involving 542 patients (271 in the ESPB group and 271 in the TAPB group), were included in the analysis. The ESP block demonstrated statistically significant lower pain scores at rest and on movement than the TAP block at all-time points except at the 1st and 6th h on movement postoperatively; however, these differences were not considered clinically significant. Additionally, patients who received the ESP block required less morphine and had a longer time before requesting their first dose of analgesia. There were no significant differences in postoperative nausea and vomiting incidence between the two groups.ConclusionIn patients undergoing LC, there is moderate evidence to suggest that the ESP block is effective in reducing pain severity, morphine equivalent consumption, and the time before the first analgesia request when compared to the TAP block during the early postoperative period.Systematic review registration: PROSPERO CRD42024505635, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024505635.