Zulkipeli, Zubaidah
(2017)
Comparing the efficacy ultrasound guided bilateral transversus abdominis plane (TAP) block between 0.25% bupivacaine versus 0.125% bupivacaine in laparoscopic appendicectomy.
Masters thesis, Universiti Sains Malaysia.
Abstract
Acute appendicitis is a common cause acute surgical abdomenl. Laparoscopic
appendicectomy becames more common practise nowadays as compare to open
appendicectomy. Transversus abdominis plane (TAP) block is a proven beneficial for
post-operative pain control in lower abdominal surgery including laparoscopic
surgery. However, more studies are needed to determine effective optimum dose
required for post-operative pain control in laparoscopic surgery. This study was aimed
to determine the efficacy of 0.125% bupivacaine as compare to standard dose 0.25%
bupivacaine in ultrasound guided bilateral transversus abdominis plane (TAP) block
for post-operative pain control in laparoscopic appendicectomy.
Method
This study was a prospective, double blinded and randomized controlled trial
involving patients came for emergency laparoscopic appendicectomy. Participants
were randomized into two groups by using computer assisted randomization. Group 1
received ultrasound guided transversus abdominis plane (TAP) block using 0.25%
bupivacaine whereas group 2 received 0.125% bupivacaine immediately after the
operation finished. The visual analogue pain score (VAS) were assessed at 30
minutes, 4H, 8H, 16H and 24H post operation. Total PCA fentanyl requirement were
compared between these two groups. Complication from the laparoscopic surgery and
TAP block was documented.
Result
Overall visual analogue pain score was comparable between these two groups.
The overall mean difference in Visual Analogue pain Score(VAS) was 0.58 {(95%
CI -0.17,3.12), p value=0.128. Mean difference of VAS at 1/2H, 4H, 8H, 12H, 16H
and 20H comparable between these 2 groups which were 0.18(n=44), 0.68(n=44),
0.86(n=44), 0.06(n=40), 0.31(n=28) and 0.38(n=19) respectively. The total PCA
fentanyl requirement between both groups were insignificant (132.95mcg vs
128.64mcg) (MD:4.32, p value = 0.73). No complication arises from TAP block.
Conclusion
Ultrasound guided bilateral TAP blocks for post-operative pain control in
laparoscopic appendectomy using 0.125% bupivacaine is as effective as 0.25%.
Lower concentrations of local anaesthetic reduce risk of toxicity and cost while
providing similar post operative analgesia quality. Ultrasound guided TAP block is
considered effective and safe with a proper technique. Oral analgesia should be
started as soon as possible to prevent breakthrough pain.
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