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J Anaesthesiol Clin Pharmacol. 2018 Oct-Dec;34(4):472-477. doi: 10.4103/joacp.JOACP_62_17.

Transversus abdominis plane block supplementation during iliac crest bone graft harvesting - Effect on postoperative pain.

Author information

1
Department of Anaesthesiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India.
2
Department of Faciomaxillary Surgery, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India.
3
Department of Social and Preventive Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India.

Abstract

Background and Aims:

Transversus abdominis plane (TAP) block is a technique proposed to minimise pain after anterior iliac crest bone harvesting. This study aims to evaluate the postoperative pain in patients who receive ultrasound-guided TAP block to supplement routine wound infiltration.

Material and Methods:

A total of 143 patients aged between 6 and 22 years were randomised into two groups. Patients in group A received supplemental TAP block on the same side. Patients in group B received local anesthetic wound infiltration alone. Pain scores were compared at the first and 24th postoperative hours.

Results:

TAP block significantly reduced pain and delirium in the immediate postoperative period. The mean FLACC (Face, Legs, Activity, Cry, Consolability) score after 10 min was 0.8 in group A versus 1.8 in group B (P = 0.001). The mean Watcha scale at 10 min was 1.0 in group A versus 1.2 in group B (P = 0.001). After 24 h, 81.7% of patients in group A had no pain versus 59.7% in group B (P = 0.004). The incidence of intolerable pain at 24 h was 5.6% in group B versus 0% in group A (P = 0.04). Cumulative ambulation scores were significantly better in group A (P < 0.05). There was a strong and positive correlation between the analgesia and ability to ambulate comfortably at 24 h postop (Pearson's coefficient 0.95).

Conclusion:

Supplemental ultrasound-guided TAP block given intraoperatively reduces the postoperative pain. The incidence of emergence delirium was low. These patients were also able to ambulate earlier.

KEYWORDS:

Early ambulation; TAP block; iliac crest bone graft harvesting; pain postoperative

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