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MAY CONTINUOUS TRANVERSUS ABDOMINIS PLANE BLOCK BE A RELIABLE ALTERNATIVE TO EPIDURAL ANALGESIA IN MAJOR ABDOMINAL SURGERY?
ESRA Academy. Ribeiro J. Sep 8, 2016; 138484
Topic: Analgesia after Major Abdominal Surgery
Dr. João Ribeiro
Dr. João Ribeiro

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Abstract
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Background and Aims:

Continuous epidural analgesia is the technique of choice for major abdominal surgery. However, the risks and complications are described and there are patients not eligible by anatomical restraints or associated disorders. The continuous transversus abdominis plane (TAP) block may be an alternative technique for effective and safe analgesia. We performed a bilateral continuous TAP block as an analgesic strategy in bladder reconstruction surgery, because the neuroaxial approach was contraindicated.

Methods:

We performed an ultrasound-guided bilateral continuous TAP block in a 19-year-old patient, ASA II, with caudal regression syndrome and neurogenic bladder, for bladder reconstruction surgery with infraumbilical midline incision, as a multimodal analgesic strategy. After the procedure, we placed TAP catheters bilaterally, by McDonnel technique, and administered initial boluses of 20ml 0,2% ropivacaine followed by continuous infusion of ropivacaine 0.2% at 6 ml/h per side.

Results:

During the postoperative period, the patient reported a pain-free postoperative course and scored great satisfaction with the analgesic strategy. There has been a log of paresthesia in the right leg, 18 h after the procedure, which gave in decreasing infusion to 5 ml/h. The catheters were removed on the third postoperative day without complications.

Conclusions:

The ultrasound-guided continuous TAP block catheters is an effective analgesic technique for procedures with infraumbilical incisions and has a good safety profile. The drawbacks described are the lack of consistency of sensory block above T10 and visceral pain. The block performed demonstrated excellent analgesic efficacy, though it is still difficult to predict the spread of the local anesthetic by the fascial planes.

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