title: The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial.
abstract: BACKGROUND
  The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. We evaluated its analgesic efficacy in patients during the first 24 postoperative hours after abdominal surgery, in a randomized, controlled, double-blind clinical trial.
  
  
  METHODS
  Thirty-two adults undergoing large bowel resection via a midline abdominal incision were randomized to receive standard care, including patient-controlled morphine analgesia and regular nonsteroidal antiinflammatory drugs and acetaminophen (n = 16), or to undergo TAP block (n = 16) in addition to standard care (n = 16). After induction of anesthesia, 20 mL of 0.375% levobupivacaine was deposited into the transversus abdominis neuro-fascial plane via the bilateral lumbar triangles of Petit. Each patient was assessed by a blinded investigator in the postanesthesia care unit and at 2, 4, 6, and 24 h postoperatively.
  
  
  RESULTS
  The TAP block reduced visual analog scale pain scores (TAP versus control, mean +/- sd) on emergence (1 +/- 1.4 vs 6.6 +/- 2.8, P < 0.05), and at all postoperative time points, including at 24 h (1.7 +/- 1.7 vs 3.1 +/- 1.5, P < 0.05). Morphine requirements in the first 24 postoperative hours were also reduced (21.9 +/- 8.9 mg vs 80.4 +/- 19.2 mg, P < 0.05). There were no complications attributable to the TAP block. All TAP patients reported high levels of satisfaction with their postoperative analgesic regimen.
  
  
  CONCLUSIONS
  The TAP block provided highly effective postoperative analgesia in the first 24 postoperative hours after major abdominal surgery.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University College Hospital, Galway, Ireland.
authors.forename: John G
authors.initials: JG
authors.lastname: McDonnell
authors.forename: Brian
authors.initials: B
authors.lastname: O'Donnell
authors.forename: Gerard
authors.initials: G
authors.lastname: Curley
authors.forename: Anne
authors.initials: A
authors.lastname: Heffernan
authors.forename: Camillus
authors.initials: C
authors.lastname: Power
authors.forename: John G
authors.initials: JG
authors.lastname: Laffey
mesh_terms: D000005:Abdomen; D000698:Analgesia; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007420:Intestine, Large / Q000601:surgery*; D007422:Intestines / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000517:prevention & control*; D013514:Surgical Procedures, Operative
chemical_list: D009467:Neuromuscular Depolarizing Agents