title: Analgesic efficacy and outcome of transversus-abdominis plane block versus low thoracic-epidural analgesia after laparotomy in ischemic heart disease patients.
abstract: BACKGROUND
  Tranversus-abdominis plane (TAP) block is a novel technique alternative to central neural blockade in providing analgesia to the anterior abdominal wall. As such, we compared the analgesic efficacy of TAP block with low thoracic-epidural analgesia (TEA) in ischemic heart disease patients after abdominal laparotomy.
  
  
  METHODS
  Forty-four American Society of Anesthesiologists physical status (ASA) III patients, 59-75 years of age and undergoing elective upper abdominal surgery under general anesthesia, were assigned randomly to receive either continuous low TEA or intermittent administration of local anesthetic in TAP block. Supplemental analgesia was provided with intravenous morphine with patient-controlled-analgesia. Morphine consumption and pain intensity using verbal rating scale (VRS) at rest and coughing over the first 48 h were recorded.
  
  
  RESULTS
  Whereas all patients in the TAP group required morphine, 16 (72.2 %) patients in TEA group received morphine postoperatively (p = 0.021). Morphine consumed on day 1 and day 2 was 11.5 mg (7.5-12.3 mg) and 7 mg (4.5-8 mg) for the TEA group, while in the TAP group, it was 18 mg (16-19 mg) and 11 mg (10-13 mg), respectively (p < 0.001). Time for first request of morphine was 311.2 ± 18.5 min in the TEA group versus 210 ± 22.2 min in the TAP group (p < 0.001). VRS at rest and cough were lower in the TEA group compared with the TAP group at 1, 6, 12, 18, 24, 36 and 48 h (p < 0.001). Incidence of hypotension and ephedrine administration were significantly higher in the TEA group than in the TAP group (p = 0.007).
  
  
  CONCLUSIONS
  Low TEA reduced morphine consumption and provided a higher analgesic efficacy compared with TAP block after laparotomy in ischemic heart disease patients.
authors.affiliation: Anesthesia Department, Faculty of Medicine, Ain-Shams University, Abassia, Cairo, Egypt, sherifwahba2012@yahoo.com.
authors.forename: Sherif Samir
authors.initials: SS
authors.lastname: Wahba
authors.forename: Sahar Mohammed
authors.initials: SM
authors.lastname: Kamal
mesh_terms: D000009:Abdominal Muscles; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000150:complications*; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine