title: [Comparison of Analgesic Efficacy between Posterior and Lateral Transversus Abdominis Plane Block Techniques for Laparoscopic Gynecological Surgery].
abstract: BACKGROUND
  Posterior transversus abdominis plane (TAP) block has been considered as a useful technique for lower abdominal postoperative analgesia, but in ultrasound-guided block, its efficacy and usability are still unknown. We prospectively compared the analgesic efficacy among posterior and lateral TAP block and with control group in laparoscopic gynecological surgery.
  
  
  METHODS
  29 patients were randomly assigned to a study group. Ultrasound-guided TAP block was performed before the operation. In the posterior group (n =10), a needle was inserted from posterior to the middle axillary line, and its tip was centrally positioned at the origin of the transversus abdominis muscle. In the lateral group (n=10), a needle was inserted from the middle axillary line, and the tip was peripherally positioned at the surface of the transversus abdominis muscle. Visual analog scale (VAS), the use frequency of fentanyl rescue dose, and the period of time until initial rescue use after the operation were measured.
  
  
  RESULTS
  In posterior group, pain scores both at rest and on movement were significantly lower than other groups at early phase (P<0.05). The number of uses of the fentanyl rescue dose was smaller in posterior group than in control group in the first 6 postoperative hours (1±1.2 vs 3±1.5, P<0.05).
  
  
  CONCLUSIONS
  Ultrasound-guided posterior TAP block could become a more useful tool for postoperative analgesia. We presumed that its additional effect is caused from reduction of visceral pain related to sympathetic nerve block.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Taketa
authors.forename: Taro
authors.initials: T
authors.lastname: Fujitani
authors.forename: Yumi
authors.initials: Y
authors.lastname: Irisawa
authors.forename: Satoko
authors.initials: S
authors.lastname: Sudo
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Harada
authors.forename: Kazushi
authors.initials: K
authors.lastname: Takaishi
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation*; D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000628:therapy*; D011446:Prospective Studies