Articles
Vol. 3 No. 1 (2025)
Comparative effectiveness of continuous subcostal transversus abdominis plane block versus thoracic epidural analgesia in postoperative pain management following major open abdominal surgery: a prospective observational study
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 5 August 2025
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This observational study compared the effectiveness of continuous subcostal transversus abdominis plane (TAP) block with bilaterally placed catheters versus continuous thoracic epidural analgesia (TEA) in managing postoperative pain following major open abdominal surgery. Thirty-one patients were enrolled between July 2019 and September 2020 at the Policlinico Paolo Giaccone in Palermo and divided into two groups. Postoperative pain, opioid consumption, incidence of postoperative nausea and vomiting (PONV), hemodynamic stability, and patient satisfaction were evaluated. No significant differences were observed in the number rating scale (NRS) values at 0, 6, 12, and 24 hours between groups. Only 3 patients in the TAP group required opioids in the first 24 hours; however, no differences were observed in median opioid consumption between groups (TEA 0.00 [0.00-0.00]; TAP 0.00 [0.00-0.00], p=0.08). Hemodynamic stability was evaluated using mean arterial pressure and heart rate values, with no significant differences found for either parameter over time. The incidence of PONV was similar in both groups (p=0.47). The continuous TAP block represents an effective, less invasive alternative to TEA, particularly in patients with contraindications to neuraxial analgesia, aligning with Enhanced Recovery After Surgery (ERAS) protocols and the procedure-specific postoperative pain management (PROSPECT) methodology.
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1. Carmichael JC, Keller DS, Baldini G, et al. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2017;60:761-84. DOI: https://doi.org/10.1097/DCR.0000000000000883
2. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS) society recommendations: 2018. World J Surg 2019;43:659-95. DOI: https://doi.org/10.1007/s00268-018-4844-y
3. Cook TM, Counsell D, Wildsmith JA. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth 2009;102:179-90. DOI: https://doi.org/10.1093/bja/aen360
4. El-Dawlatly AA, Turkistani A, Kettner SC, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy [published correction appears in Br J Anaesth 2009;103:622]. Br J Anaesth 2009;102:763-7. DOI: https://doi.org/10.1093/bja/aep067
5. Soliz JM, Lipski I, Hancher-Hodges S, et al. Subcostal Transverse Abdominis Plane Block for Acute Pain Management: A Review. Anesth Pain Med 2017;7:e12923. DOI: https://doi.org/10.5812/aapm.12923
6. Desai N, El-Boghdadly K, Albrecht E. Epidural vs. transversus abdominis plane block for abdominal surgery - a systematic review, meta-analysis and trial sequential analysis. Anaesthesia 2021;76:101-17. DOI: https://doi.org/10.1111/anae.15068
7. Hamid HKS, Marc-Hernández A, Saber AA. Transversus abdominis plane block versus thoracic epidural analgesia in colorectal surgery: a systematic review and meta-analysis.Langenbecks Arch Surg 2021;406:273-82. DOI: https://doi.org/10.1007/s00423-020-01995-9
8. Aly NM, Talaat SM, Menshawi MA, Mohammed ER. Bilateral Transversus Abdominis Plane Block versus Epidural analgesia for Postoperative Pain Relief in Lower Abdominal Surgery. QJM-Int J Med 2020;113:hcaa039.003. DOI: https://doi.org/10.1093/qjmed/hcaa039.003
9. Joshi GP, Bonnet F, Kehlet H, PROSPECT collaboration. Evidence-based postoperative pain management after laparoscopic colorectal surgery. Color Dis 2013;15:146-55. DOI: https://doi.org/10.1111/j.1463-1318.2012.03062.x
10. Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol 2016;33:160-71. DOI: https://doi.org/10.1097/EJA.0000000000000366
11. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care 2007;35:616-7.
12. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 2008;248:189-98. DOI: https://doi.org/10.1097/SLA.0b013e31817f2c1a
13. Charlton S, Cyna AM, Middleton P, Griffiths JD. Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery. Cochrane Database Syst Rev 2010;CD007705. DOI: https://doi.org/10.1002/14651858.CD007705.pub2
14. Liu X, Song T, Chen X, et al. Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2020;20:53. DOI: https://doi.org/10.1186/s12871-020-00967-2
15. Scimia P, Gentili L, Fusco P, et al. When a TAP becomes a QL block: a dynamic way to perform the fascial blocks. Minerva Anestesiol 2022;88:976-8. DOI: https://doi.org/10.23736/S0375-9393.22.16772-6
16. McDonnell JG, O’Donnell B, Curley G, et al. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 2007;104:193-7. DOI: https://doi.org/10.1213/01.ane.0000250223.49963.0f
17. Apfel CC, Kranke P, Eberhart LH. Comparison of predictive models for postoperative nausea and vomiting. Br J Anaesth 2002;88:234-40. DOI: https://doi.org/10.1093/bja/88.2.234
18. Regmi S, Shah R, Shrestha B, Subedi A. Continuous transversus abdominis plane block versus epidural analgesia for postoperative pain management in abdominal surgery. JNMA J Nepal Med Assoc 2020;58:134-40.
19. Kadam RV, Howell S. Ultrasound-guided continuous transverse abdominis plane block for abdominal surgery. Br J Anaesth 2011;106:367-8. DOI: https://doi.org/10.4103/0970-9185.83676
20. Kandi R, Bhargava AK, Sarangi P, Mishra A. Comparison of efficacy of continuous subcostal TAP block and thoracic epidural block in patients undergoing upper abdominal surgery: A randomized controlled trial. Indian J Anaesth 2022;66:196-202.
21. Edwards P, Krishna Prasad T, Balasubramaniyan A, Soundarya Priyadharsini K. Use of Dexamethasone with Local Anaesthetic in Ultrasound-Guided Transversus Abdominis Plane Block – A Narrative Review. J Clin Res Rep 2024;16. DOI: https://doi.org/10.31579/2690-1919/388
22. Chen Q, An R, Zhou J, Yang B. Clinical analgesic efficacy of dexamethasone as a local anesthetic adjuvant for transversus abdominis plane (TAP) block: A meta-analysis. PLoS One 2018;13:e0198923. DOI: https://doi.org/10.1371/journal.pone.0198923
How to Cite
Comparative effectiveness of continuous subcostal transversus abdominis plane block versus thoracic epidural analgesia in postoperative pain management following major open abdominal surgery: a prospective observational study. (2025). Advances in Anesthesia and Pain Medicine, 3(1). https://doi.org/10.4081/aapm.53.
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