الفهرس 
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Abstract
The transversus abdominis plane (TAP) block is a relatively
new regional anesthesia technique that provides analgesia to the
anterior abdominal wall after lower abdominal surgeries. The
anterior abdominal wall components (skin, muscles and parietal
peritoneum) are supplied by sensory neurons derived from the
anterior rami of spinal nerves T6 to L1. These neurons traverse
through the neurofascial plane between the internal oblique and
the transversus abdominis muscles. The aim in TAP block is to
access these nerves in this neurofascial plane through surface
anatomical landmark i.e. “the lumbar triangle of Petit”. Later on,
ultrasound guidance was used in TAP block and offers high
success rate with almost no reported complications.
The use of ultrasound allows for accurate deposition of the local
anesthetic in the correct neurovascular plane. Recently, ultrasound-guided
TAP blockade has been described in three different techniques: The
posterior TAP block involves injection of local anesthetic in the TAP in
the lateral abdominal wall between the costal margin and the iliac crest and
is suitable for surgery below the umbilicus. The subcostal TAP block
involves injection of local anesthetic into the TAP lateral to the linea
semilunaris immediately inferior and parallel to the costal margin and is
suitable for abdominal surgery in the periumbilical region. The subcostal
TAP block can be modified, and the needle can be introduced into the TAP
near the costal margin but medial to the linea semilunaris with subsequent
needle advancement and hydrodissection occurring along a line from the
xyphoid toward the anterior part of the iliac crest. We refer to this line as
the oblique subcostal line and its associated block as the oblique
subcostal TAP block. The goal of this approach was to produce a wider
analgesic blockade suitable for surgery both superior and inferior to the
umbilicus.
The current study was designed to evaluate the use of
bupivacaine 0.25% in right-sided ultrasound-guided TAP block in
open appendicectomy. Fifty adult patients undergoing open
appendicectomy under general anesthesia were randomly
allocated into two groups; group B received right-sided TAP
block using 20 ml of bupivacaine 0.25% (n=25), group S received
general anesthesia without TAP block (n=25).
The primary outcomes from this study were postoperative
pain (evaluated by time for first analgesic request and visual
analog scale VAS (at rest and at movement) and opioids
consumption (intraoperative fentanyl and NSAIDs consumption in
the postoperative 24 hours), whereas the secondary outcomes
were effect on hemodynamics, and the occurrence of nausea
&vomiting and pruritus.
Use of intraoperative fentanyl was lower in group B
regarding the total amount & number of patients (2 in group B vs
25 in group S). Postoperative VAS (at rest and movement) was
lower in group B than in group S, ketorolac consumption in the
postoperative 24 hours was lower in group B than in group S.
Intraoperative MAP was lower after 30 minutes in group B than in
group S. There were significant difference in postoperative
complications as nausea & vomiting and pruritis between 2
groups.
The conclusion from the current study is that right-sided
ultrasound-guided TAP block decreases the need of intraoperative
fentanyl, prolongs the time for first rescue analgesic, lowers
postoperative pain scores and decreases the postoperative
analgesic consumption.