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Transversus abdominis plane (TAP) block is a novel type of peripheral nerve block that involves innervations of the anterolateral abdominal wall derived from T6-L1.It provides adequate post-operative pain relieve following the various abdominal surgeries. Theoretically, TAP block may replace the need for epidural analgesia after abdominal operations. The oblique subcostal approach of the TAP (OSTAP) block, which was de¬scribed by (Hebbard et al, 2010) , has been reported to provide analgesia to the entire anterior abdomen.
The transversus abdominis plane (TAP) technique, originally described by involves injection of local anaesthetic in the plane between the internal oblique and transversus abdominis muscle layers, with the aim of anaesthetising the intercostal nerves supplying the abdominal wall. Initially, the block used surface landmarks of the triangle of Petit (latissimus dorsi posteriorly, external oblique superiorly, iliac crest inferiorly) and a double fascial 'pop' (loss of resistance) to guide placement of the local anaesthetic. More recently, ultrasonography has been used to guide the delivery of the injectate into the appropriate plane, thereby increasing the accuracy of the Technique.
The duration of the TAB is limited to effect of administered local anesthetics. To prolong the block's duration, adjuvant medications were added to LA to magnify the effect of TAP block . Opiates such as morphine and tramadol have peripheral and central analgesic effects. Opiate receptors are present at the terminals of afferent peripheral nerves; therefore, administration of opiates peripherally might provide a significant analgesic effect.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Bupivacaine 0.25% | Active Comparator | Bupivacaine 0.25% 20ml will be administered for ultrasound guided TAP block on each side on each side at end of the surgery. |
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| Morphine 10mg | Active Comparator | Morphine 10mg and Bupivacaine 0.25% 20ml will be administered for ultrasound guided TAP block on each side at end of the surgery.Patients will recieve 5mg morphine on each side |
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| Morphine 15mg | Active Comparator | Morphine 15mg and Bupivacaine 0.25% 20ml will be administered for ultrasound guided TAP block on each side at end of the surgery. Patients will recieve 7.5mg morphine on each side |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Bupivacaine 0.25% 20ml on each side Sonar guided TAB | Drug | Bupivacaine 0.25% 20ml on each side Sonar guided TAP block. After careful aspiration injection of 20ml of 0.25% bupivacaine will be performed and hypoechoic layer will be detected on ultrasound then the maneuver will be repeated on the other side |
| Measure | Description | Time Frame |
|---|---|---|
| Verbal Rating Scale Score | The 24 hours postoperative verbal rating scale score on cough | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Time to first request of rescue analgesia. | The total 24 hours consumption of analgesic drugs taken. | 24 hours |
| Time to first request of rescue analgesics. | The time from end of the operation, PACU admission and the request for analgesic drugs. |
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Inclusion Criteria:
BMI< 30kg/m2.
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Hala S Abdel-Ghaffar, MD | Assisstant professor in anesthesia and intensive care, faculty of medicine, Assiut university, Egypt | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hala Saad Abdel-Ghaffar | Asyut | Assiut Governorate | 715715 | Egypt |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D010146 | Pain |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009461 | Neurologic Manifestations |
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| ID | Term |
|---|---|
| D002045 | Bupivacaine |
| D009020 | Morphine |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
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|
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| Morphine 10mg | Drug | Morphine 10mg will be added to bupivacaine in sonar guided- TAP block divided into 5mg on each side. |
|
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| Morphine 15mg | Drug | Morphine 15mg will be added to bupivacaine in sonar guided- TAP block divided into 7.5mg on each side. |
|
|
| 24 hours |
| Spirometric assessment | Measurment of lung function by spirometry. | 24 hours |
| Adverse effects | Recording and treatment of adverse effects. | 24 hours |
| D012816 | Signs and Symptoms |
| D000588 |
| Amines |
| D009022 | Morphine Derivatives |
| D009019 | Morphinans |
| D053610 | Opiate Alkaloids |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D010616 | Phenanthrenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D011083 | Polycyclic Compounds |