viernes, 15 de noviembre de 2013

Bloqueo del plano transverso/TAP Block

¿Bloqueo del plano transverso abdominal para analgesia postoperatora en cesárea realizada bajo raquia? Revisión sistemática y meta-análisis

Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis.
Abdallah FW, Halpern SH, Margarido CB.
Division of Obstetrical Anesthesia, Department of Anesthesia, Obstetrical Anesthesia Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Br J Anaesth. 2012 Nov;109(5):679-87. doi: 10.1093/bja/aes279. Epub 2012 Aug 19.
The transversus abdominis plane (TAP) block is a field block that provides postoperative analgesia for abdominal surgery. Its analgesic utility after Caesarean delivery (CD) remains controversial. This systematic review and meta-analysis examines whether TAP block can reduce i.v. morphine consumption in the first 24 h after CD. The authors retrieved randomized controlled trials comparing TAP block with placebo in CD. Postoperative i.v. morphine consumption during the first 24 h was selected as a primary outcome. Pain scores and both maternal and neonatal opioid-related side-effects were secondary outcomes. Where possible, meta-analytic techniques and random effects modelling were used to combine data. Trials were stratified based on whether or not spinal morphine was used as part of the analgesic regimen. Five trials including 312 patients were identified. TAP block reduced the mean 24 h i.v. morphine consumption by 24 mg [95% confidence interval (CI) -39.65 to -7.78] when spinal morphine was not used. TAP block also reduced visual analogue scale pain scores (10 cm line where 0 cm, no pain, and 10 cm, worst pain) by 0.8 cm (95% CI -1.53 to -0.05, P=0.01), and decreased the incidence of opioid-related side-effects. The differences in primary and secondary outcomes were not significant when spinal morphine was used. TAP block provides superior analgesia compared with placebo and can reduce the first 24 h morphine consumption in the setting of a multimodal analgesic regimen that excludes spinal morphine. TAP block can provide effective analgesia when spinal morphine is contraindicated or not used.

Bloqueo del plano abdominal transverso guiado con ultrasonido correlacionado con tomografía computada. Estudio en cadáveres

Ultrasound-guided transversus abdominis plane injection with computed tomography correlation: a cadaveric study.
Moeschler SM, Murthy NS, Hoelzer BC, Gazelka HM, Rho RH, Pingree MJ.

Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.

J Pain Res. 2013 Jul 1;6:493-6. doi: 10.2147/JPR.S45913


BACKGROUND:Ultrasound-guided transversus abdominis plane (TAP) in
jections are increasingly being used as an alternative to traditional perioperative analgesia in the abdominal region. With the use of a "blind"TAP block technique, these procedures have had variable success in cadaver and in vivo studies. For more accurate injection with the intended medication, ultrasound guidance allows visualization of the correct layer of the abdominal wall planes in which the thoracolumbar nerves reside.OBJECTIVE:To assess the spread of various volumes of contrast placed under live ultrasound guidance into the TAP using computed tomography (CT).METHODS:Four TAP blocks were performed on 2 fresh frozen cadaver torsos with predetermined contrast volumes of 5, 10, 15, or 20 mL. A CT scan of the cadaver was then performed and interpreted by a musculoskeletal radiologist. This cadaver study was carried out at a tertiary care academic medical center.RESULTS:Cranial-caudal spread of injected contrast correlated with increasing injectate volume and was roughly 1 vertebral level (end plate to end plate) for the 5 mL injection and 2 vertebral levels for the 10, 15, and 20 mL injections. However, the degree of injectate spread may be different for live patients than for cadavers.CONCLUSION:This study helps further the understanding of injectate spread following ultrasound-guided TAP injections. Specifically, it suggests that 15 mL provides additional cranial-caudal spread and may be an optimal volume of anesthesia.
KEYWORDS:TAP block, abdominal cadaver study, abdominal computed tomography scan, abdominal wall pain, ultrasound-guided injection

Anestesiología y Medicina del Dolor
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