POST OPERATIVE ANALGESIA FOR LSCS: ROLE OF TAP BLOCK WITH MINIMAL RESOURCES: OUR EXPERIENCES WITH RENOVATED LOR TECHNIQUE
|IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:114
Conference: TACON 2014 The Anaesthetist Conference [Click here for details]
Authors: Surajit Giri
Authors Affiliations: Consultant Anaesthesiologist, Sivasagar,Assam
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There is tremendous resurgence of TAP block in abdominal surgeries in last few years. However Rafi et al first described it as two POP techniques in 2001 but latter it is advocated to perform this block only by USG because of frequent failures and complications of LOR TAP block. USG availability is an issue for a country like India. Rural anaesthetist still has to rely on the landmark technique for TAP block.
Find out the cause of frequent failure of LOR TAP block and the solution for successful TAP block.
We have found that the ‘CUSHION EFFECT’ is the consistent cause of failure. This cushion effect gives us false interpretation of POPs and ultimately we deposit the LA in wrong plane. Needle insertion point is just above iliac crest at mid axillary line. As caesarian incision crosses midline TAP was given BL.20ml 0.25% Levobupivacaine was used BL. All patients were given Spinal anaesthesia with bupivacaine heavy 10mg plus 20microgram fentanyl using 25G Whitacare needle and same needle was used for TAP block. By oblitering the cushion effect we can meticulously look for ‘BOUNCE’ and POP from external oblique fascia and second ‘BOUNCE’ and POP from internal oblique fascia and deposit the LA in right plan. Prospective chart review was done in 200 numbers of LSCS patients. TAP block was given at the end of surgery using needle through needle technique.
Primary outcome was effectiveness of our renovated technique of TAP block. Secondary outcome was postoperative VAS score and toileting.
93 % mother had VAS <2, 5% requested for rescue analgesic and 2% had severe pain. VAS score was significantly less in between 1-3 both in rest and movement in first 24hrs in postoperative period.91% said toileting was very easy and without discomfort by 8hrs, 5% had some discomfort and 4% had no toileting at all. No complications were noted.
Our renovated LOR technique for TAP block is equally safe and efficacious as compared to USG provided one has thoroughly understood the cushion effect and techniques to eliminate this effect.
|How to Cite this Abstract|
|Giri S. POST OPERATIVE ANALGESIA FOR LSCS: ROLE OF TAP BLOCK WITH MINIMAL RESOURCES: OUR EXPERIENCES WITH RENOVATED LOR TECHNIQUE. International Journal of Conference Proceedings 2015;(2015):114|