TAP blocks

[urge]

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Liposomal Bupivacaine, Plain Bupivacaine, and Saline for... : Anesthesiology

effectiveness remains unclear. Therefore, two coprimary hypotheses were tested: first, that opioid consumption during the initial 24 postoperative hours is higher with saline than plain bupivacaine or liposomal bupivacaine; and second, that opioid consumption between 24 to 48 h after surgery is...

journals.lww.com

Are fascial plane blocks bogus?

 

[2019medstudent]

Where's that doc who does TAPs for all lap procedures?

 

[UscGhost]

Where's that doc who does TAPs for all lap procedures?

Hes probably busy following the ASA taskforce guidelines...that specifically recommend them...

ASA Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries Guideline Summary - Guideline Central

www.guidelinecentral.com

 

[aneftp]

Would you do a tap block for elective robot gallbladder Easter morning Sunday at 4am after working 21 hours straight with another case to follow another robot lap appy? All solo

True story.

I would not do it out of principal that working 21 hours in a row solo already

 

[psychbender]

Would you do a tap block for elective robot gallbladder Easter morning Sunday at 4am after working 21 hours straight with another case to follow another robot lap appy? All solo

True story.

I would not do it out of principal that working 21 hours in a row solo already

There's so much wrong with that story besides the TAP block question.

 

[JoelJoel84]

For those who don’t want to click through to the article:

Conclusions:​

Single-shot, four-quadrant TAP blocks performed with liposomal bupivacaine, plain bupivacaine, or normal saline before incision for various open and laparoscopic abdominal procedures resulted in similar postoperative opioid consumption and pain scores at 24, 48, and 72 h. Absence of early benefit suggests that routine preincision, single-shot TAP blocks in this mixed surgical population provide little analgesia.

 

[UscGhost]

For those who don’t want to click through to the article:

Conclusions:​

Single-shot, four-quadrant TAP blocks performed with liposomal bupivacaine, plain bupivacaine, or normal saline before incision for various open and laparoscopic abdominal procedures resulted in similar postoperative opioid consumption and pain scores at 24, 48, and 72 h. Absence of early benefit suggests that routine preincision, single-shot TAP blocks in this mixed surgical population provide little analgesia.

Of note..

Same author concluded that TAP blocks were comparable to epidurals

https://www.anesthesiologynews.com/Clinical-Anesthesiology/Article/04-21/TAP-Block-Liposomal-Bupivacaine-Epidural/63136

 

[gunnershow]

Would you do a tap block for elective robot gallbladder Easter morning Sunday at 4am after working 21 hours straight with another case to follow another robot lap appy? All solo

True story.

I would not do it out of principal that working 21 hours in a row solo already

Time of day doesn't affect my anesthetic. But I won't be doing these for a robot gallbladder anyway. Incarcerated hernia.. yeah I would.

 

[cittykat]

Good read.

Few points stick out for me.

1. No mention of intraoperative opioid doses.

2. Pacira funded study.

3. Blocks performed prior to incision.

4. Close to zero Asian and Hispanic patients.

 

[Maverikk]

They're asking the wrong question. The surgeries include 'major abdominal,' their example was: colorectal, gyn, hernia repairs. Read the deatils: 25% laparoscopic surgery. Who knows how many open inguinal hernias.

I don't do TAPs for gyn unless it's a big open tumor, and definitely not for hernias, even open inguinal which I think it would help for but the surgeons local is enough. Imagine if you did a study of infraclavicular block vs local vs bupivicaine for 'lower extremity surgery' but then 25% were carpal tunnel releases...think that might affect your outcomes? What about finger ID or amp?

If your question is stupid what do you think of the answer? The question should be: for open surgeries does it matter. I do TAPs and rectus sheath and I think they get better relief than if the surgeon tried to localize that much area.

 

[Hoya11]

They're asking the wrong question. The surgeries include 'major abdominal,' their example was: colorectal, gyn, hernia repairs. Read the deatils: 25% laparoscopic surgery. Who knows how many open inguinal hernias.

I don't do TAPs for gyn unless it's a big open tumor, and definitely not for hernias, even open inguinal which I think it would help for but the surgeons local is enough. Imagine if you did a study of infraclavicular block vs local vs bupivicaine for 'lower extremity surgery' but then 25% were carpal tunnel releases...think that might affect your outcomes? What about finger ID or amp?

If your question is stupid what do you think of the answer? The question should be: for open surgeries does it matter. I do TAPs and rectus sheath and I think they get better relief than if the surgeon tried to localize that much area.

well i think there are some who do have a shotgun approach to TAPS and block everything abdominal whether laparoscopic or not, i agree it would be a better study for open incisions and hernias where the abdominal wall is the main pain generator

 

[Maz777]

Would you do a tap block for elective robot gallbladder Easter morning Sunday at 4am after working 21 hours straight with another case to follow another robot lap appy? All solo

True story.

I would not do it out of principal that working 21 hours in a row solo already

The bigger question is why would anyone take a job that is doing elective chole's at 4am. I wouldn't last a week at that workplace.

I've probably done over 1000 TAP blocks in my career. If I never did another one, I might die a happy person. They are utterly pointless. The only time it even makes some degree of sense is a stat GA C-section/Pfannenstiel with no time for neuraxial. That's about it, in my opinion. And doing TAPs for midline exlaps is beyond absurd.

Decent study overall though minus the glaring heterogeneity of the types of surgeries (lumping open and laparoscopic surgeries together is silly). This study makes no mention if the surgeons were allowed to infiltrate at the end of the case (I'm guessing not given how much LA was used but that's a key missing point). 50cc of 0.5% bupi is legit BTW (and by legit, I mean excessive). Overall, surprised that Anesthesiology published this, but it's a Sessler group paper, so they have an automatic in.

We need that lap appy TAP guy to come back and tell us how we are all *****s.

 

[mapa1001]

I think most people have known these things don't work very well, but surgeons keep asking for them, it satisfies admins "multimodal" opiate reduction checklists, and it generates revenue.