Nerijus Jakutis1, Andrius Pajėda2, Karolis Černauskis3, Tomas Petras Vileikis4
1Centre of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania.
2 “Nordclinic”, Lithuania.
3Department of Surgery, Lithuanian University of Health Sciences, Lithuania
4Faculty of Medicine, Vilnius University, Lithuania.
This paper introduces 4 different ways described in literature of performing transversus abdominis plane block in abdominoplasty. Based on the results of these four techniques, it can be assumed that ultrasound guided method, described by E. M. Salama, showed lowest pain scores 24 hours postoperatively, and in this patient group lowest total amount of morphine was consumed. Whereas longest median time to first analgesic demand was in group of patients to whom Abo-Zeid described technique was applied – in this group TAP block was applied after flap resection and plication of anterior abdominal wall muscles. Other methods of performing TAP block: anesthetic injection after splitting of the external oblique fascia lateral to the semilunar line, advancing needle towards the costal margin (A. J. Oppenheimer method) and anesthetic injection both superolaterally and inferolaterally after the plication of diastasis and after making a small 2-3cm incision medial to anterior superior iliac spine (T. Fiala method) showed the least effective results of postoperative pain relief. However, in order to draw more reliable, clinically and statistically significant conclusions, it is appropriate to carry out more studies by changing the methodologies for evaluating the results, choosing a larger sample of patients and including a control group in the study.
Key words: abdominoplasty, nerve block, postoperative pain, local anaesthetic, analgesia.