Transversus Abdominis Plane Block as a Substitute to Conscious Sedation for Perioperative Pain Management in Percutaneous Gastrostomy Tube Insertions

Purpose: Percutaneous Gastrostomy (PEG) tube is typically inserted under conscious sedation with midazolam and fentanyl being most used agents. However, this can be associated with respiratory depression which makes it unsuitable for patients with respiratory problems, challenging airways and other comorbidities that makes them high risk of adverse effects. The purpose of this study is to evaluate the effectiveness of transversus abdominis plane (TAP) block in comparison to conscious sedation in tolerating of pain.

Materials and Methods: A retrospective observational cohort review of patients who underwent PEG tube insertion between April 2023 and December 2023 was performed to review alternative methods of pain control to sedation including TAP block. During the 8-month period 25 patients were included, 15 (60%) patients had PEG insertion under conscious sedation and 10 (40%) patients using TAP blocks. Data included patient demographics, anesthesia type, ASA score, patient pain scores during and postprocedure and opiate use postprocedure.

Results: Out of 10 patients who had TAP block, 60% were female in comparison to 66.7% under conscious sedation. The average American society of Anesthesiology score for patients who underwent the procedure under a TAP block and the moderate sedation was 3. In comparison to patients who had sedation, the postprocedural pain scores and maximum pain scores were noted to be significantly lower in patients who had regional block (7.0 vs. 4.8). In the first 24 hours, patients who had regional block were noted to use less opiates. There was no difference in pain levels after 24 hours postprocedure.

Conclusion: In conclusion, regional blocks provide a suitable alternative to moderate sedation particularly in patients who are considered at high risk of adverse effects associated with sedation as it is associated with lower risk of respiratory depression while having better pain control for patients up to 24 hours postprocedure.

 

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Artikel online veröffentlicht:
02. April 2024