Comparative study between ultrasound guided tap block and paravertebral block in upper abdominal surgeries. Randomized controlled trial

Background: TAP and the paravertebral block both have been described as successful as an adjunct for postoperative analgesia following abdominal procedures. The proposed benefits of both include the avoidance of neuraxial analgesic techniques and their associated risks, as well as a reported reduction in opioid consumption. Objective: This study was to compare between ultrasound guided (TAP) block and ultrasound guided paravertebral block (PVB) and their effect as regards postoperative analgesia, the total analgesic requirements 24 h after abdominal surgeries, their impact on stress response and incidence of postoperative complications. Methods: We performed a randomized controlled trial on 80 patients subjected to unilateral upper abdominal surgeries of both sexes, age between 20 and 50, and ASA physical status I-II. Patients were randomly divided into two equal groups: Group (I): 40 patients undergoing ultrasound guided unilateral transversus abdominis plane block and Group (II): 40 patients undergoing ultrasound guided unilateral thoracic paravertebral block. Results: There was a significant decrease in VAS scores in PVB group with relatively longer time to 1st order analgesia and relatively lower analgesic requirements than TAP group as regards stress response and both groups attenuate increase in postoperative stress hormone with no significant difference. On the other hand PVB group decreases PONV more than TAP group with no significant difference between both groups as regards total ephedrine consumption. Conclusion: We concluded that ultrasound guided transversus abdominis plane block and thoracic paravertebral block were safe and effective anesthetic technique for upper abdominal surgery with longer and potent postoperative analgesia in thoracic paravertebral block than transversus abdominis block.