Transversus Abdominis Plane Block as a Treatment Modality for Chronic Abdominal Pain

Abstract

Background: This study describes the use of transversus abdominis plane (TAP) blocks to treat and manage chronic abdominal pain (CAP) in patients who have exhausted other treatment options. Typically, this is a procedure prescribed for treating acute abdominal pain following abdominal surgery. Here we evaluate the use of TAP blocks for longer relief from CAP. Objectives: To assess the efficacy of TAP blocks for pain control in patients with CAP. Study Design: This was a retrospective chart review and analysis of TAP blocks performed over 5 years. This project qualified for institutional review board exemption. Setting: This study was completed at an academic institution. Methods: We reviewed the charts of 92 patients who received TAP blocks for CAP after previous treatment was ineffective. Some patients underwent multiple TAP blocks, with a total of 163 individual procedures identified. For most blocks, a solution of 0.25% bupivacaine and triamcinolone was injected into the TAP. Efficacy of the injection was measured using pain scores, percent improvement, and duration of relief from pain. Results: TAP blocks were associated with a statistically significant (P ≤ 0.05) improvement in abdominal pain scores in 81.9% of procedures. Improvement was 50.3% ± 39.0% with an average duration of 108 days after procedures with ongoing pain relief at time of follow-up were removed. There was a significant reduction in emergency department visits for abdominal pain before and after the procedure (P ≤ 0.05). Limitations: This was a retrospective chart review with lack of a control group. Conclusions: TAP blocks can be extrapolated for treating abdominal pain beyond acute settings. TAP injections can be considered as a treatment option for patients with somatosensory CAP refractory to other forms of pain management. Key words: Abdominal pain, transversus abdominis plane block, chronic pain, chronic abdominal pain, pain management, somatosensory pain, transversus abdominis plane, steroid injection