*Co esponding au ho : Kadek Ind iani Adwi ya
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
E ec i eness o bila e al block ans e sus abdominis plane app oach linea
semiluna compa ed o la e al app oach as pos -lapa o omy colo ec al analgesia
Kadek Ind iani Adwi ya *, I Made Subagia ha, I Wayan A yabian a a, I Made Gede Widnyana and Tjoko da
Gde Agung Senapa hi
Residen o a Depa men o Anes hesiology, Pain Managemen , and In ensi e Ca e, Udayana Uni e si y, Sanglah Gene al
Hospi al Bali.
GSC Biological and Pha maceu ical Sciences, 2025, 32(03), 286-293
Publica ion his o y: Recei ed on 16 Augus 2025; e ised on 19 Sep embe 2025; accep ed on 22 Sep embe 2025
A icle DOI: h ps://doi.o g/10.30574/gscbps.2025.32.3.0348
Abs ac
Backg ound: Pa ien s who unde go midline incision colo ec al su ge y o en expe ience mode a e o se e e
pos ope a i e pain, which lead o high le el o opioid need. T ans e sus Abdominis Plane (TAP) block is a componen o
mul imodal analgesia which May educe pos ope a i e pain and amoun o opioid consump ion. This s udy aims o
compa e he e ec i eness o Linea Semiluna is app oaches o La e al app oach o TAP block on he pos ope a i e pain,
du a ion o he pos ope a i e analgesia e ec and quali y o pos ope a i e eco e y in pa ien s unde going colo ec al
su ge y wi h gene al anes hesia
Me hods: This s udy was a single blind andom con olled ial. Fo y pa ien s who me he c i e ia and we e planned
o colo ec al su ge y unde gene al anes hesia a P o . D . IGNG Ngoe ah Gene al Hospi al, Denpasa . Subjec s we e
hen andomly alloca ed in o 2 g oups, g oup P1 we e planned o ecei e bila e al TAP block wi h semiluna app oach,
while g oup P2 we e planned o ecei e bila e al TAP block wi h la e al app oach. Bo h ea men g oups ecei ed
Bupi acaine 0.25% 20 ml on each side o he abdomen pos ope a i ely. Fu he mo e, an e alua ion o pain in ensi y
(VAS) was ca ied ou a 1, 6, 12, 24 and 48 hou s pos ope a i ely, eco ding he du a ion o he analgesic and he quali y
o pos ope a i e eco e y which was assessed using he QoR-40 ques ionnai e.
Resul s: The e we e no signi ican di e ences in demog aphic cha ac e is ics be ween he wo g oups. S a is ical es s
showed ha g oup P1 had lowe pain in ensi y (VASE) a 6 hou s (median: 0 s. 3), 12 (mean: 2.42 s. 3.36), and 24
(mean:2.45 s. 3.18) (p < 0.001), longe du a ion o analgesic e ec (minu es) (median:460 s. 260, p < 0.001), lowe o al
opioid mo phine equi emen (mg) in 24 hou s (median 3 s. 5, p < 0.001) and highe quali y o eco e y (QoR-40
sco e) o pa ien s a 24 hou s (median 180 s. 147.5, p < 0.001) and 48 hou s (median: 181.5 s. 151.5, p < 0.001).
Conclusion: Bila e al TAP block in wi h semiluna app oach show be e analgesia e ec i eness and quali y o eco e y
a e midline incision colo ec al su ge y han la e al app oach
Keywo ds: T ans e sus Abdominis Plane Block; La e al; Semiluna ; Colo ec al lapa o omy; Quali y o pos ope a i e
eco e y; Pos ope a i e analgesia
1. In oduc ion
Colo ec al lapa o omy is one o he majo su gical p ocedu es o he ea men o colo ec al cance ha can cause
complica ions such as pain. Pos ope a i e pain can a ec he ime o mobiliza ion and ehabili a ion, leng h o
hospi aliza ion, pa ien sa is ac ion and ch onic pain. Con en ional pain managemen using opioids has side e ec s
GSC Biological and Pha maceu ical Sciences, 2025, 32(03), 286-293
287
(nausea, omi ing, dec eased bowel mo ili y) so ha egional echniques such as epidu al analgesia ha e been
de eloped o educe opioid use and accele a e eco e y. The applica ion o epidu al analgesia o pain managemen
o en causes complica ions such as in ec ion and hema oma, as well as he isk o mo e se e e ins alla ion such as en y
in o he suba achnoid space o spinal ne e inju y.1 To educe side e ec s and deal wi h his pe iope a i e pain
p oblem, mul imodal pain managemen can be used, one o which is using epidu al analgesia.2
Ano he echnique de eloped is he T ans e sus Abdominis Plane (TAP) block. This echnique has a low isk o
complica ions because i is easily ecognized based on sonoana omy. In he de elopmen o analgesia echniques in
midline lapa o omy, se e al app oaches o local anes he ic injec ion in he TAP echnique we e de eloped such as he
la e al, subcos al and pos e io app oaches. Each TAP block app oach has i s own cha ac e is ics o analgesic co e age.
These app oaches each ha e di e en b oad scopes o analgesia and al hough ini ially he la e al TAP app oach was
said o be used o midline lapa o omy, he esul s o di e en s udies ha e caused esea che s o no be able o p o ide
clea ecommenda ions. The TAP echnique o he semiluna line app oach de eloped wi h ini ial s udies showed a
be e analgesic p o ile and p o ided a wide scope o analgesia.3,4
TAP block wi h semiluna line app oach is said o be an e ec i e and sa e p ocedu e o colo ec al lapa o omy, his
block has a e y low isk o complica ions, because he sonoana omy is easily ecognized and he e a e no nea by
s uc u es a isk o inju y. Bila e al TAP block wi h semiluna line app oach p oduces senso y block wi h de ma ome
co e age T10-L1 and wide sp ead la e ally and medially in colo ec al lapa o omy su ge y, combining he e ec s o TAP
block and ec us shea h.5,6
2. Ma e ials and me hods
This s udy is a pu e expe imen al esea ch wi h a double-blind andomized con ol ial design. The subjec s in his
s udy we e di ided in o wo g oups: he con ol g oup ecei ed la e al app oach TAP Block, while he expe imen al
g oup ecei ed semiluna linea app oach TAP Block. To assign he subjec s in o ei he he i s expe imen al g oup o
he con ol g oup, andomiza ion was conduc ed, and blinding was applied o bo h he subjec s and he esea che .
Then he pain in ensi y was assessed using a isual analogue scale (VAS) a 1, 6, 12, 24, and 48 hou s, he du a ion o
he analgesic e ec , he o al opioid equi emen in 24 and 48 hou s, he quali y o pos ope a i e eco e y 24 and 48
hou s (QoR-40) pos ope a i ely . The s udy was conduc ed in he ope a ing oom o he Cen al Su gical Ins alla ion o
a eaching hospi al om May o Oc obe 2024.
Inclusion C i e ia includes adul pa ien s aged 18-65 yea s unde going colo ec al lapa o omy su ge y wi h physical
s a us ASA I-II. Exclusion C i e ia include d ug alle gy , in ec ion in he a ea o be blocked , se e e ca dio ascula
diso de s , his o y o ch onic analgesia use , use o blood hinne s ha ha e no been s opped acco ding o guidelines
and coagulopa hy, he pa ien o pa ien 's gua dian e uses o sign a consen o m o pa icipa e in his s udy , pa ien s
wi h impai ed consciousness . D op Ou C i e ia includes complica ions ( eg , alle gic eac ions, se e e bleeding, dea h)
and pa ien was on en ila o pos ope a i ely
2.1. P ocedu e
Pa ien s in g oup P1 will be gi en bila e al TAP block wi h a semiluna line app oach a e gene al anes hesia. The
ul asound machine uses a linea p obe placed la e al o he umbilicus o isualize he ec us shea h, hen di ec ed
la e ally o isualize he ex e nal obliquus, in e nal obliquus and ans e sus abdominis muscles wi h he semiluna
line as a connec o . The injec ion a ge is he a ea below he semiluna line. The needle is inse ed using he in-plane
echnique. Local anes he ic bupi acaine 0.25% is hen injec ed in o he a ge a ea as much as 20 ml. Iden i y he
hypoechoic sign ha appea s a e injec ion in he a ea, wi h he local anes he ic appea ing o sp ead medially and
la e ally, li ing he in e nal oblique and ec us abdominis muscles upwa ds. A e he needle injec ion is emo ed, he
block is pe o med wi h he same p ocedu e on he opposi e side.
Pa ien s in g oup P2 will be gi en bila e al TAP block wi h a la e al app oach a e gene al anes hesia. The ul asound
machine uses a linea p obe placed be ween he iliac c es and he lowe bo de o he ibs in he an e io midaxilla y
line a he le el o he umbilicus. Iden i y he abdominal laye s (ex e nal oblique, in e nal oblique, and ans e sus
abdominis muscles). The injec ion a ge is he a ea be ween he in e nal oblique and ans e sus abdominis muscles.
The needle is inse ed using he in-plane echnique. Local anes he ic bupi acaine 0.25% is hen injec ed in o he a ge
a ea as much as 20 ml. Iden i y he hypoechoic sign ha appea s a e injec ion in he a ea ha li s he in e nal oblique
muscle upwa ds. A e he needle injec ion is emo ed, a block is pe o med wi h he same p ocedu e on he opposi e
side.
GSC Biological and Pha maceu ical Sciences, 2025, 32(03), 286-293
288
Pa ien s we e gi en PCA mo phine demand only analgesia wi h he ollowing p o isions: bolus dose o 1 mg pe
squeeze, maximum dose o 10 mg/4 hou s and lockou in e al o 6 minu es and ke o olac 30 mg (i ) gi en e e y 8
hou s and pa ace amol 500 mg (po) gi en e e y 6 hou s.
A e he pa ien mo es o he oom, he acu e pain se ice (APS) eam will e alua e he pain scale a 1, 6, 12, 24, 48
hou s pos ope a i ely, he i s ime he PCA bu on was p essed and he o al opioid consump ion da a in 24 and 48
hou s on he PCA machine will be eco ded.
Complica ions and side e ec s du ing su ge y and pos ope a i ely such as hypo ension, a hy hmia, b adyca dia,
nausea, omi ing, in a ascula injec ion, lowe ex emi y muscle weakness, and local anes hesia sys emic oxici y a e
eco ded in he e alua ion eco ding shee
Pa ien s a e gi en he Indonesian e sion o he QoR-40 ques ionnai e o assess he quali y o pos ope a i e eco e y
a 24 hou s and 48 hou s pos ope a i ely.
2.2. S a is ical Analysis
Desc ip i e analysis aims o desc ibe he cha ac e is ics o he subjec s and esea ch a iables based on he ea men
g oup. Va iables ha a e on a nume ic da a scale a e displayed as he mean and s anda d de ia ion (SD) i hey a e
no mally dis ibu ed, while i hey a e no no mally dis ibu ed, hey use he median and in e qua ile ange . The
no mali y es aims o assess whe he a iables such as age (yea s), heigh (cm), weigh (kg), BMI (kg/m²), dis ibu ion
o pain scale a iables, o al in a enous opioid use, ime in e al o i s pos ope a i e PCA use and quali y o
pos ope a i e eco e y ollows a no mal dis ibu ion. This analysis was conduc ed using he Shapi o-Wilk es a a
signi icance le el o 0.05, whe e da a is conside ed no mal i p > 0.05. The homogenei y es is used o e alua e whe he
he a iances be ween g oups a e homogeneous. The homogenei y o a iance is es ed using Le ene's es . Va iances
a e conside ed homogeneous i p > 0.05 and no homogeneous i p ≤ 0.05. Di e ences in The e ec i eness o he block
in e ms o pain scale, o al use o in a enous opioids, ime in e al be ween i s PCA use pos ope a i ely, quali y o
pos ope a i e eco e y we e assessed based on mean di e ences, so an independen - es was used. I he da a
be ween he con ol and ea men g oups a e no no mally dis ibu ed, he Mann-Whi ney es is applied in he da a
analysis. Pe cen ages and igu es a e used o ep esen quali a i e da a such as gende , ASA physical s a us, and
in uba ion condi ions using 2x2 c oss- abula ion analysis. The s a is ical es applied is he Chi-Squa e es . The esul s
will be p esen ed as Rela i e Risk (RR). Conclusions a e d awn based on a 95% Con idence In e al (CI) and a P- alue
wi h a signi icance le el o α < 0.05. The en i e da a analysis p ocess is pe o med using SPSS s a is ical so wa e.
3. Resul
The sample's cha ac e is ics can be seen in Table 1. All he subjec s be ween he case and he con ol g oup we e
compa able.
Table 1 Subjec Cha ac e is ics
Pa ien Cha ac e is ics
G oup
p- alue
Case (n=20)
Con ol(n=20)
Age ( yea s ), mean ± SD
58.5( 3)
59.3(±3.6)
0.452 T
Gende
0.342 C
Female, n (%)
8 (42.1)
11 (57.9)
Male , n (% )
12 (57.1)
9 (42.9)
BMI (kg/ m2 ) , mean ± S D
21.9 ( 2.6)
20.2 ( 3.2)
0.092 T
ASA Physical S a us
0.752 C
I, n (%)
11 (52.4)
10 (47.6)
II, n (%)
9 (47.4)
10 (52.6)
Su ge y du a ion ( minu e )
175 [140-210]
171 [140-210]
0.841 M
GSC Biological and Pha maceu ical Sciences, 2025, 32(03), 286-293
289
To al Fen anyl in aope a i e (mcg)
175 [150-250]
150 [150-250]
0.478 M
Type Su ge y
LAR And Ul a LAR
6 (35.3)
11 (64.7)
0.070 C
Colec omy
3 (33.3)
6 (66.7)
P ocedu e making S oma
8 (80)
2 (20)
O he s ( biopsy , adhesiolysis )
3 (75)
1 (25)
T Tes independen - es . C Pea son Chi-Squa e Tes . M Tes Mann Whi ney, signi ican i p < 0.05
In his s udy, an e alua ion was conduc ed a 1, 6, 12, 24 and 48 hou s a e colo ec al lapa o omy assessed by VAS.
A e conduc ing he Shapi o-Wilk and Le ene es s, an abno mal da a dis ibu ion was ob ained (p < 0.005) in he VAS
da a a 1 and 6 hou s, o de e mine a signi ican di e ence be ween he wo g oups, a non-pa ame ic Mann-Whi ney
es was used. The Shapi o-Wilk es showed a no mal da a dis ibu ion (p > 0.05) in he VAS da a a 12, 24 and 48
hou s, so an independen - es was pe o med o de e mine he mean di e ence. Based on he esul s o s a is ical
analysis (Table 2), he e was a signi ican di e ence be ween he median VAS alues o g oup P1 and g oup P2 a 6, 12
and 24 hou s pos ope a i ely (p < 0.001) bu he e was no signi ican di e ence a 1 and 48 hou s pos ope a i ely (p >
0.05). F om he s a is ical es s conduc ed, i can be concluded ha g oups P1 and P2 showed simila le els o pain a 1
hou pos -su ge y, bu a 6, 12 and 24 hou s showed lowe le els o pain in g oup P1 and a 48 hou s showed simila
le els o pain again.
Table 2 Compa ison Table o VAS alues a 1, 6, 12, 24 and 48 hou s pos ope a i ely
VASE
G oup
p- alue
Case (n=20)
Con ol(n=20)
VASE 1s hou
0 [0 – 0.48]
0 [0 – 0.95]
<0.565 M
VASE 6 h hou
0 [0 – 1.48]
3.0 [2.0 – 3.0]
<0.001 M
VASE 12 h hou
2.42 (± 0.59)
3.36 (± 0.63)
<0.001 T
VASE 24 h hou
2.46 (± 0.33)
3.18 (± 0.53)
<0.001 T
VASE 48 h hou
2.31 (± 0.55)
2.42 (± 0.60)
0.566 T
Desc ip ion : Mann-Whi ney es ; independen T- es . , Da a displayed as median [IQR] And mean (± SD). signi ican i p < 0.05
The du a ion o he analgesic e ec was calcula ed om he ime he TAP block, ei he he semiluna o la e al line
app oach, was comple ed in il a ed un il he pa ien p essed he PCA bu on o he i s ime. Due o he non-no mal
dis ibu ion o da a based on he Shapi o-Wilk es (p < 0.01), a non-pa ame ic Mann-Whi ney es was pe o med.
F om he s a is ical es pe o med (Table 3), a signi ican di e ence was ound in he du a ion o he analgesic e ec
pa ame e s in g oups P1 and P2 (p <0.05). The analgesic e ec in g oup P1 was an a e age o 460 (385-487.5) minu es,
while in g oup P2 i was an a e age o 215 (180-240) minu es. This analysis showed ha he du a ion o he analgesic
e ec a e colo ec al lapa o omy su ge y in g oup P1 was longe han in g oup P2. The e o e, i can be said ha he
g oup ha ecei ed TAP block wi h a semiluna line app oach a e colo ec al lapa o omy su ge y expe ienced a longe
pain- ee pe iod compa ed o he g oup ha ecei ed TAP block wi h a la e al app oach a e colo ec al lapa o omy
su ge y.
Table 3 Analysis Du a ion da a E ec Analgesia Pos -ope a i e
G oup In e en ion
Va iables
Ma k p
P1 (n=20)
P2 (n=20)
E ec Du a ion Analgesia (minu e)
460 [385 – 487.5]
215 [180 – 240]
<0.001 M
Da a displayed as median [IQR]. p <0.05 se as meaning ul.
GSC Biological and Pha maceu ical Sciences, 2025, 32(03), 286-293
290
To al opioid equi emen s we e assessed a 24 and 48 hou s a e colo ec al lapa o omy su ge y. Da a we e ound o
be abno mally dis ibu ed (p < 0.05) in he da a on mo phine opioid equi emen s o 0 o 24 hou s and mo phine
opioid equi emen s o 24 o 48 hou s and no mally dis ibu ed in he da a on o al mo phine opioid equi emen s o
48 hou s (p > 0.05) wi h he Shapi o-Wilk no mali y es , so ha a compa ison es will be pe o med using he Mann-
Whi ney es on he da a on o al mo phine opioid equi emen s o 0 o 24 hou s and mo phine opioid equi emen s
o 24 o 48 hou s, as well as an independen es on he da a on o al mo phine opioid equi emen s o 48 hou s.
F om he s a is ical es s pe o med, he e was a signi ican di e ence in o al opioid equi emen s o 24 and 48 hou s
a e colo ec al lapa o omy su ge y (p < 0.05) in g oup P1 compa ed o g oup P2, bu he e was no signi ican di e ence
in opioid equi emen s o he pe iod 24 o 48 hou s a e su ge y in bo h g oups. Thus, i can be concluded ha he
g oup ecei ing TAP block using he semiluna line app oach equi ed less o al in a enous opioids in 24 and 48 hou s,
wi h a median alue o 3 and 5 mg pos ope a i ely o colo ec al lapa o omy, bu he e was no di e ence in opioid
equi emen s in he 24-48 hou pos ope a i e pe iod .
Table 4 Da a analysis o he amoun o in a enous opioid equi emen s 0-24, 24-48 and 0-48 hou s pos ope a i ely
G oup In e en ion
Va iables
Ma k p
P1 (n=20)
P2 (n=20)
Amoun mo phine (mg) 0-
24 hou s
3 [3 – 4]
5 [5 – 6]
<0.001 M
Amoun mo phine (mg)
24-48 hou s
4 [3 – 5]
3.5 [3 – 5]
1,000 M
Amoun o al mo phine
(mg) in 48 O'clock
7.15 (± 1.39)
8.8 (± 1.58)
<0.005 T
M Tes Mann-Whi ney; T Tes independen T es
Da a displayed as median [IQR] And mean (± SD). Ma k p <0.05 se as meaning ul.
In his s udy, an e alua ion o he quali y o eco e y a e colo ec al lapa o omy su ge y was ca ied ou based on he
QoR-40 ques ionnai e a 24 and 48 hou s a e su ge y. A e he Shapi o-Wilk es , an abno mal da a dis ibu ion was
ob ained (p<0.05) apa om he QoR-40 com o and independence da a in 24 hou s and QoR-40 com o in 48 hou s,
o de e mine a signi ican di e ence be ween he wo g oups, a non-pa ame ic Mann-Whi ney es was pe o med on
da a ha was no no mally dis ibu ed and an independen es on da a ha was no mally dis ibu ed. Based on he
esul s o s a is ical analysis (Table 5.5), he e was a signi ican di e ence in he o al QOR-40 alue which was highe
in g oup P1 compa ed o g oup P2 (p<0.001). In addi ion o he o al QOR-40 alue, all aspec s assessed we e ound o
be s a is ically highe (p<0.001) in g oup P1 compa ed o g oup P2 (Figu e 5.4). Thus, i can be concluded ha he
eco e y quali y p oduced by he TAP block semiluna line app oach is highe compa ed o he la e al app oach.
Table 5 Analysis da a QoR-40 Sco e 24 and 48 Hou s Pos -ope a i e
Va iable
P1 (n=20)
P2 (n=20)
p- alue
QoR-40 sco e 24 h hou
180 [175.2 - 184]
147.5 [138- 155.5]
<0.001M
Com o
52 (±3.11)
43.1 (±4.76)
<0.001T
Feeling
42 [39 – 43.8]
36 [34 – 38.8]
<0.001M
Physical Independece
21.15 (±1.93)
17.25 (±2.149)
<0.001T
Pa ien ’s suppo
32 [31.3 – 34.8]
25.5 [24 - 28]
<0.001T
Pain
32 [30.5 – 34.8]
25 [22.3 - 28]
<0.001M
QoR-40 sco e 48 h hou
181.5 [117.3 - 186]
151.5 [143.5 – 162.8]
<0.001M
Com o
52.75 (±3.23)
44.15 (±4.68)
<0.001T
Feeling
42 [40 - 44]
36.5 [35.3 - 39]
<0.001M
GSC Biological and Pha maceu ical Sciences, 2025, 32(03), 286-293
291
Physical Independece
22 [20.5 – 23.8]
18 [17 - 21]
<0.001M
Pa ien ’s suppo
32 [31.3 - 34]
27 [24.3 – 31.8]
<0.001M
Pain
32.5 [32 – 34.8]
25.5 [23.3 – 28]
<0.001M
MMann Whi ney Tes ; T Tes independen T es ; Da a displayed as median [IQR] And mean (± SD). Ma k p <0.05 se as meaning ul.
4. Discussion
The indings in his s udy indica e ha bila e al TAP block wi h semiluna line app oach a e colo ec al lapa o omy
su ge y is mo e e ec i e in educing pain in ensi y compa ed o la e al app oach a 6, 12 and 24 hou s, bu he e is no
signi ican di e ence a 1 and 48 hou s a e colo ec al lapa o omy su ge y. The low pain in ensi y a 1 hou in bo h
g oups indica es adequa e analgesic e ec in bo h ea men s, bu a 6 hou s, he e is a highe pain in ensi y in he
la e al TAP app oach g oup indica ing ha he analgesic e ec o TAP wi h semiluna line app oach is mo e du able
han la e al app oach. This is in acco dance wi h he esea ch o Xu e al. (2023) which s a ed ha wi h semiluna line
echnique, he highes median [IQR] VAS sco e was 4 [4-5] and he lowes was 2 [1-2] wi h an e ec i e block du a ion
o 8.0 [6.8-9.2] hou s7.
TAP block wi h bo h app oaches showed simila analgesic e ec in he i s hou a e he p ocedu e. These esul s a e
suppo ed by p e ious s udies. A adiological s udy ound ha a e injec ion o local anes he ic (0.5% lidocaine) wi h
a adiological agen o TAP block, he e was a senso y de ici ha wo ked maximally 90 minu es a e injec ion, his
e ec began o dec ease a e 4 hou s and comple ely disappea ed a 24 hou s pos -injec ion. 8 In a clinical ial s udy
conduc ed by Bha i e al. (2011) i was ound ha subjec s who ecei ed a la e al app oach TAP block a e colo ec al
lapa o omy su ge y wi h a midline incision had low pain in ensi y (VAS 1-2/10) in he i s hou a e su ge y, bu hen
he pain in ensi y inc eased o be simila o subjec s who did no ecei e TAP block ea men 24 hou s a e su ge y.9
Howe e , he addi ional indings ha we ob ained we e by using he semiluna line app oach, showing lowe pain
in ensi y compa ed o he la e al app oach un il 24 hou s a e su ge y, so i can be concluded ha he semiluna line
app oach TAP block is supe io o educing he in ensi y o pa ien pain in he i s 24 hou s.
One ac o ha may in luence he di e ence in pain in ensi y a 6, 12 and 24 hou s is he subop imal placemen o local
anes he ic d ugs. S udies aimed a assessing he success a e o TAP block placemen s a e ew. One s udy ound ha
wi h he use o ca he e s, he ailu e a e o con inuous TAP block he apy eached 30%.10,11 A s udy conduc ed o
assess ilioinguinal and iliohypogas ic blocks wi h a blind echnique ound ha al hough only 14% o blocks we e
a ge ed a he ne e, injec ion in o adjacen s uc u es, namely m. T ans e sus Abdominis and m. In e nal Oblique can
also p o ide analgesia wi h unp edic able e ec s.12 E en wi h he use o ul asound guidance and he Seldinge
echnique, ca he e placemen o he pu pose o con inuous TAP block has a ca he e success a e o 88%. 13 In his
s udy, local anes he ic d ug placemen was ca ied ou unde ul asound guidance which is expec ed o educe he isk
o displacemen , bu he limi a ion o using ul asound is i s ope a o -dependen na u e, making i di icul o assess
whe he he injec ion o local anes he ic d ug is in he igh loca ion o no .14
D ug up ake ac o s also play a ole in educing he pain in ensi y o he s udy subjec s. The aponeu osis issue in he
semiluna line is an ex ension o he muscle ha is simila o a endon, and when compa ed o muscle issue i sel has
lowe ascula iza ion.15 Local anes he ic d ugs ha e he p ope y o being abso bed mo e quickly in o he sys emic
ci cula ion in issues wi h highe ascula iza ion.16 The placemen o local anes he ic d ugs in he semiluna line will
heo e ically ake longe o deposi because he ascula iza ion p ope ies in he aponeu osis a e lowe han in he
muscle, so ha he analgesia p o ided will las longe . The indings in his s udy also showed ha bila e al TAP block
wi h a semiluna line app oach was associa ed wi h a signi ican ly longe du a ion o analgesia han he la e al
app oach. The ime o he i s PCA bu on p ess pos ope a i ely in he bila e al TAP g oup wi h a semiluna line
app oach had a median ime o 460 minu es, while he la e al app oach had a median ime o 215 minu es. This indica es
a longe analgesic e ec which is likely due o longe e en ion o local anes he ic d ug in he semiluna line app oach.
Fac o s ha in luence he du a ion o analgesia a e hough o be he deposi ion ac o o local anes he ic d ugs ha a e
igh on a ge and he longe d ug up ake ac o in he aponeu osis a ea. 12,13 The placemen o local anes he ic d ugs
in he semiluna line will heo e ically ake longe o deposi because he ascula iza ion p ope ies in he aponeu osis
a e lowe han he muscles and his is suppo ed by he indings in his s udy. In his s udy, i was ound ha he e was
a s a is ical di e ence in he amoun o opioid consump ion in he i s 24 hou s and a o al o 48 hou s, bu he e was
no signi ican di e ence in o al opioid consump ion in he 24-48 hou pe iod be ween he bila e al TAP block ea men
g oups wi h he semiluna line app oach compa ed o he la e al app oach. Al hough he o al mo phine consump ion
in 24 and 48 hou s in he TAP block ea men g oup wi h he semiluna line app oach ( o al mo phine 3 mg in 24 hou s
GSC Biological and Pha maceu ical Sciences, 2025, 32(03), 286-293
292
and 7.15 mg in 48 hou s) ended o be less han he la e al app oach ( o al mo phine 5 mg in 24 hou s and 8.8 mg in 48
hou s), clinically he e was only a sligh di e ence (2 mg in 24 hou s and 1.65 mg in 48 hou s).
The use o la e al TAP block in colo ec al su ge y was ound o educe he o al opioid consump ion 24 hou s a e
su ge y. In he s udy, he amoun o 24-hou opioid consump ion was ound o be 6.45 ± 3.26 mg in he La e al TAP
g oup and 17.55 ± 5.78 mg in he con ol g oup (Bha i e al., 2011). A simila s udy also ound ha he amoun o
mo phine consump ion in he use o la e al TAP block in colo ec al lapa o omy su ge y in 24 hou s was 17.7 ± 11.8 mg
and in he con ol g oup was 22.3 ± 20.7 mg. 15 Ul asound-guided TAP block blocks he in e cos al ne es and p o ides
analgesia whe e LA deposi ion in he TAP block causes myocu aneous senso y blockade o he midaxilla y line and
la e al cu aneous b anches o he an e io . TAP block has also been ound o consis en ly educe mo phine
equi emen s by up o 70% in pa ien s unde going colo ec al lapa o omy.14
The opioid equi emen educ ion e ec seen in his s udy may be ela ed o he sensi iza ion supp ession e ec o he
analgesic agen used, namely bila e al TAP semiluna line o la e al TAP block. Good analgesia echnique will p o ide a
s ong analgesic e ec wi h a du a ion long enough o p e en sensi iza ion om occu ing, his concep is also known
as he concep o p e en i e analgesia. TAP block wi h ei he he semiluna o la e al line app oach showed an opioid
educ ion e ec , bu he e ec was be e wi h he semiluna line app oach. Al hough he analgesic e ec wi h TAP
semiluna line was be e han la e al TAP, in he nex 24-48 hou s, he analgesic e ec was simila , as we e he pa ien s'
opioid equi emen s. This may be because al hough he analgesic e ec due o TAP semiluna o la e al line block was
gone, he sensi iza ion ha occu ed had also dec eased, as indica ed by a dec easing pain cu e a e 24 hou s.15
In his s udy, i was ound ha he g oup ha ecei ed bila e al TAP block wi h a semiluna line app oach
pos ope a i ely had be e pos ope a i e eco e y quali y compa ed o he g oup o pa ien s who ecei ed bila e al
TAP wi h a la e al app oach pos ope a i e colo ec al lapa o omy. This is e idenced by he a e age median o al QoR-
40 sco e a 24 and 48 hou s o he la e al TAP app oach g oup (147.5 and 151.5) and he semiluna line app oach g oup
(180 and 181.5), s a is ically analyzed ound o be signi ican ly di e en (p < 0.001). This s udy ound a di e ence in
he median QoR-40 sco e a 24 and 48 hou s o aling 32.5 and 30. The di e ence in he QoR-40 sco e has passed he
Minimum Clinically Impo an Di e ence (MCID) se in a s udy, which is 6.3, indica ing ha he e is a di e ence ha
has implica ions o he quali y o clinical eco e y o pa ien s. 13 The assessmen o he e ec i eness o he anes he ic
echnique ecei ed by he pa ien includes he in ensi y o pain el by he pa ien along wi h he side e ec s ha appea
consis ing o he p esence o absence o physiological diso de s ha occu , such as hemodynamic diso de s, pain,
nausea and omi ing, and he leng h o he pa ien 's eco e y pe iod. Howe e , hese pos ope a i e complica ions a e
e y a e, so an ins umen was c ea ed ha ocuses on he pa ien 's quali y o li e ( he abili y o ca y ou ac i i ies as
usual) and one o he ins umen s ha is qui e ecognized is he QoR-40. The QoR-40 sco e has a nega i e co ela ion
be ween he leng h o hospi aliza ion compa ed o he pa ien 's QoR-40 sco e, indica ing ha he highe he pa ien 's
QoR-40 sco e, he sho e he pa ien 's du a ion o hospi aliza ion.11,14
5. Conclusion
TAP block wi h semiluna line app oach is an e ec i e and sa e analgesia adju an o colo ec al lapa o omy.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
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