Ultrasound-guided subcostal transversus abdominis plane block for pain management in open surgical gastrostomy: A case series

Gastrostomy is needed to provide nutritional support in patients with head and neck cancer surgery. The incision in upper abdomen causes moderate pain. We usually encountered our postoperative patients complaining of significant discomfort that leads us to think about adding some regional anesthesia techniques with conventional pain management. Recently, the role of regional anesthetic techniques for involving anterior abdominal wall has been increased. Ten patients who underwent head and neck cancer surgery requiring open surgical gastrostomy for long-term nutritional support were taken into this descriptive case series. In addition to general anesthetic, intravenous nalbuphine, and paracetamol, ultrasound-guided subcostal transversus abdominal plane (TAP) block was performed 30 min prior to incision of gastrostomy to improve postoperative analgesia. All 10 patients had significant pain relief at gastrostomy incision site which is different from our experience in the same patient population before. The numerical rating score (NRS) was between 0 and 2, and average satisfaction score was 7–8 on a scale of 10. The patients reported a very low level of discomfort. No adverse events were recorded up to patient discharge from the hospital. Subcostal TAP block under ultrasound guidance is a valuable addition to improve postoperative pain management in open surgical gastrostomy. The available case series show encouraging analgesic results with no adverse events recorded. Formal prospective randomized trials are needed to provide further evidence on its efficacy, failure rate, and safety.