***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Transversus abdominis plane block is a safe , simple and effective technique of providing analgesia for lower abdominal surgeries with easily identifiable l and marks . Aims : To compare the analgesic efficacy of transversus abdominis plane block with that of direct infiltration of local anesthetic into surgical incision in lower abdominal procedures . Setting s and Design : Prospect i ve r and omized controlled trial in lower abdominal surgeries done under general anesthesia . Material s and Methods : 52 ASA I-II patients undergoing lower abdominal gynecological procedures under general anesthesia were divided r and omly into two groups each after written informed consent . A bilateral TAP block was performed on Group T with 0.25 % bupivacaine 0.6 ml/kg with half the volume on either side intra-operatively after skin closure before extubation using a short bevelled needle , whereas Group I received local infiltration intra-operatively after skin closure with the same amount of drug . The time taken for the first rescue analgesic and visual analog score ( VAS ) was noted , following which , the patient was administered intravenous morphine 0.1 mg/kg and connected to an intravenous patient controlled analgesia system with morphine for 24 hrs from the time of block administration . 24 h morphine requirement was noted . VAS and sedation scores were noted at 2 , 4 , 6 and 24 h postoperatively . Statistical Analysis Used : The results were analyzed with SPSS 16 . A P value < 0.05 was considered significant . Duration of analgesia and 24 h morphine requirement was analysed by Student 's t-test . VAS scores , with paired comparisons at each time interval , were performed using the t-test or Mann-Whitney U-test , as appropriate . Categorical data were analyzed using Chi square or Fisher 's exact test . Results : In Group T , the time to rescue analgesic was significantly more and the VAS scores were lower ( P = 0.001 and 0.003 respectively ) . The 24 hr morphine requirement and VAS at 2 , 4 , 6 and 24 h were less in the Group T ( P = 0.001 ) . Incidence of PONV was significant in Group I ( P = 0.043 ) , whereas Group T were less se date d at 2 and 4 h ( P = 0.001 and 0.014 ) . Conclusions : Transversus abdominis plane block proved to be an effective means of analgesia for lower abdominal surgeries with minimal side-effects Background Coagulation changes can complicate liver resection , particularly in patients with cirrhosis . The aim of this prospect i ve hospital-based comparative study was to compare the postoperative analgesic efficacy of intravenous fentanyl patient-controlled analgesia ( IVPCA ) with and without transversus abdominis plane ( TAP ) block . Methods Fifty patients with Child ’s A cirrhosis undergoing liver resection were r and omly divided into two groups for postoperative analgesia , ie , an IVPCA group receiving a 10 μg/mL fentanyl bolus of 15 μg with a 10-minute lockout and a maximum hourly dose of 90 μg , and an IVPCA + TAP group that additionally received TAP block ( 15 mL of 0.375 % bupivacaine ) on both sides via a posterior approach with ultrasound guidance before skin incision . Postoperatively , bolus injections of bupivacaine 0.375 % were given every 8 hours through a TAP catheter inserted by the surgeon in the open space during closure of the inverted L-shaped right subcostal with midline extension ( subcostal approach ) guided by the visual analog scale score ( <3 , 5 mL ; 3 to < 6 , 10 mL ; 6–10 , 15–20 mL ) according to weight ( maximum 2 mg/kg ) . The top-up dosage of local anesthetic could be omitted if the patient was not in pain . Coagulation was monitored using st and ard coagulation tests . Results Age , weight , and sex were comparable between the groups ( P>0.05 ) . The visual analog scale score was significantly lower at 12 , 18 , 24 , 48 , and 72 hours ( P<0.01 ) in IVPCA + TAP group . The Ramsay sedation score was lower only after 72 hours in the IVPCA + TAP group when compared with the IVPCA group ( 1.57±0.74 versus 2.2±0.41 , respectively , P<0.01 ) . Heart rate , systolic blood pressure , and fentanyl consumption were lower in the IVPCA + TAP group at 24 , 48 , and 72 hours ( P<0.05 ) . Intensive care unit stays were significantly shorter with TAP ( 2.61±0.74 days versus 4.35±0.79 days , P<0.01 ) . Prothrombin time and International Normalized Ratio indicated temporary hypocoagulability in both groups . Conclusion Combining TAP with IVPCA  improved postoperative pain management and reduced fentanyl consumption , with a shorter stay in intensive care . TAP block can be included as part of a balanced multimodal postoperative pain regimen Postoperative pain is a common complaint following living kidney donation or tumor resection using the laparoscopic h  and -assisted technique . To evaluate the potential analgesic benefit of transversus abdominis plane blocks , we conducted a r and omized , double-blind , placebo-controlled study in 21 patients scheduled to undergo elective living-donor nephrectomy or single-sided nephrectomy for tumor . Patients were r and omized to receive either 20 mL of 0.5 % ropivacaine or 20 mL of 0.9 % saline bilaterally to the transversus abdominis plane under ultrasound guidance . We found that transversus abdominis plane blocks reduced overall pain scores at 24 hours , with a trend toward decreased total morphine consumption . Nausea , vomiting , sedation , and time to discharge were not significantly different between the two study groups Purpose In this prospect i ve , r and omized , double-blind study , our aim was to compare the analgesic efficacy of the semi-blind approach of transversus abdominis plane ( TAP ) block with a placebo block in patients undergoing unilateral inguinal hernia repair . Methods After receiving hospital ethical committee approval and informed patient consents , American Society of Anesthesiologists ( ASA ) I – III patients aged 18–80 were enrolled in the study .  St and ard anesthesia monitoring was applied to all patients . After premedication , spinal anesthesia was administered to all patients with 3.5 mL heavy bupivacaine at the L3-L4 subarachnoid space . Patients were r and omly allocated into 2 groups . Group I ( n = 32 ) received a placebo block with 20 mL saline , Group II ( n = 32 ) received semi-blind TAP block with 0.25 % bupivacaine in 20 mL with a blunt regional anesthesia needle into the neurofascial plane via the lumbar triangle of Petit near the midaxillary line before fascial closure . At the end of the operation , intravenous ( IV ) dexketoprofen was given to all patients . The verbal analog scale ( VAS ) was recorded at 2 , 4 , 6 , 12 , and 24 hours postoperatively . Paracetamol IV was given to patients if their VAS score > 3 . A rescue analgesic of 0.05 mg/kg morphine IV was applied if VA S > 3 . Total analgesic consumption and morphine requirement in 24 hours were recorded . Results TAP block reduced VAS scores at all postoperative time points ( P < 0.001 ) . Postoperative analgesic and morphine requirement in 24 hours was significantly lower in group II ( P < 0.01 ) . Conclusion Semi-blind TAP block provided effective analgesia , reducing total 24-hour postoperative analgesic consumption and morphine requirement in patients undergoing elective unilateral inguinal hernia repair CONTEXT The transversus abdominis plane ( TAP ) block is a new regional anaesthesia technique applicable to infants and children . OBJECTIVE ( S ) The present study was design ed to evaluate the analgesic efficacy of ultrasound-guided TAP block with high volume local anaesthetic ( 0.5 ml kg−1 ) during the first 24 h after surgery in children undergoing inguinal hernia repair . DESIGN R and omised comparative study . SETTING Gaziantep University Hospital between December 2010 and May 2011 . PATIENTS OR OTHER PARTICIPANTS Fifty-seven children between 2 and 8 years of age undergoing unilateral inguinal hernia repair were r and omised to TAP block ( group T , n = 29 ) or to wound infiltration ( group C , n = 28 ) . INTERVENTION(S ) A TAP block using ultrasound guidance with 0.25 % levobupivacaine 0.5 ml kg−1 or wound infiltration with 0.2 ml kg−1 0.25 % levobupivacaine , was performed on the same side as the hernia under general anaesthesia . MAIN OUTCOME MEASURES Time to first analgesic , cumulative number of doses of analgesic , pain scores and adverse effects were assessed over the course of 24 h. RESULTS The time to first analgesic ( mean ± SD ) was significantly longer in group T than in group C ( 17 ± 6.8 vs. 4.7 ± 1.6 h , respectively ; P < 0.001 ) . Thirteen ( 45 % ) patients in group T did not require any analgesic within the first 24 h. The cumulative number of doses of analgesic was significantly lower in group T than in group C ( 1.3 ± 1.2 vs. 3.6 ± 0.7 , respectively , P < 0.001 ) . Pain scores were significantly different between the groups at all time points except at 1 , 20 and 24 h ( P < 0.001 ) . CONCLUSION Ultrasound-guided TAP block with high volume ( 0.5 ml kg−1 ) 0.25 % levobupivacaine provides prolonged postoperative analgesia and reduced analgesic use without any clinical side-effects after unilateral hernia repair in children . TRIAL REGISTRATION ACTRN12611000585921 ( 7/06/2011 ) from Australian New Zeal and Clinical Trials Registry Background The transversus abdominis plane block is recently described peripheral block to providing analgesia to the anterior abdominal wall . The goal of this study is to evaluate the analgesic efficacy of the ultrasound-guided transversus abdominis plane block ( US-TAP block ) in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision . Methods Thirty-two patients undergoing gynecologic surgery were r and omized to undergo  st and ard care such as PCA , or to receive additional US-TAP block with st and ard care .  After general anesthesia induction , a bilateral US-TAP block was performed using 0.375 % ropivacaine 20 ml on each side .  Postoperative dem and of rescue analgesics in PACU and ward were recorded . Each patient was assessed postoperatively by a blinded investigator in the postanesthesia care unit ( PACU ) and at 2 , 6 , 10 , 24 , 48 hr postoperatively to investigate pain , drowsiness , nausea and itch . Results The US-TAP block reduced pain intensity compared to st and ard care in the PACU ( 5.2 ± 3.1 vs 8.4 ± 1.3 ) and at 2 , 24 postoperative hours ( 3.0 ± 2.4 vs 5.2 ± 2.4 , 0.9 ± 1.5 vs 2.2 ± 1.9 ) . Fentanyl requirements in PACU was reduced ( 20.3 ± 20.9 vs 62.5 ± 35.4 µg , P < 0.05 ) . In ward , pethidine requirements was reduced ( 21.9 ± 28.7 vs 56.3 ± 34.8 mg , P < 0.05 ) . Conclusions The US-TAP block with st and ard care provide more effective analgesia after gynecologic surgery via a transverse lower abdominal skin incision Purpose The transversus abdominis plane ( TAP ) block is a technique increasingly used for analgesia after surgery on the anterior abdominal wall . We undertook this study to determine the feasibility and analgesic efficacy of ultrasound-guided TAP blocks in morbidly obese patients . We describe the dermatomal spread of local anesthetic in TAP blocks administered , and test the hypothesis that TAP blocks decrease visual analog scale ( VAS ) scores . Patients and methods After ethics committee approval and informed consent , 35 patients with body mass index > 35 undergoing single-port sleeve gastrectomy ( SPSG ) were enrolled . All patients received balanced general anesthesia , followed by intravenous patient-controlled analgesia ( IV-PCA ; hydromorphone ) postoperatively ; all reported VAS > 3 upon arrival to the recovery room . From the cohort of 35 patients having single-port laparoscopy ( SPL ) , a sealed envelope method was used to r and omly select ten patients 
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We observed this reduction in pain scores and morphine consumption in the TAP block group after gynecological surgery , appendectomy , inguinal surgery , bariatric surgery , and urological surgery .
Nevertheless , separate analysis of the studies comparing ITM with TAP block revealed that ITM seemed to have a greater analgesic efficacy .
Conclusions The TAP block can play an important role in the management of pain after abdominal surgery by reducing both pain scores and 24-hr morphine consumption .
It may have particular utility when neuraxial techniques or opioids are contraindicated .
Toutefois , une analyse séparée des études comparant la MIT au TAP bloc a révélé que la MIT semblait avoir une efficacité analgésique plus prononcée .