Written by Chris Thom
Spoon Feed
Ultrasound-guided transversus abdominis plane (TAP) block for acute pancreatitis was associated with lower opioid consumption and hospital length of stay.
Let’s consider a novel way to treat pain without opioids
This was a non-randomized prospective study of patients presenting with acute pancreatitis to a single tertiary care center. Patients were enrolled on a convenience basis for US guided TAP blocks by trained ED physicians. A control group was established that met the same eligibility criteria, but did not undergo TAP block.
Fifty-six patients were enrolled, with 28 in each group. In the TAP group, pain scores were lower at all follow-up time points (up to 24 hours). Mean opioid consumption was 6.43 mg in the TAP group and 12.59 mg in the control group (p < 0.001). The average hospital stay was 5 days in the TAP group, compared to 6.71 in the control group (p = 0.006).
How will this change my practice?
This small pilot study provides insight into a novel analgesic strategy for acute pancreatitis patients. The TAP block has been shown to be effective in chronic pancreatitis patients, and this study suggests that it could be a useful tool in acute pancreatitis as well. The small size and non-randomized nature means further study is needed, but the potential of treating pancreatitis pain without the side effects and addiction risk of systemic opioid therapy is certainly worthy of attention.
POCUS pro-tips and clips
The TAP block is an easy one to pick up, as the anatomy is simple and easy to visualize for most patients. The probe is placed in the mid-axillary line with the indicator dot towards the ceiling. You identify three muscle layers (external oblique, internal oblique, and transversus abdominis muscle). The needle is then guided in the long axis approach deep to the external oblique and internal oblique muscles, with anesthetic being deposited superficial to the transversus abdominis muscle. Developing ultrasound guided needling skills cannot be understated in emergency medicine. Plus, the same skills learned from US-guided vascular access and arthrocentesis are immediately applicable to regional anesthesia as well. Pick up the probe and hone those skills––you’ll become a better ED physician, and your patients will reap the benefits.
Source
Ultrasound-guided TAP block: A promising strategy for managing acute pancreatitis pain in a prospective interventional study. Am J Emerg Med. Published online July 14, 2025.
