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Coşkun M, Uprak TK, Günal Ö, Aliyeva A, Cingi A. Reinforcement in Laparoscopic Sleeve Gastrectomy: Is It Effective? Surg Laparosc Endosc Percutan Tech 2024; 34:290-294. [PMID: 38736400 DOI: 10.1097/sle.0000000000001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/08/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Despite the success of bariatric surgery in treating obesity, it can still lead to complications. The most serious and feared technical complications are bleeding and leakage from the gastric staple line. In this study, stapler line reinforcement was investigated to determine whether it affects postoperative leakage and bleeding rates and their management. MATERIALS AND METHODS Overall, 510 patients who underwent sleeve gastrectomy were evaluated retrospectively. They were divided into 2 groups according to whether reinforcement of the staple line with running imbricating sutures was performed. RESULTS In the reinforcement group, there were two leaks (0.7%), which were diagnosed seven and eight days after surgery. In the non-reinforcement group, there were nine leaks (4%). There was no difference between the two groups in staple line bleeding. CONCLUSIONS This study shows that reinforcement with continuous imbricating sutures is associated with less stapler line leakage and a lower reoperation rate at the cost of increased operative time.
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Affiliation(s)
- Mümin Coşkun
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Kara YB, Buluc H, Elgezen M, Yildiz E, Yardimci S. A Simple Way to Estimate a Difficult Sleeve Gastrectomy Prior to Operating. Obes Surg 2024; 34:1159-1167. [PMID: 38374321 PMCID: PMC11026237 DOI: 10.1007/s11695-024-07093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Today, bariatric procedures are common. These surgeries' difficulties are classified as patient- or surgical team-related and are estimated by body mass index (BMI). More efficient methods are needed to help surgeons. This study evaluated the effect of measuring patients' subcutaneous fat tissue thickness (SFT) and umbilicus-xiphoid (DXU) to anticipate surgical difficulties. MATERIAL AND METHODS This was a prospective retrospective data analysis study. Laparoscopic sleeve gastrectomy patients seen between May and October 2022 were included in the analysis and divided into three groups, according to a surgeon's assessment. All patients' SFT, DXU, rectus muscle thickness, total fat tissue amount (TFT), and operational time were recorded prospectively and analyzed. RESULTS In all, 151 patients were included in the study; of these, 124 (82.1%) were women and 27 (17.9%) were men. Their mean BMI value was 41.1 ± 6.2. Based on expert's opinion, we classified three groups: easy (n = 123, 81.5%), intermediate (n = 22, 14.6%), or difficult (n = 6, 4%). When the easy group was compared to the intermediate/difficult groups, we found that intermediate/difficult groups' SFT values were statistically significantly higher than the easy group (p = 0.000). Also, the intermediate/difficult group's TFT value was statistically significantly higher than the easy group (p = 0.000). We found no statistically significant differences between groups' DXU and rectus muscle thickness. CONCLUSION This is the first study to anticipate sleeve gastrectomy difficulty using SFT and TFT. This is an easy technique to apply and no additional costs. Anticipating difficulties based on these criteria can ensure necessary preparations are made and help avoid complications.
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Affiliation(s)
- Yalcin Burak Kara
- General Surgery Department, Bahcesehir University VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey.
| | - Halil Buluc
- Department of Anestesiology, VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey
| | - Mehmet Elgezen
- Department of Radiology, VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey
| | - Edanur Yildiz
- School of Medicine, Bahcesehir University, Sahrayı Cedit, Batman Sk., No: 66, Kadıkoy, 34734, Istanbul, Turkey
| | - Samet Yardimci
- General Surgery Department, Istinye University VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey
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Kara YB, Ital I, Ertekin SC, Yol S, Yardimci S. Ultrasonography Guided Modified BRILMA (Blocking the Cutaneous Branches of Intercostal Nerves in the Middle Axillary Line) Block in Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2023; 33:1141-1145. [PMID: 37787937 DOI: 10.1089/lap.2023.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Background: Postoperative pain is one of the major problems after laparoscopic sleeve gastrectomy besides complications. Management of pain control is still unclear in the obese population. Modified BRILMA (blocking the cutaneous branches of intercostal nerves in the middle axillary line) is a new analgesia technique which is performed by ultrasonography guided through the way between eighth and ninth rib level. This study is to evaluate the efficiency of modified BRILMA in bariatric patients while comparing with trocar site infiltration. Materials and Methods: This is a prospective designed retrospective data analysis study. Patients undergoing laparoscopic sleeve gastrectomy between June 2019 and January 2020 were divided into two groups. One group underwent BRILMA block; the other group used traditional trocar site injection. Postoperative pain was followed by using visual analogue scale (VAS) (at 1, 3, 6, 12, 24, 36, 48 hours postoperatively). Results: Thirty patients were included in the study. Twenty-four (80%) of the patients were women, and 6 (20%) of the patients were men. Mean body mass index of patients were 39.83 ± 4.02 kg/m2. Mean operational time was calculated 86.16 ± 19.94 minutes. When the patients' VAS was compared, 12th hour VAS value was statistically less in the BRILMA group. There were no significant differences in other hours' VAS between two groups. When compared with the use of opioid amount, there were no statistically significant difference between the two groups (P = .66), but BRILMA group had less amount. Conclusion: Modified BRILMA is an alternative technique to the use of trocar site bupivacain injection in bariatric surgery. It is new technique that is tried in bariatric population, which is also cost-effective and has less opioid consumption.
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Affiliation(s)
- Yalcin Burak Kara
- General Surgery Department, Bahcesehir University VM Medical Park Pendik Hospital, Istanbul, Turkey
| | - Ilker Ital
- Department of Anesthesiology, VM Medical Park Pendik Hospital, Istanbul, Turkey
| | | | - Sinan Yol
- General Surgery Department, Bahcesehir University VM Medical Park Pendik Hospital, Istanbul, Turkey
| | - Samet Yardimci
- General Surgery Department, Bahcesehir University VM Medical Park Pendik Hospital, Istanbul, Turkey
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Cavallaro G, Gazzanelli S, Iossa A, De Angelis F, Fassari A, Micalizzi A, Petramala L, Crocetti D, Circosta F, Concistrè A, Letizia C, De Toma G, Polistena A. Ultrasound-guided Transversus Abdominis Plane Block is Effective as Laparoscopic Trocar site infiltration in Postoperative Pain Management in Patients Undergoing Adrenal Surgery. Am Surg 2023; 89:4401-4405. [PMID: 35797715 DOI: 10.1177/00031348221114035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pain management in patients undergoing laparoscopy is still a matter of debate as several techniques have been proposed to reduce postoperative analgesic consumption and improve recovery. Among these, transversus abdominis plane (TAP) block is considered as safe, effective, and easy to perform under ultrasound guidance; even so, recently laparoscopically guided trocar site anesthetic infiltration has been proposed as a "surgeon-dependent alternative to TAP block." The aim of this evaluation is to compare these analgesic techniques in the setting of laparoscopic adrenalectomy. METHODS This is a retrospective evaluation of a prospectively maintained database. Patients were divided into two groups: Group A patients received laparoscopic-assisted trocar site infiltration of ropivacaine; Group B patients received bilateral ultrasound-guided TAP block with ropivacaine. All patients received 24 h infusion of 20 mg morphine postoperatively; pain was checked at 6, 24 and 48 h after surgery. A rescue analgesia was given if numerical rating scale (NRS) score was > 4 or on patient request. RESULTS One hundred and three patients were enrolled in the evaluation (57 in group A and 46 in group B). There were no differences in operative time, complications and postoperative stay, and no complications related to trocar site infiltration. There were no differences in NRS at 6, 24, and 48 hours as well as in patients requiring further analgesic administration. CONCLUSIONS Laparoscopic-guided trocar site ropivacaine infiltration has similar pain outcomes compared to ultrasound-guided TAP block in the management of postoperative pain in patients undergoing laparoscopic adrenalectomy. Since there is no difference among these techniques, the decision can be based on surgeon or anesthesiologist preference.
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Affiliation(s)
| | - Sergio Gazzanelli
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Francesco De Angelis
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Alessia Fassari
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Alessandra Micalizzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Luigi Petramala
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Daniele Crocetti
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Francesco Circosta
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonio Concistrè
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Claudio Letizia
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giorgio De Toma
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Andrea Polistena
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
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Cavallaro G, Gazzanelli S, Iorio O, Iossa A, Giordano L, Esposito L, Crocetti D, Tarallo MR, Sibio S, Brauneis S, Polistena A. Laparoscopic transversus abdominis plane block is useful in pain relief after laparoscopic stapled repair of diastasis recti and ventral hernia. J Minim Access Surg 2023; 19:207-211. [PMID: 37056085 PMCID: PMC10246641 DOI: 10.4103/jmas.jmas_111_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/08/2022] [Accepted: 10/17/2022] [Indexed: 01/22/2023] Open
Abstract
Background There is still no consensus on perioperative pain control techniques in patients undergoing laparoscopic surgery; protocols of conventional therapy can be improved by the use of perioperative anaesthesiologic techniques, such as epidural or loco-regional analgesic administration as transversus abdominis plane (TAP) block. The aim of this evaluation was to investigate the role of laparoscopic-assisted TAP block during repair of diastasis recti associated with primary midline hernias in term of post-operative pain relief. Materials and Methods This was a retrospective evaluation of a prospectively maintained database including patients undergoing laparoscopic repair of diastasis recti associated with primary ventral hernia. Patients were divided into two groups: Group A patients (n = 34) received laparoscopic-assisted bilateral TAP-block of 7.5 mg/ml ropivacaine for each side and Group B patients (n = 29) received conventional post-operative therapy. All patients received 24 h infusion of 20 mg morphine; pain was checked at 6, 24 and 48 h after surgery by numeric rating scale (NRS) score. A rescue analgesia by was given if NRS score was >4 or on patient request. Results No differences in operative time, complications and post-operative stay, no complications related to TAP-block technique were found. Post-operative pain scores (determined by NRS) were found to be significantly different between groups. Group A patients showed a significant reduction in NRS score at 6, 24 and 48 h (P < 0.005) and in the number of patients requiring further analgesic drugs administration (P < 0.005) compared to Group B patients. Conclusions Laparoscopic-guided TAP-block can be considered safe and effective in the management of post-operative pain and in the reduction of analgesic need in patients undergoing laparoscopic repair of diastasis recti and ventral hernias. The non-randomised nature of the study and the lack of a consistent series of patients require further evaluations.
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Affiliation(s)
| | - Sergio Gazzanelli
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
| | - Olga Iorio
- Department of Surgery, General Surgery Unit, F. Spaziani Hospital, Frosinone, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Luca Giordano
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
| | - Luca Esposito
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
| | - Daniele Crocetti
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
| | | | - Simone Sibio
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
| | | | - Andrea Polistena
- Department of Surgery, “P. Valdoni,” Sapienza University, Rome, Italy
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Todurov IM, Perekhrestenko OV, Kosiukhno SV, Yevsieieva VV, Lisun YB. ASSESSMENT OF THE EFFICIENCY OF ANALGETIC ACTION OF LAPAROSCOPICALLY ASSISTED TAP BLOCK AS A COMPONENT OF PERIOPERATIVE MULTIMODAL ANALGESIA PLAN IN OBESE PATIENTS UNDERGOING METABOLIC SURGERY. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1259-1264. [PMID: 37364082 DOI: 10.36740/wlek202305219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The aim: To assess the effectiveness and feasibility of laparoscopically assisted TAP block utilization in the system of multimodal analgesia by comparing the severity of pain and associated postoperative recovery indicators in obese patients after laparoscopic sleeve gastrectomy. PATIENTS AND METHODS Materials and methods: The retrospective study included 39 patients, who underwent metabolic surgery from 2013-2022. All patients were divided into 2 groups depending on the chosen perioperative analgesia protocol. Group 1 included 19 patients who prior to skin incision a local infiltration of the trocar puncture areas of the abdominal wall. Group 2 included 20 patients, whom in addition to the above-described anaesthesia procedure after completion of the main stage of surgery, a laparoscopically assisted bilateral subcostal TAP block was additionally performed. RESULTS Results: The need to use opioid analgesics in the rescue analgesia mode arose in 17.6% (3/17) of patients of the first group, and 5% (1/20) of patients in the second group Average duration of postoperative hospitalization in group 1 was 7.2±1.1 days, and in group 2 it was 6.2±1.4 days (P <0.05). CONCLUSION Conclusions: Subcostal TAP block in obese patients is a safe and effective method of regional anaesthesia. Further study of this option of regional anaesthesia is required in order to be able to form clearer recommendations for its routine use in clinical practice.
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Affiliation(s)
- Ivan M Todurov
- STATE SCIENTIFIC INSTITUTION «CENTER FOR INNOVATIVE MEDICAL TECHNOLOGIES OF THE NATIONAL ACADEMY OF SCIENCES OF UKRAINE», KYIV, UKRAINE
| | - Oleksandr V Perekhrestenko
- STATE SCIENTIFIC INSTITUTION «CENTER FOR INNOVATIVE MEDICAL TECHNOLOGIES OF THE NATIONAL ACADEMY OF SCIENCES OF UKRAINE», KYIV, UKRAINE
| | - Sergii V Kosiukhno
- STATE SCIENTIFIC INSTITUTION «CENTER FOR INNOVATIVE MEDICAL TECHNOLOGIES OF THE NATIONAL ACADEMY OF SCIENCES OF UKRAINE», KYIV, UKRAINE
| | - Viktoriia V Yevsieieva
- STATE SCIENTIFIC INSTITUTION «CENTER FOR INNOVATIVE MEDICAL TECHNOLOGIES OF THE NATIONAL ACADEMY OF SCIENCES OF UKRAINE», KYIV, UKRAINE; STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
| | - Yurii B Lisun
- STATE SCIENTIFIC INSTITUTION «CENTER FOR INNOVATIVE MEDICAL TECHNOLOGIES OF THE NATIONAL ACADEMY OF SCIENCES OF UKRAINE», KYIV, UKRAINE
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Aldohayan A, Alshammari S, Binjaloud A, Bamehriz F, Narejo AS, Aqil M, Aldahian N, Aldabaeab A, Eldawlatly A. Pre-incisional Laparoscopic Preperitoneal Local Anesthetic Technique in Laparoscopic Sleeve Gastrectomy. JSLS 2022; 26:JSLS.2022.00049. [PMID: 36071990 PMCID: PMC9439284 DOI: 10.4293/jsls.2022.00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The increasing prevalence of obesity is a significant concern worldwide. Laparoscopic sleeve gastrectomy (LSG) is an effective and standard procedure for sustained weight loss. However, optimal pain control is essential for enhanced recovery after surgery. The aim of this randomized controlled study was to investigate the efficacy of a pre-incisional laparoscopic preperitoneal local anesthetic technique (PLPLAT) on recovery characteristics following LSG. Methods: A total of 120 obese patients scheduled to undergo LSG were randomized into the PLPLAT or placebo group (n = 60 patients in both groups). All patients received conventional intravenous or other analgesics postoperatively, as required. The primary outcome was the postoperative pain score. The secondary outcomes included morphine consumption, other analgesics, length of stay in the postanesthesia care unit (PACU), hemodynamic changes, postoperative nausea and vomiting (PONV), early mobilization, and length of hospital stay. Results: Pain scores in the PACU and at 12 hours after surgery in the ward were significantly lower in the PLPLAT group than in the placebo group (P < 0.05). The morphine consumption was significantly less in PLPLAT group with mean dosage of 2.95 mg (± 0.39) compared to 6.0 mg (± 0.4) in placebo group. PONV, mean arterial pressure, and PACU stay were significantly higher in the placebo group than in the PLPLAT group (P < 0.05). Conclusion: Intraoperative PLPLAT provide effective postoperative pain relief for patients undergoing LSG. The findings indicated the efficacy of PLPLAT in reducing postoperative pain, enhancing recovery, and facilitating early discharge.
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Affiliation(s)
- Abdullah Aldohayan
- Department of Surgery, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman Alshammari
- Department of Surgery, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Binjaloud
- Department of Surgery, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Bamehriz
- Department of Surgery, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdul Sattar Narejo
- Anesthesia Department, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mansoor Aqil
- Anesthesia Department, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Nahlah Aldahian
- Anesthesia Department, University Medical City, King Saud University, Riyadh, Saudi Arabia.,Pharmacology Department, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdulaziz Aldabaeab
- Department of Surgery, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdelazeem Eldawlatly
- Anesthesia Department, University Medical City, King Saud University, Riyadh, Saudi Arabia
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Cavallaro G, Polistena A, Petramala L, Gazzanelli S, Crocetti D, Iorio O, Iossa A, Fiori E, Bracale U, De Toma G, Letizia C. Laparoscopic-Guided Ropivacaine Trocar-Site Infiltration Can Improve Post-Operative Pain Control after Laparoscopic Adrenalectomy. Surg Innov 2021; 29:747-751. [PMID: 34861813 DOI: 10.1177/15533506211057967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is no consensus on pain control in patients undergoing laparoscopy; nowadays, conventional therapy may be improved by transversus abdominis plane block. The aim of this evaluation is to investigate the role of laparoscopic-assisted trocar-site ropivacaine infiltration during adrenalectomy in pain control. METHODS This is a retrospective evaluation of a prospectively maintained database including patients undergoing adrenalectomy. Patients were divided into 2 groups: Group A patients received laparoscopic-assisted trocar-site infiltration of 7.5 mg/mL ropivacaine and Group B patients did not receive any infiltration. All patients received a 24-hour infusion of 20 mg morphine; pain was checked at 6, 24, and 48 hours after surgery by Visual Analogue Scale (VAS) score. A rescue analgesia by was given if VAS score was > 4 or on patient request. RESULTS No differences in operative time, complications, and post-operative stay and no complications related to trocar-site infiltration were found. 6-hour and 48-hour VAS scores were not found to be significantly different between groups, even if a slight decrease in VAS score in Group A was reported. Group A showed significant reduction in VAS score at 24 hours (2.44 +/- .41 vs 3.01 +/- .78, P < .005) and in the number of patients requiring further analgesic drugs administration (40.6% vs 57.8%, P < .005). CONCLUSIONS Laparoscopic-guided trocar-site ropivacaine infiltration can be considered safe and effective in the management of post-operative pain and in the reduction of analgesic need in patients undergoing laparoscopic adrenalectomy. The retrospective nature of the study and the lack of a consistent series of patients require further evaluations.
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Affiliation(s)
- Giuseppe Cavallaro
- Department of Surgery "P. Valdoni", 9311Sapienza University, Rome, Italy
| | - Andrea Polistena
- Department of Surgery "P. Valdoni", 9311Sapienza University, Rome, Italy
| | - Luigi Petramala
- Department of Translational and Precision Medicine, 9311Sapienza University, Rome, Italy
| | - Sergio Gazzanelli
- Department of Surgery "P. Valdoni", 9311Sapienza University, Rome, Italy
| | - Daniele Crocetti
- Department of Surgery "P. Valdoni", 9311Sapienza University, Rome, Italy
| | - Olga Iorio
- General Surgery Unit, F. Spaziani Hospital, Frosinone, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, 9311Sapienza University, Rome, Italy
| | - Enrico Fiori
- Department of Surgery "P. Valdoni", 9311Sapienza University, Rome, Italy
| | - Umberto Bracale
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Giorgio De Toma
- Department of Surgery "P. Valdoni", 9311Sapienza University, Rome, Italy
| | - Claudio Letizia
- Department of Translational and Precision Medicine, 9311Sapienza University, Rome, Italy
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Factors affecting the surgeon preference for bolus opioid use to control postoperative pain after bariatric surgery. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.959976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Ozdemir H, Araz C, Karaca O, Turk E. Comparison of Ultrasound-Guided Erector Spinae Plane Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia after Laparoscopic Cholecystectomy: A Randomized, Controlled Trial. J INVEST SURG 2021; 35:870-877. [PMID: 34085883 DOI: 10.1080/08941939.2021.1931574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Laparoscopic cholecystectomy causes moderate to severe pain despite its minimally invasive nature. This study was performed to compare the efficacy of the bilateral erector spinae plane block (ESPB) and the subcostal transversus abdominis plane block (STAPB) under ultrasound guidance. METHODS 64 patients were included in this prospective, randomized study. The patients were allocated into two groups as those receiving ESPB (n = 32) and those receiving STAPB (n = 32). Pain scores at rest and during movement, fentanyl requirement, postoperative walking time, and duration of hospital stay were compared. The complications which related to block were also recorded. RESULTS In the ESPB group, the Numeric Rating Scale (NRS) scores at rest were lower at hour 0 [at the time of post-anesthetic care unit (PACU) admission] and postoperative hours 2, 4, 6, and 12 (p < 0.05). In the same group, the NRS scores at movement were lower at hours 0, 2, 4, 6, 12, and 24 (p < 0.05). In the ESPB group, the time to first analgesic need was longer (p < 0.05), intraoperative and postoperative Fentanyl requirement (p < 0.0001 for both) and PACU rescue analgesic requirement were lower (p < 0.05), the lengths of PACU and hospital stay were shorter (p < 0.0001), and unassisted walking time was shorter (p < 0.0001). There were no complications related to the block in either group. CONCLUSION Bilateral ultrasound-guided ESPB provides superior analgesia after laparoscopic cholecystectomy surgery compared to STAPB and further reduces unaided walking time and hospital stay.
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Affiliation(s)
- Halime Ozdemir
- Department of Anesthesiology and Reanimation, Baskent University Research and Training Hospital, Konya, Turkey
| | - Coskun Araz
- Department of Anesthesiology and Reanimation, Baskent University School of Medicine, Ankara, Turkey
| | - Omer Karaca
- Department of Anesthesiology and Reanimation, Private Anit Hospital, Konya, Turkey
| | - Emin Turk
- Department of General Surgery, Baskent University Research and Training Hospital, Konya, Turkey
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