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Ryu C, Choi GJ, Jung YH, Baek CW, Cho CK, Kang H. Postoperative Analgesic Effectiveness of Peripheral Nerve Blocks in Cesarean Delivery: A Systematic Review and Network Meta-Analysis. J Pers Med 2022; 12:jpm12040634. [PMID: 35455750 PMCID: PMC9033028 DOI: 10.3390/jpm12040634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/05/2022] [Accepted: 04/10/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of this systematic review and network meta-analysis was to determine the analgesic effectiveness of peripheral nerve blocks (PNBs), including each anatomical approach, with or without intrathecal morphine (ITMP) in cesarean delivery (CD). All relevant randomized controlled trials comparing the analgesic effectiveness of PNBs with or without ITMP after CD until July 2021. The two co-primary outcomes were designated as (1) pain at rest 6 h after surgery and (2) postoperative cumulative 24-h morphine equivalent consumption. Secondary outcomes were the time to first analgesic request, pain at rest 24 h, and dynamic pain 6 and 24 h after surgery. Seventy-six studies (6278 women) were analyzed. The combined ilioinguinal nerve and anterior transversus abdominis plane (II-aTAP) block in conjunction with ITMP had the highest SUCRA (surface under the cumulative ranking curve) values for postoperative rest pain at 6 h (88.4%) and 24-h morphine consumption (99.4%). Additionally, ITMP, ilioinguinal-iliohypogastric nerve block in conjunction with ITMP, lateral TAP block, and wound infiltration (WI) or continuous infusion (WC) below the fascia also showed a significant reduction in two co-primary outcomes. Only the II-aTAP block had a statistically significant additional analgesic effect compared to ITMP alone on rest pain at 6 h after surgery (−7.60 (−12.49, −2.70)). In conclusion, combined II-aTAP block in conjunction with ITMP is the most effective post-cesarean analgesic strategy with lower rest pain at 6 h and cumulative 24-h morphine consumption. Using the six described analgesic strategies for postoperative pain management after CD is considered reasonable. Lateral TAP block, WI, and WC below the fascia may be useful alternatives in patients with a history of sensitivity or severe adverse effects to opioids or when the CD is conducted under general anesthesia.
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Affiliation(s)
- Choongun Ryu
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul 06911, Korea; (C.R.); (G.J.C.); (Y.H.J.); (C.W.B.)
| | - Geun Joo Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul 06911, Korea; (C.R.); (G.J.C.); (Y.H.J.); (C.W.B.)
| | - Yong Hun Jung
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul 06911, Korea; (C.R.); (G.J.C.); (Y.H.J.); (C.W.B.)
| | - Chong Wha Baek
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul 06911, Korea; (C.R.); (G.J.C.); (Y.H.J.); (C.W.B.)
| | - Choon Kyu Cho
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University, Daejeon 35365, Korea;
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul 06911, Korea; (C.R.); (G.J.C.); (Y.H.J.); (C.W.B.)
- Correspondence: ; Tel.: +82-2-6299-2586
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Gabriel RA, Burton BN, Curran BP, Urman RD. Regional Anesthesia Abdominal Blocks and Local Infiltration After Cesarean Delivery: Review of Current Evidence. Curr Pain Headache Rep 2021; 25:28. [PMID: 33761010 DOI: 10.1007/s11916-021-00945-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW In this review, we discuss surgical infiltration and various abdominal wall blocks, including transversus abdominis plane (TAP) block and quadratus lumborum blocks, and review the literature on the evidence behind these approaches and analgesia for cesarean delivery (CD). RECENT FINDINGS Adequate pain management in the parturient following CD is important to facilitate early ambulation and neonatal care while also improving patient satisfaction and decreasing hospital length of stay. Neuraxial opioids have been a mainstay for postoperative analgesia; however, this option may not be available for patients undergoing emergency CD and have contraindications to neuraxial approaches, refusing an epidural or spinal, or with technical difficulties for neuraxial placement. In such cases, alternative options include a fascial plane block or surgical wound infiltration. The use of regional blocks or surgical wound infiltration is especially recommended in the parturient who does not receive neuraxial opioids for CD. Adequate postoperative analgesia following CD is an important component of the overall care of the parturient as it helps facilitate early mobilization and improve patient satisfaction. In conclusion, the use of abdominal fascial plane blocks or surgical wound infiltration is recommended in the parturient who does not receive neuraxial opioids for CD.
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Affiliation(s)
- Rodney A Gabriel
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.
- Division of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA.
| | - Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brian P Curran
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
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Riemma G, Schiattarella A, Cianci S, La Verde M, Morlando M, Sisti G, Esposito I, Della Corte L, Sansone P, De Franciscis P. Transversus abdominis plane block versus wound infiltration for post-cesarean section analgesia: A systematic review and meta-analysis of randomized controlled trials. Int J Gynaecol Obstet 2021; 153:383-392. [PMID: 33368204 DOI: 10.1002/ijgo.13563] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/12/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Transversus abdominis plane (TAP) block and wound infiltration (WI) with local anesthetics are used for postoperative analgesia after cesarean section (CS), reducing the need for administration of opioids. OBJECTIVE To compare the analgesic effect of TAP block related to WI. SEARCH STRATEGY MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Cochrane Library, and CINAHL were searched from inception until April 2020. SELECTION CRITERIA Randomized controlled trials (RCTs) about women who underwent TAP block or WI after CS. DATA COLLECTION AND ANALYSIS Relevant data were extracted and tabulated. Review Manager 5.3 was used for data analysis. Primary outcome was cumulative opioid consumption (COC) 24 and 48 h after CS. MAIN RESULTS Five RCTs, enrolling 268 women, were included. There were no significant differences between the interventions regarding COC at 24 (mean difference [MD] -1.68, 95% confidence interval [CI] -6.29 to 2.93) and 48 hours (MD 1.28, 95% CI -10.44 to 13.00). Adverse effects (relative risk [RR] 0.93, 95% CI 0.75-1.16), gastrointestinal reactions (RR 1.30, 95% CI 0.46-3.68), or mild-moderate sedation (RR 1.12, 95% CI 0.72-1.74), pain scores, satisfaction of women, and withdrawals were similar between groups. CONCLUSIONS There might be no significant advantages selecting TAP block over WI for post-CS analgesia.
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Affiliation(s)
- Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Schiattarella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Cianci
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco La Verde
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maddalena Morlando
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Sisti
- Lincoln Medical and Mental Health Center, Bronx, NY, USA
| | - Irene Esposito
- Anesthesiology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pasquale Sansone
- Anesthesiology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale De Franciscis
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Point-of-Care Ultrasound: Applications in Low- and Middle-Income Countries. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:69-75. [PMID: 33424456 PMCID: PMC7785781 DOI: 10.1007/s40140-020-00429-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/31/2023]
Abstract
Purpose of Review This review highlights the applications of point-of-care ultrasound in low- and middle-income countries and shows the diversity of ultrasound in the diagnosis and management of patients. Recent Findings There is a paucity of data on point-of-care ultrasound in anesthesiology in low- and middle-income countries. However, research has shown that point-of-care ultrasound can effectively help manage infectious diseases, as well as abdominal and pulmonary pathologies. Summary Point-of-care ultrasound is a low-cost imaging modality that can be used for the diagnosis and management of diseases that affect low- and middle-income countries. There is limited data on the use of ultrasound in anesthesiology, which provides clinicians and researchers opportunity to study its use during the perioperative period.
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Mansoor A, Ellwood S, Hoffman G, Scholer A, Gore A, Grech D, Patrick B, Sifri Z. The Efficacy and Safety of Transversus Abdominis Plane Blocks After Open Cholecystectomy in Low- and Middle-Income Countries. J Surg Res 2020; 256:136-142. [PMID: 32693331 DOI: 10.1016/j.jss.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/08/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postoperative pain management is challenging in low- and middle-income countries (LMICs). This study assesses the safety and efficacy of transversus abdominis plane (TAP) blocks as an adjunct for postoperative pain control after an open cholecystectomy in LMICs during short-term surgical missions (STSMs). TAP block is a regional anesthesia technique that has been shown to be effective in providing supplementary analgesia to the anterolateral wall post abdominal surgery. METHODS A retrospective chart review of patients undergoing open cholecystectomy during STSMs was performed. STSMs took place in Guatemala, the Philippines, and Peru from 2009 to 2019. Measured outcomes including pain scores, presence of postoperative nausea or vomiting, and opioid consumption were compared between TAP block and non-TAP block groups. RESULTS Of the 48 patients analyzed, 28 underwent TAP block (58%). Non-TAP block patients received, on average, 8 mg of oral morphine equivalents more than the TAP patients (P = 0.035). No significant difference was noted in pain scores, which were taken immediately after surgery, 2 h after surgery, and at multiple times between these time points to calculate an average. Of the patients who received a TAP block, 11% reported nausea or vomiting compared with 45% in the standard group (P < 0.01). There were no reported procedure-related complications. CONCLUSIONS TAP blocks are safe and effective adjuncts for postoperative pain management on STSMs to LMICs. Additional studies are needed to investigate the potential advantages and disadvantages of more widespread use of TAP blocks in LMICs.
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Affiliation(s)
- Amtul Mansoor
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey
| | - Stephen Ellwood
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey
| | - Gary Hoffman
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey.
| | - Anthony Scholer
- John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, California; Department of Surgical Oncology, Prisma Health Greenville Memorial Medical Campus, Greenville, South Carolina
| | - Amy Gore
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey
| | - Dennis Grech
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey
| | - Bradley Patrick
- International Surgical Health Initiative, Jersey City, New Jersey
| | - Ziad Sifri
- Department of Surgery, New Jersey Medical School, Newark, New Jersey; International Surgical Health Initiative, Jersey City, New Jersey
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The analgesic effect of tramadol combined with butorphanol on uterine cramping pain after repeat caesarean section: a randomized, controlled, double-blind study. J Anesth 2020; 34:825-833. [PMID: 32627064 DOI: 10.1007/s00540-020-02820-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/27/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aimed to explore the effect of patient-controlled intravenous analgesia (PCIA) using tramadol combined with butorphanol on uterine cramping pain in women undergoing repeat caesarean section. METHODS A total of 126 patients, who were scheduled to undergo repeat caesarean section under spinal anesthesia, were included. PCIA using tramadol combined with butorphanol or sufentanil was randomly performed for postoperative pain control. Postoperative uterine cramping pain and wound pain within 48 h after surgery were evaluated. Postoperative analgesic consumption, early activity time, and length of hospital stay were also recorded and analyzed. RESULTS Uterine cramping pain intensity in women undergoing repeat caesarean section was significantly higher compared with their wound pain (P < 0.05). The mean visual analog scale (VAS) score for uterine cramping pain in the tramadol-butorphanol group was significantly lower than that in the sufentanil group at rest, and at 6 h and 12 h after surgery. VAS scores for uterine cramping pain during movement at 6 h, 12 h, and 24 h after surgery in the tramadol-butorphanol group were also significantly lower than that in sufentanil group (P < 0.05). There was no significant difference in VAS score for wound pain at the different time points between the tramadol-butorphanol and sufentanil groups (P > 0.05). Patient-controlled intravenous analgesia with tramadol accelerated early rehabilitation and decreased the length of hospital stay (P < 0.05). CONCLUSION PCIA using tramadol combined with butorphanol provided a better analgesic effect and accelerated postoperative rehabilitation compared with sufentanil, and may be an optimal analgesic strategy for women undergoing repeat caesarean section. CLINICAL TRIAL REGISTRATION The trial was registered at Chinese Clinical Trial Registry ( www.chictr.org.cn ) with ID: ChiCTR-1800014986.
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7
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Liu HL, Zhou RH, Luo LL, Yuan X, Ye L, Luo HG. Ultrasound-Guided Transversus Abdominis Plane Block for Cesarean Delivery: Injection Site Pain as a New Complication and Dexamethasone Reduced Incidence. J Pain Res 2020; 13:565-573. [PMID: 32256104 PMCID: PMC7090204 DOI: 10.2147/jpr.s222767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 03/07/2020] [Indexed: 02/05/2023] Open
Abstract
Background Although ultrasound-guided transversus abdominis plane block (TAPB) is widely used in multimodal analgesia after cesarean delivery (CD), the complications of TAPB during analgesia after CD have rarely been reported. Methods A total of 84 cases of CD were randomly assigned to either a ropivacaine group (R group) or ropivacaine + dexamethasone group (RD group) in this double-blind trial. The pain site and pain degree at rest and during activity at 2 h, 6 h, 10 h, 12 h, 14 h, 16 h, 20 h, and 24 h after maternal surgery were recorded. The consumption of opioids at 24h, postoperative nausea, vomiting, exhaustion, and other adverse reactions were recorded. Results A total of 80 patients were included in the analysis of results. A total of 19 patients developed ISP, 14 in the R group and 5 in the RD group. The incidence of ISP in the R and RD groups was 35% and 12.5%, respectively. The results described above showed that combining dexamethasone with ropivacaine reduced the incidence of ISP, and the difference was statistically significant (P<0.05). Two groups of women with positive ISP had higher values of opioid consumption than women with negative ISP, but the difference was not significant. Conclusion Dexamethasone as an adjuvant for ropivacaine can effectively relieve the ISP of ultrasound-guided TAPB after CD, and can enhance the analgesic effect of ropivacaine.
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Affiliation(s)
- Hai-Lin Liu
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
| | - Rui-Hao Zhou
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Li-Li Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
| | - Xue Yuan
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
| | - Ling Ye
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - He-Guo Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
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Duan G, Yang G, Peng J, Duan Z, Li J, Tang X, Li H. Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study. BMC Anesthesiol 2019; 19:189. [PMID: 31640565 PMCID: PMC6806491 DOI: 10.1186/s12871-019-0865-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 09/30/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The differences in post-operative pain are unclear between the primiparas who underwent a primary cesarean section and multiparas who underwent their first repeat cesarean section. The study aimed to explore the possible differences in postoperative pain between primiparas and multiparas. METHODS A prospective cohort study was performed only including women who underwent cesarean deliveries under spinal anesthesia. Postoperative patient-controlled intravenous analgesia (PCIA) was administered to all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen; the pump was programmed as 2.0 mL/h background infusion with a loading dose of 1 mL and a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using the visual analogue scale, and inadequate analgesia was defined as a visual analogue scale score ≥ 40 during 48 h post-operation. Additionally, the patients' pain statuses in postoperative week 1 and week 4 were also assessed during follow-up via telephone. RESULTS From January to May 2017, a total of 168 patients (67 primiparas and 101 multiparas) were included. The relative risk for multiparas to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primiparas. In patients aged < 30 years, inadequate analgesia on visceral pain was higher in multiparas than in primiparas (RR, 3.56 [1.05 to 12.04], P = 0.025). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multiparas and primiparas (33.7% vs. 40.2%, P = 0.381). No difference was found in PCIA use between the two groups (111.1 ± 36.0 mL vs. 110.9 ± 37.3 mL, P = 0.979). In addition, a significantly higher incidence of pain was noted 4 weeks post-surgery in primiparas than that in multiparas (62.2% vs. 37.7%, P = 0.011). CONCLUSION Multiparas who underwent their first repeat cesarean section have a lower for inadequate analgesia on incision pain during the first 48 h after surgery than primiparas. Multiparas aged under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain. TRAIL REGISTRATION ClinicalTrial.gov: NCT03009955 , Date registered: December 30, 2016.
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Affiliation(s)
| | | | - Jing Peng
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Zhenxin Duan
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Jie Li
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Xianglong Tang
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Hong Li
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China.
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Jin Y, Li Y, Zhu S, Zhu G, Yu M. Comparison of ultrasound-guided iliohypogastric/ilioinguinal nerve block and transversus abdominis plane block for analgesia after cesarean section: A retrospective propensity match study. Exp Ther Med 2019; 18:289-295. [PMID: 31258664 PMCID: PMC6566038 DOI: 10.3892/etm.2019.7540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/29/2019] [Indexed: 01/03/2023] Open
Abstract
Effective and adequate post-operative analgesia for cesarean section is in demand due to increasing rates of cesarean deliveries, and may help promote recovery, ambulation and breastfeeding. Local nerve block has been applied as post-operative analgesia for maternal patients receiving cesarean section; specifically, lateral abdominal transversus abdominis plane block (TAPB) and iliohypogastric/ilioinguinal nerve block (IHINB) under ultrasound guidance have been proven to be effective. The present study aimed to compare the analgesic effect of TAPB and IHINB in maternal females undergoing cesarean section. Propensity-matched females who received cesarean section (n=124) were retrospectively enrolled and divided into the TAPB group (n=62) and the IHINB group (n=62) according to their post-operative analgesia treatment. All of the patients have been given spinal-epidural anesthesia during the operation, while they received either TAPB or IHINB for post-operative analgesia. Demographic and clinical data were collected and compared, including time to first morphine request, cumulative morphine consumption, visual analogue scale (VAS) score and adverse events. Due to propensity matching, there was no significant difference between the two groups in their baseline characteristics (all P>0.05). The log-rank test indicated no significant difference in the Kaplan-Meier curves for the time to first morphine request between the two groups (P=0.575). The VAS score and cumulative morphine consumption at 6 and 12 h was similar between the two groups (all P>0.05). However, these two parameters were significantly lower in the IHINB group at 24 and 48 h (P<0.001). Uni- and multivariate logistic regression analysis indicated that the method of block was not an independent influencing factor regarding postoperative pain relief (P=0.628). There was also no difference between the two groups in adverse events of analgesia (all P>0.05). In conclusion, the present study demonstrated that TAPB and IHINB achieved a comparably satisfactory analgesic effect after cesarean section. However, the analgesic effect of IHINB was better than that of TAPB at the later stages.
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Affiliation(s)
- Yulu Jin
- Department of Anesthesiology, Yueqing Third People's Hospital, Yueqing, Zhejiang 325604, P.R. China
| | - Yongliang Li
- Department of Anesthesiology, Ruian People's Hospital, Ruian, Zhejiang 325200, P.R. China
| | - Sanrong Zhu
- Department of Anesthesiology, Yueqing Third People's Hospital, Yueqing, Zhejiang 325604, P.R. China
| | - Guangfeng Zhu
- Department of Anesthesiology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang 325003, P.R. China
| | - Min Yu
- Department of Anesthesiology, Ruian Maternal and Child Health Hospital, Ruian, Zhejiang 325200, P.R. China
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Bishop DG, Gibbs MW, Dyer RA. Post-caesarean delivery analgesia in resource-limited settings: a narrative review. Int J Obstet Anesth 2019; 40:119-127. [PMID: 31230992 DOI: 10.1016/j.ijoa.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 04/02/2019] [Accepted: 05/10/2019] [Indexed: 01/26/2023]
Abstract
Post-caesarean pain is an important and often neglected outcome. It causes suffering, affects breastfeeding and is associated with postpartum depression and the development of chronic pain syndromes. Pain control is often difficult even in resource-rich environments; it is likely far worse in resource-limited settings, where emphasis is on reducing the high maternal mortality rate. Lack of adequate staffing, education, and postoperative monitoring severely limit the options in resource-limited settings. Resource-limited settings are further compromised by limited access to essential analgesic drugs and equipment for their administration. Solutions using affordable and accessible medications as part of a multimodal analgesic strategy are possible, supplemented by education and training programmes. More research is required, both to establish current practice and to test methods for improving maternal pain control. While government involvement is necessary to improve infrastructure and resources in individual countries, other solutions should also be sought, empowering local institutions and harnessing individual cultural characteristics.
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Affiliation(s)
- D G Bishop
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
| | - M W Gibbs
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - R A Dyer
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
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Kwikiriza A, Kiwanuka JK, Firth PG, Hoeft MA, Modest VE, Ttendo SS. The analgesic effects of intrathecal morphine in comparison with ultrasound-guided transversus abdominis plane block after caesarean section: a randomised controlled trial at a Ugandan regional referral hospital. Anaesthesia 2018; 74:167-173. [PMID: 30383289 DOI: 10.1111/anae.14467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 12/25/2022]
Abstract
Both transversus abdominis plane block and intrathecal morphine may produce prolonged postoperative analgesia, but the respective clinical outcomes of these anaesthetic techniques in resource-limited settings are not well described. We randomly assigned patients undergoing caesarean section to receive a hyperbaric bupivacaine (10 mg) spinal anaesthetic followed by an ultrasound-guided transversus abdominis plane block, or a hyperbaric bupivacaine (10 mg) spinal anaesthetic with 100 mcg intrathecal morphine, followed by a postoperative sham block. Supplemental postoperative analgesia included self-administered oral diclofenac 50 mg and paracetamol 1 g every 8 h. Numerical pain rating scores, the need for rescue medication, side-effects and patient satisfaction were recorded at 8, 16 and 24 h. We enrolled a total of 130 patients, with 65 women in each group. The mean numerical rating score for intrathecal morphine vs. transversus abdominis plane blocks at 8 h were: at rest, 2.5 vs. 3.1 (p = 0.04); with coughing, 4.3 vs. 4.8 (p = 0.07); and with movement, 3.6 vs. 4.2 (p = 0.06). At 16 h, respective scores were: 2.9 vs. 3.1 (p = 0.40) at rest; 4.0 vs. 4.3 (p = 0.19) with coughing; and 4.8 vs. 5.0 (p = 0.33) with movement. At 24 h, the respective scores were: 2.9 vs. 2.3 (p = 0.01); 4.6 vs. 4.2 (p = 0.04) with coughing; and 3.9 vs. 3.4 (p = 0.02) with movement. The need for rescue medication and the incidence of pruritis, sedation and nausea and vomiting were similar in both groups. Patient satisfaction with pain control was similar in both groups, with the majority of patients reporting satisfaction as good or excellent. Intrathecal morphine and transversus abdominis plane block provided clinically similar outcomes for pain relief after caesarean section.
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Affiliation(s)
- A Kwikiriza
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - J K Kiwanuka
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - P G Firth
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M A Hoeft
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - V E Modest
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S S Ttendo
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
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Duan G, Wu Z, Zhao P, Peng J, Chen Z, Zhang Q, Xu R, Li H. Protocol for a randomised, double-blind, placebo-controlled trial to explore the effect of tramadol in the prevention of postpartum depression (ETPPD). BMJ Open 2018; 8:e022538. [PMID: 30344172 PMCID: PMC6196816 DOI: 10.1136/bmjopen-2018-022538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Postpartum depression is one of the most commonly experienced psychological disorders for women patients undergoing caesarean section, which accounts for about one-third of puerpera worldwide. Tramadol, a commonly used analgesic with an inhibitory effect on the reuptake of norepinephrine and serotonin, is an effective and well-tolerated agent for analgesia after caesarean section. Based on the role of changes in the postpartum levels of serotonin and norepinephrine in postpartum depression, we speculated that postoperative intravenous analgesia using tramadol may decrease the incidence of postpartum depression for caesarean patients. Therefore, this trial aimed to explore the effect of tramadol in the prevention of postpartum depression. METHODS AND ANALYSIS A randomised double-blind placebo-controlled trial will be performed and 1230 singleton parturients will be randomised to receive patient-controlled intravenous analgesia with tramadol or hydromorphone, or patient-controlled epidural analgesia with ropivacaine. The primary outcome of this trial will be the incidence of postpartum depression at 4 weeks after the caesarean section, together with the collection of the relevant data during hospitalisation and at 3 months after the caesarean section. Subgroup data according to the preoperative depression score will be analysed. Demographic characteristics, postoperative analgesic effects and postoperative recovery score will also be summarised and presented. ETHICS AND DISSEMINATION The current trial protocol was approved by the Institutional Ethics Committee of Xinqiao Hospital (ID: 2017-026), Third Military Medical University, Chongqing, China. The results of this trial will be disseminated at scientific meetings and in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03309163; Pre-results.
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Affiliation(s)
- Guangyou Duan
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zhuoxi Wu
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Peng Zhao
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jing Peng
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zhengqiong Chen
- Department of Obstetrics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Qingling Zhang
- Department of Psychology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Rufu Xu
- Department of Health Statistics, Third Military Medical University, Chongqing, China
| | - Hong Li
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Spread of Quadratus Lumborum Block to the Paravertebral Space Via Intramuscular Injection. Reg Anesth Pain Med 2018; 43:372-377. [DOI: 10.1097/aap.0000000000000735] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Li Q, Tang X, Tao T, Zhang W, Qin W, Zhang J, Li Z. A Randomized Controlled Trial of Comparing Ultrasound-Guided Transversus Abdominis Plane Block with Local Anesthetic Infiltration in Peritoneal Dialysis Catheter Implantation. Blood Purif 2017; 45:8-14. [PMID: 29161695 DOI: 10.1159/000479083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/29/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The ultrasound-guided transversus abdominis plane (TAP) block has been demonstrated as a useful analgesia technique in lower-abdomen surgeries. We hypothesized that it could be the principal anesthesia technique for end-stage renal disease (ESRD) patients undergoing peritoneal dialysis (PD) catheter (PDC) implantation using the open dissection method. METHODS This was a single-center, prospective, randomized, and double-blinded study. All eligible patients were randomized into 2 groups: the TAP block group (n = 20) and the local anesthetic infiltration (LAI) group (n = 20). RESULTS Compared with the LAI group, the TAP block group revealed a remarkably lower visual analogue score, lower switching rate into general anesthesia, higher satisfaction rate, and less rescuing analgesic consumption during operation (p < 0.05). Both PD- and anesthesia-related complications were rare in the 4-week follow-up. CONCLUSIONS The ultrasound-guided TAP block had better analgesic effect than LAI and can be used as a principal anesthesia technique for PDC implantation in ESRD patients without previous abdominal surgery.
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Affiliation(s)
- Qi Li
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, PR China
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Tawfik MM, Mohamed YM, Elbadrawi RE, Abdelkhalek M, Mogahed MM, Ezz HM. Transversus Abdominis Plane Block Versus Wound Infiltration for Analgesia After Cesarean Delivery: A Randomized Controlled Trial. Anesth Analg 2017; 124:1291-1297. [PMID: 27984230 DOI: 10.1213/ane.0000000000001724] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Transversus abdominis plane (TAP) block and local anesthetic wound infiltration provide analgesia after cesarean delivery. Studies comparing the 2 techniques are scarce, with conflicting results. This double-blind, randomized controlled trial aimed to compare bilateral ultrasound-guided TAP block with single-shot local anesthetic wound infiltration for analgesia after cesarean delivery performed under spinal anesthesia. We hypothesized that the TAP block would decrease postoperative cumulative fentanyl consumption at 24 hours. METHODS Eligible subjects were American Society of Anesthesiologists physical status II parturients with full-term singleton pregnancies undergoing elective cesarean delivery under spinal anesthesia. Exclusion criteria were: <19 years of age or >40 years of age; height <150 cm, weight <60 kg, body mass index ≥40 kg/m; contraindications to spinal anesthesia; history of recent opioid exposure; hypersensitivity to any of the drugs used in the study; significant cardiovascular, renal, or hepatic disease; and known fetal abnormalities. Eighty subjects were randomly allocated to 2 equal groups. In the infiltration group, participants received 15 mL of bupivacaine 0.25% in each side of the surgical wound (total 30 mL); and in the TAP group, participants received 20 mL of bupivacaine 0.25% bilaterally in the TAP block (total 40 mL). The TAP block and wound infiltration were performed by the primary investigator and the operating obstetrician, respectively. All participants received postoperative standard analgesia (ketorolac and paracetamol) and intravenous fentanyl via patient-controlled analgesia. Patients and outcome assessors were blinded to the study group. The primary outcome was the cumulative fentanyl consumption at 24 hours. Secondary outcomes were the time to the first postoperative fentanyl dose, cumulative fentanyl consumption at 2, 4, 6, and 12 hours, pain scores at rest and on movement at 2, 4, 6, 12, and 24 hours, the deepest level of sedation, the incidence of side effects (nausea and vomiting and pruritis), and patient satisfaction. RESULTS Data from 78 patients (39 patients in each group) were analyzed. The mean ± SD of cumulative fentanyl consumption at 24 hours was 157.4 ± 63.4 μg in the infiltration group and 153.3 ± 68.3 μg in the TAP group (difference in means [95% confidence interval] is 4.1 [-25.6 to 33.8] μg; P = .8). There were no significant differences between the 2 groups in the time to the first postoperative fentanyl dose, cumulative fentanyl consumption at 2, 4, 6, and 12 hours, pain scores at rest and on movement at 2, 4, 6, 12, and 24 hours, the deepest level of sedation, and patient satisfaction. The incidence of side effects (nausea and vomiting and pruritis) was low in the 2 groups. CONCLUSIONS TAP block and wound infiltration did not significantly differ regarding postoperative fentanyl consumption, pain scores, and patient satisfaction in parturients undergoing cesarean delivery under spinal anesthesia.
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Affiliation(s)
- Mohamed Mohamed Tawfik
- From the Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Egypt
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Champaneria R, Shah L, Wilson M, Daniels J. Clinical effectiveness of transversus abdominis plane (TAP) blocks for pain relief after caesarean section: a meta-analysis. Int J Obstet Anesth 2016; 28:45-60. [DOI: 10.1016/j.ijoa.2016.07.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 11/29/2022]
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