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Li XT, Xue FS, Cheng Y. Letter to the Editor Regarding "The Role of Ultrasound-Guided Multipoint Fascial Plane Block in Elderly Patients Undergoing Combined Thoracoscopic-Laparoscopic Esophagectomy: A Prospective Randomized Study". Pain Ther 2024; 13:289-291. [PMID: 38386183 DOI: 10.1007/s40122-024-00582-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Affiliation(s)
- Xin-Tao Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
| | - Yi Cheng
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
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Zhang H, Huang Z, Guo C, Lin Z. Efficacy and safety of laparoscopically assisted transversus abdominis plane block for the postoperative analgesia of pediatric inguinal hernia. Asian J Surg 2024; 47:1023-1024. [PMID: 37977926 DOI: 10.1016/j.asjsur.2023.10.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Huiying Zhang
- General Surgery Dept.2, Shantou Central Hospital, Shantou, 515000, China
| | - Zehong Huang
- General Surgery Dept.2, Shantou Central Hospital, Shantou, 515000, China
| | - Chunming Guo
- Anesthesiology Department, Shantou Central Hospital, Shantou, 515000, China
| | - Zhongliang Lin
- General Surgery Dept.2, Shantou Central Hospital, Shantou, 515000, China.
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Liu J, Tian JM, Liu GZ, Sun JN, Gao PF, Zhang YQ, Yue XQ. Application of remimazolam transversus abdominis plane block in gastrointestinal tumor surgery. World J Gastrointest Oncol 2023; 15:2101-2110. [PMID: 38173426 PMCID: PMC10758652 DOI: 10.4251/wjgo.v15.i12.2101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/26/2023] [Accepted: 11/25/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Transversus abdominis plane block (TAPB) is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics. It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect. However, the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear. AIM To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients. METHODS A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023. The patients were categorized into a control group (n = 51), receiving remimazolam for general anesthesia, and an observation group (n = 51), receiving TAPB combined with remimazolam for general anesthesia. A comparison was made between both groups in terms of hemodynamic parameters, stress markers, pain levels, recovery quality, analgesic effects, and adverse reactions during the perioperative period. RESULTS The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group (P < 0.05). The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group (P < 0.05). Five minutes after extubation, the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group (P < 0.05). At 12 h, 24 h, and 48 h following surgery, the visual analog scale scores of the observation group were considerably lower than those of the control group (P < 0.05). The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group (P < 0.05). The observation group exhibited considerably fewer effective pump presses, lower fentanyl dosages, and lower incidences of rescue analgesia within 24 h following surgery than the control group (P < 0.05). CONCLUSION The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good, which is helpful to promote faster recovery after operation.
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Affiliation(s)
- Jun Liu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Jian-Min Tian
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Guo-Ze Liu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Jun-Na Sun
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Peng-Fei Gao
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Yong-Qiang Zhang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Xiu-Qin Yue
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
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Dai J, Lin S, Cui X, Xu Z, Zheng R, Wu D. The effects of ultrasound-guided QLB and TAPB combined with opioid-free anesthesia (OFA) on clinical efficacy of the patients undergoing abdominal surgery. Heliyon 2023; 9:e20878. [PMID: 37867884 PMCID: PMC10589855 DOI: 10.1016/j.heliyon.2023.e20878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023] Open
Abstract
Background Although opioids provide effective analgesia for abdominal surgery, they also present serious unwanted side effects. Ultrasound-guild quadratus lumborum block (QLB) and transversus abdominis plane block (TAPB) have been proven to offer long-lasting and efficient analgesia during abdominal surgery. However, the clinical efficacy of ultrasound-guided QLB and TAPB combined with opioid-free anesthesia (OFA) in abdominal surgery remains unclear. Objective This study aimed to investigate the impact of ultrasound-guided QLB and TAPB combined with opioid-free anesthesia (OFA) on the clinical efficacy of abdominal surgery. Methods A total of 122 patients scheduled for abdominal surgery at People's Hospital of Wanning between March 2021 and April 2022 were enrolled in this study. Participants were randomly divided into two groups: the experimental group (QLB/TAPB + OFA, 62 patients) and the control group (opioid anesthesia, 60 patients). The clinical efficacy of the QLB/TAPB combined with OFA technique was evaluated by analyzing patients' vital signs, postoperative consciousness recovery time, numeric rating scale (NRS) score, and immune function in both groups. Results We observed that systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in experimental group were significantly higher than those in control group after induction (p < 0.05). Heart rate (HR) in experimental group was significantly lower than in the control group at intraoperative 1h (p < 0.05). Additionally, bispectral index (BIS), state entropy (SE), and response entropy (RE) levels in the experimental group were significantly higher than those in the control group (p < 0.05). Furthermore, extubation and awakening time were significantly shorter in the experimental group compared to the control group (p < 0.05). The NRS scores in the experimental group were markedly lower than those in the control group. Moreover, IL-6 and CRP levels in the experimental group were obviously lower than in the control group after postoperative 1d (p < 0.05). Interestingly, IL-6 (p < 0.001), CRP (p < 0.001), and PCT (p = 0.037) levels in female patients of the experimental group were all significantly lower than those in the control group after postoperative 1d. Conclusions Ultrasound-guided QLB and TAPB combined with OFA technique can reduce pain intensity and enhance the patients' immune function in abdominal surgery.
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Affiliation(s)
- Jingwei Dai
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, Hainan, China
| | - Shiwen Lin
- Department of Medical Laboratory, People's Hospital of Wanning, Wanning, Hainan, China
| | - Xiaoguang Cui
- Department of Anesthesiology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Zhixin Xu
- Department of Anesthesiology, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Riyue Zheng
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, Hainan, China
| | - Duozhi Wu
- Department of Anesthesiology, Hainan General Hospital, Haikou, Hainan, China
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Hubbard G, Hubert C, Vudayagiri L, Tullington J, Merino K, Vaidya A, Gemma R. Transversus abdominis plane blocks in laparoscopic inguinal hernia repair: a review. Hernia 2023; 27:1059-1065. [PMID: 37395916 DOI: 10.1007/s10029-023-02831-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/25/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Throughout its history, there have been significant advances in pain control of inguinal hernia repairs. One of the most recent developments is locoregional pain blocks. There is a multitude of literature available on laparoscopic inguinal hernia repair and transversus abdominis plane (TAP) blocks. OBJECTIVES This paper seeks to provide a thorough and systematic literature review on the role of TAP blocks in laparoscopic inguinal hernia repairs. METHODS PubMed and Google Scholar were searched for relevant literature using predetermined medical subject heading (MeSH) terms: "(TAP block)" AND "(Laparoscopic inguinal hernia repair)". RESULTS A total of 166 publications were identified, from which 18 publications were included in the final review after eligibility criteria were applied. CONCLUSION The majority of studies conclude that TAP blocks performed in the setting of laparoscopic inguinal hernia repair improve post-operative pain and mobility, decrease opiate analgesic usage, and are superior in pain control compared to other modalities of regional anesthesia. Thus, to improve post-operative outcomes and patient satisfaction, TAP blocks should be heavily considered for routine use in surgical practice for laparoscopic inguinal hernia repair.
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Affiliation(s)
- G Hubbard
- Department of Surgery, Western Reserve Hospital, 1900 23rd St, Cuyahoga Falls, OH, 44223, USA.
- Department of Graduate Medical Education, Western Reserve Hospital, 1900 23rd St, Cuyahoga Falls, OH, 44223, USA.
| | - C Hubert
- Kirksville College of Osteopathic Medicine, A.T. Still University, 800 W. Jefferson St, Kirksville, MO, 63501, USA
| | - L Vudayagiri
- Department of Surgery, Western Reserve Hospital, 1900 23rd St, Cuyahoga Falls, OH, 44223, USA
| | - J Tullington
- Department of Surgery, University of Nevada-Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
| | - K Merino
- Department of Surgery, Western Reserve Hospital, 1900 23rd St, Cuyahoga Falls, OH, 44223, USA
| | - A Vaidya
- Department of Surgery, Western Reserve Hospital, 1900 23rd St, Cuyahoga Falls, OH, 44223, USA
| | - R Gemma
- Department of Surgery, Western Reserve Hospital, 1900 23rd St, Cuyahoga Falls, OH, 44223, USA
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Xue B. Comment on "Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia After Laparoscopic Cholecystectomy: a Double-Blind, Randomized Controlled Trial". J Gastrointest Surg 2023; 27:2035-2036. [PMID: 37528317 DOI: 10.1007/s11605-023-05791-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/22/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Bai Xue
- Department of Anaesthesiology, Sengkang General Hospital, 110 Sengkang East Way, Singapore, Singapore.
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Schott N, Chamu J, Ahmed N, Ahmed BH. Perioperative truncal peripheral nerve blocks for bariatric surgery: an opioid reduction strategy. Surg Obes Relat Dis 2023; 19:851-857. [PMID: 36854643 DOI: 10.1016/j.soard.2023.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/14/2022] [Accepted: 01/14/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Bariatric surgical patients are vulnerable to cardiopulmonary depressant effects of opioids. The enhanced recovery after surgery (ERAS) protocol to improve postoperative morbidity recommends regional anesthesia for postoperative pain management. However, there is limited evidence that peripheral nerve blocks (PNB) have added benefit. OBJECTIVE Study the effect of PNB on postoperative pain and opioid use following bariatric surgery. SETTING Academic medical center, United States. METHODS We conducted a cohort study of patients who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. A total of 44 patients received the control ERAS protocol with preoperative oral extended-release morphine sulfate (MS), while 45 patients underwent a PNB with either intrathecal morphine (IM) or oral MS per local ERAS protocol. The PNB group either underwent preoperative bilateral T7 paravertebral (PVT) PNBs (27 patients) with IM or postoperative transversus abdominis plane (TAP) PNBs (18 patients) with oral MS. The primary outcome compared total opioid consumption between the ERAS control group and the PNB group up to 48 hours postoperatively. Secondary outcomes included comparison by block type and postoperative pain scores. RESULTS PVT or TAP PNB patients had a reduction in mean postoperative oral morphine equivalent (OME) requirements compared with the ERAS protocol cohort at 24 hours (93.9 versus 42.8 mg), P < .0001; at 48 hours (72.6 versus 40.5 mg); and in pain scores at 24 hours (5.64/10 versus 4.46/10), P = .02. OME and pain scores were higher in the SG cohort. CONCLUSION Addition of truncal PNB to standard ERAS protocol for bariatric surgical patients reduces postoperative total opioid consumption.
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Affiliation(s)
- Nicholas Schott
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jauhleene Chamu
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Noor Ahmed
- North Allegheny Senior High School, Pittsburgh, Pennsylvania
| | - Bestoun H Ahmed
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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Zhu C, Fang J, Yang J, Geng Q, Li Q, Zhang H, Xie Y, Zhang M. The Role of Ultrasound-Guided Multipoint Fascial Plane Block in ElderlyPatients Undergoing Combined Thoracoscopic-Laparoscopic Esophagectomy: A Prospective Randomized Study. Pain Ther 2023; 12:841-852. [PMID: 37099123 PMCID: PMC10199967 DOI: 10.1007/s40122-023-00514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/04/2023] [Indexed: 04/27/2023] Open
Abstract
INTRODUCTION We estimated the safety and efficacy of ultrasound-guided multipoint fascial plane block, including serratus anterior plane block (SAPB) and bilateral transversus abdominis plane block (TAPB) in elderly patients who underwent combined thoracoscopic-laparoscopic esophagectomy (TLE). METHODS The authors enrolled 80 patients in this prospective study after patient selection using the inclusion and exclusion criteria who were scheduled for elective TLE from May 2020 to May 2021. Patients were randomly assigned to the treated group (group N) or the control group (group C) (n = 40 per group) using the sealed-envelope method. Multipoint fascial plane blocks, including serratus anterior plane block (SAPB) and bilateral TAPB, were performed on patients undergoing TLE using a solution of 60 mL 0.375% ropivacaine plus 2.5 mg dexamethasone by 3 injections of 20 mL each (group N) or no interventions (group C). RESULTS Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) at T incision and 30 min after T incision were significantly higher in group C than in group N, and also significantly higher than at baseline (P < 0.01). Blood glucose at 60 min, 2 h after T incision, was significantly higher in group C than in group N and significantly higher than at baseline (P < 0.01). Compared to group N, the dosages of propofol and remifentanil used during surgery in group C were more than those in group N (P < 0.01). The time to first rescue analgesic in group C was earlier than in group N. The total postoperative use of sufentanil, and the number of patients requiring rescue analgesics in group C, were more than in group N (P < 0.01). CONCLUSIONS This study showed that applying the multipoint fascia pane block technique in TLE for elderly patients could significantly reduce postoperative pain, decrease the dosages of drugs used in general anesthesia, improve the quality of the awakening, and have no obvious adverse reactions. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR-2000033617).
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Affiliation(s)
- Chenchen Zhu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No 9 Lujiang Road, Hefei, 230001, People's Republic of China
| | - Jun Fang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No 9 Lujiang Road, Hefei, 230001, People's Republic of China
| | - Jia Yang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No 9 Lujiang Road, Hefei, 230001, People's Republic of China
| | - Qingtian Geng
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No 9 Lujiang Road, Hefei, 230001, People's Republic of China
| | - Qijian Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No 9 Lujiang Road, Hefei, 230001, People's Republic of China
| | - Huaming Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No 9 Lujiang Road, Hefei, 230001, People's Republic of China
| | - Yanhu Xie
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No 9 Lujiang Road, Hefei, 230001, People's Republic of China
| | - Min Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No 9 Lujiang Road, Hefei, 230001, People's Republic of China.
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Yuan YJ, Xue FS, Cheng Y. Letter to the Editor Regarding "Effect of Transcutaneous Electrical Acupoint Stimulation Combined with Transversus Abdominis Plane Block on Postoperative Recovery in Elderly Patients Undergoing Laparoscopic Gastric Cancer Surgery: A Randomized Controlled Trial". Pain Ther 2023; 12:885-888. [PMID: 37067683 PMCID: PMC10199969 DOI: 10.1007/s40122-023-00509-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/28/2023] [Indexed: 04/18/2023] Open
Affiliation(s)
- Yu J Yuan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
| | - Yi Cheng
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
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Tejedor A, Deiros C, Bijelic L, García M. Wound infiltration or transversus abdominis plane block after laparoscopic radical prostatectomy: a randomized clinical trial. Anesth Pain Med (Seoul) 2023; 18:190-197. [PMID: 37183287 PMCID: PMC10183622 DOI: 10.17085/apm.23005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/13/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Regional anesthesia techniques are commonly used for postoperative pain management during laparoscopic surgery. Our aim was to compare the analgesic efficacy of pre-incisional subcutaneous wound infiltration (WI) with that of the transversus abdominis plane (TAP) block as part of a multimodal analgesic approach in laparoscopic radical prostatectomy. METHODS In this prospective, double-blinded, randomized controlled clinical trial, 60 patients were assigned to either TAP or WI group. The main outcome was acute postoperative pain control assessed using the mean numeric rating scale (NRS) at the 24 hours postoperatively. The secondary outcomes were opioid requirements, procedure-related complications, overall complications, and length of stay. RESULTS In this study, 60 patients were randomized: 30 to TAP group and 28 to WI (two were excluded due to conversion to open surgery). We found no significant difference in the median (1Q, 3Q) NRS scores during the 24 h postoperatively neither at rest (TAP, 0 (0, 1) vs. WI, 0 (0, 1), P = 0.812), nor during movement (TAP, 1 (0, 2) vs. WI, 1 (0, 2), P = 0.708). There were no statistical differences in the postoperative intravenous morphine requirements in the TAP vs. WI groups during the same period (1.7 ± 3.1 vs. 1.8 ± 4.1 mg; P = 0.910). Only one patient in the TAP group presented with postoperative nausea and vomiting. CONCLUSIONS Both pre-incisional subcutaneous WI and TAP blockade were associated with very low pain scores as part of a non-opioid multimodal analgesic regimen in laparoscopic radical prostatectomy. This study did not demonstrate the benefits of WI over TAP.
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Affiliation(s)
- Ana Tejedor
- Departmentsof Anesthesiology, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Carme Deiros
- Departmentsof Anesthesiology, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Lana Bijelic
- Department of Surgery, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Marta García
- Departmentsof Anesthesiology, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
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Ying J, Jiang C, Xu C, Liu Y, Gu L. Utility of transversus abdominis plane block on patients undergoing transanal total mesorectal excision. Pak J Med Sci 2023; 39:518-523. [PMID: 36950394 PMCID: PMC10025717 DOI: 10.12669/pjms.39.2.7062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 08/26/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Objective To evaluate the analgesic effect of transversus abdominis plane block (TAPB) on patients undergoing transanal total mesorectal excision (taTME). Methods Medical records of patients who were eligible to receive proctectomy surgery in Renji Hospital, Shanghai Jiao Tong University School of Medicine (From January 2019 to December 2021) were retrospectively reviewed. Propensity score matching (PSM) was applied to the included cases. A total of 120 cases were divided into three groups based on the different operation and anesthesia methods used. Group-A (Lap, n=40) included patients that underwent laparoscopic surgery under general anesthesia. Group- B (ta, n=40) included patients who received taTME surgery under general anesthesia. Group-C (ta+TAPB, n=40) included patients who received taTME surgery under general anesthesia combined with TAPB. The dosage of sufentanil, time of postoperative revival and extubation, anal exhaust time and other adverse events were recorded. Pain assessment using the visual analogue scale (VAS) was performed at 12, 24,48 and 72 hours after the operation. Results There were no significant differences in the general parameters, operative conditions, and anesthetic administration between the three groups (P>0.05). The dosage of sufentanil was significantly reduced in Group-C, compared with Group-A and Group-B, with no difference between the groups A and B. There was no significant difference between the three groups in postoperative recovery time and extubation time. VAS score was lower in Group-C than Group-A and Group-B. This difference was more obvious in the early postoperative period and gradually diminished with time. VAS score became similar in all three groups 72 hours after the surgery. Conclusion Transanal total mesorectal excision was associated with less pain, compared to laparoscopic TME. TAPB with general anesthesia in patients undergoing taTME is safe and effective. It can significantly reduce the use of sufentanil and has optimal analgesic effect.
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Affiliation(s)
- Jun Ying
- Jun Ying, Department of Anesthesiology, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Chunhui Jiang
- Chunhui Jiang, Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Chunjie Xu
- Chunjie Xu, Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Ye Liu
- Ye Liu, Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Lei Gu
- Lei Gu, Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200127, P.R. China
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Abdildin Y, Tapinova K, Nugumanova M, Viderman D. Transversus abdominis plane block in adult open liver surgery patients: A systematic review with meta-analysis of randomized controlled trials. J Visc Surg 2023:S1878-7886(22)00174-6. [PMID: 36775697 DOI: 10.1016/j.jviscsurg.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
AIM OF THE STUDY The objective of this meta-analysis is to evaluate the efficacy of Transversus Abdominis Plane Block (TAPB) in pain control and recovery after open hepatic surgery. METHODS We searched for the articles in PubMed, Google Scholar, and the Cochrane Library published before March 2022. We included randomized controlled trials (RCTs) comparing TAPB with a placebo in adult patients after open liver surgery. Meta-analysis was conducted in RevMan 5.4. Methodological quality was assessed via the Jadad/Oxford scale and Cochrane Risk of Bias tool. RESULTS Five RCTs with 347 patients were included. All studies had an acceptable Jadad score or higher. For pain at rest at 24hours postoperatively, the standardized mean difference (SMD) with a 95% confidence interval (CI) was -1.08 [-1.97, -0.18], P-value 0.02, favoring TAPB. Models for total opioid consumption, nausea and vomiting, and duration of hospital stay did not demonstrate a difference between the groups. The model for time to first flatus favored TAPB with SMD with a 95% CI of -1.48 [-2.72, -0.24], P-value 0.02. DISCUSSION Our meta-analysis of five RCTs favored TAPB regarding pain control at rest and time to first flatus. Due to the small sample size and considerable heterogeneity, more RCTs are needed. REGISTRATION NUMBER CRD42022320565.
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Affiliation(s)
- Y Abdildin
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Avenue, Astana, 010000, Kazakhstan.
| | - K Tapinova
- Nazarbayev University School of Medicine (NUSOM), Department of Biomedical Sciences, 5/1 Kerey and Zhanibek Khans Street, Astana, 020000, Kazakhstan.
| | - M Nugumanova
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Avenue, Astana, 010000, Kazakhstan.
| | - D Viderman
- Nazarbayev University School of Medicine (NUSOM), Department of Biomedical Sciences, 5/1 Kerey and Zhanibek Khans Street, Astana, 020000, Kazakhstan; Department of Anesthesiology, Intensive Care and Pain Medicine, National Research Oncology Center, 3 Kerey and Zhanibek Khans Street, Astana, 020000, Kazakhstan.
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Morrell DJ, Chau MH, Winder JS, Stredny ES, Alli VV, Sinz EH, Hazard SW, Simmons Z, Pauli EM. Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: outcomes of a dedicated anesthesia and surgery protocol. Surg Endosc 2023. [PMID: 36735049 DOI: 10.1007/s00464-023-09896-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients requiring percutaneous endoscopic gastrostomy (PEG) for amyotrophic lateral sclerosis (ALS) related dysphagia represent a clinical challenge. Diminished pulmonary function and aspiration risks can lead to anesthesia-related complications, and gastric displacement from hemidiaphragm elevation may preclude safe gastric access. This study reports the efficacy and outcomes of a dedicated anesthesia/surgery management protocol for ALS patients undergoing PEG. METHODS In 2013, a PEG placement protocol for ALS patients was developed emphasizing efficient pre-operative evaluation, rapidly metabolized anesthetic agents, and minimization of opioid use. Outcomes were analyzed retrospectively. Preoperative weight loss, pulmonary function tests, total analgesia, procedural time, and 90-day morbidity and mortality were recorded. RESULTS From 2013-2019, 67 ALS patients (mean age 65.3 years, 52.2% female) received a PEG under the protocol. Mean percentage weight loss 6 months before PEG was 9.3 ± 5.1% with 38.8% of patients meeting criteria for severe malnutrition. Mean anesthesia time (propofol induction to anesthesia emergence) was 34.5 ± 10.8 min and mean operative time (endoscope insertion to dressing placement) was 16.4 ± 8.2 min. Regional anesthesia with liposomal bupivacaine was performed in 76.1%. All attempts at PEG placement were successful. With a mean follow-up of 6.1 ± 6.8 months, all PEGs were functional and there were no surgical site complications. Thirty-day readmission rate was 7.0% and 90-day mortality was 22.4% (46.7% occurring within 30 days). Mean time from surgery to death was 8.8 ± 7.8 months. CONCLUSIONS Protocols for optimizing PEG may help overcome challenges present in the ALS patient population. Despite patient comorbidities, protocol implementation and dedicated team members resulted in a high procedural success rate and low complication rate. Further study is warranted to optimize the timing of PEG placement in relation to ALS disease progression and determine the utility of regional anesthesia during PEG placement.
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Li RP, Xue FS, Cheng Y. Letter to the Editor Regarding "Analgesia Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Intravenous Analgesia After Cesarean Section: A Double-Blind Controlled Trial". Pain Ther 2023; 12:309-11. [PMID: 36417166 DOI: 10.1007/s40122-022-00454-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
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Mostafa M, Mousa MS, Hasanin A, Arafa AS, Raafat H, Ragab AS. Erector spinae plane block versus subcostal transversus abdominis plane block in patients undergoing open liver resection surgery: A randomized controlled trial. Anaesth Crit Care Pain Med 2023; 42:101161. [PMID: 36154912 DOI: 10.1016/j.accpm.2022.101161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to compare the analgesic efficacy of erector spinae plane block (ESPB) in relation to subcostal transversus abdominis plane block (TAPB) in patients undergoing open liver resection surgery. METHODS In this randomized controlled trial, we included adult patients undergoing open liver resection surgery. After induction of general anaesthesia, the included patients were randomized to receive either ESPB (n = 30) or subcostal TAPB (n = 30). Postoperative pain was assessed using the numeric rating scale (NRS) at rest and during cough. Intravenous morphine boluses were used for management of breakthrough pain intra- and postoperatively. The study's primary outcome was morphine consumption during the first 24 h postoperatively. Secondary outcomes included intraoperative morphine consumption, time to first postoperative morphine requirement, incidence of complications, and patient satisfaction. RESULTS Sixty patients were included and were available for the final analysis in this study. The intra-and postoperative morphine consumption were less in the ESPB group than the subcostal TAPB group (median [quartiles] morphine dose: 0 [0-0] vs 2 [0-5] mg, p = 0.007 and 20 [15-20] vs 25 [20-30] mg, p = 0.006, respectively). The time to first morphine requirement was longer in the ESPB group (median [quartiles]: 6.5 [5.5-6.5] h) than the subcostal TAPB group (median [quartiles]: 4.3 [1.0-6.5] h), P = 0.013. Patients in the ESPB group had lower incidence of sedation and higher level of satisfaction than the subcostal TAPB group. CONCLUSION In patients undergoing open liver resection surgery, ESPB provided superior analgesic properties than subcostal TAPB. CLINICAL TRIAL REGISTRATION NCT05253079, Principal investigator: Maha Mostafa, Date of registration: February 23, 2022. URL: https://clinicaltrials.gov/ct2/show/NCT05253079.
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Affiliation(s)
- Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
| | - Maggie Saeed Mousa
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Amany S Arafa
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Heba Raafat
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Shaker Ragab
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
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Zhang Y, Wang YP, Wang HT, Xu YC, Lv HM, Yu Y, Wang P, Pei XD, Zhao JW, Nan ZH, Yang JJ. Ultrasound-guided quadratus lumborum block provided more effective analgesia for children undergoing lower abdominal laparoscopic surgery: a randomized clinical trial. Surg Endosc 2022; 36:9046-9053. [PMID: 35764836 DOI: 10.1007/s00464-022-09370-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Postoperative pain treatment for pediatrics is often inadequate and the evidence of pediatric postoperative analgesia is scarce. To our knowledge, no report regarding the comparison among caudal block, transversus abdominis plane (TAP) block and quadratus lumborum (QL) block for children undergoing lower abdominal laparoscopic surgery was found at present. Thus this trial aimed to compare the efficacies of them for children undergoing lower abdominal laparoscopic surgery. METHODS One hundred and eighty children aged from 1 to 12 years undergoing lower abdominal laparoscopic surgery were included and randomized to receive caudal block, TAP block or QL block. The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) score at 30 min, 1 h, 4 h, 8 h, 12 h, and 24 h and tramadol consumption during first 24 h postoperatively. Secondary outcomes included the number of children received tramadol, time to first tramadol request, parents' satisfaction and postoperative adverse reactions. RESULTS The QLB group had lower postoperative FLACC scores at 8 h (median difference - 0.43, P = 0.03) than the Caudal group and at 4 h (median difference - 0.6, P = 0.001) and 8 h (median difference - 0.43, P = 0.03) than the TAPB group. The tramadol consumption was lower in the QLB group (28.43 ± 6.55) than the TAPB group (37.17 ± 6.12, P = 0.023). Although the number of children received tramadol did not differ among the three groups, the time to first tramadol request was longer in the QLB group (7.20 ± 0.79) than the caudal group (8.42 ± 0.61, P = 0.008). No statistical difference was observed concerning other secondary outcomes. CONCLUSIONS QLB produced more effective postoperative analgesia for children undergoing laparoscopic abdominal surgery compared with the TAPB and caudal block.
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Affiliation(s)
- Yue Zhang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Yan-Ping Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Hai-Tao Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Yu-Can Xu
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Hui-Min Lv
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Yang Yu
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Peng Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Xiang-Dong Pei
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Jing-Wei Zhao
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Zhen-Hua Nan
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Jian-Jun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, China.
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Yang DX, Zhou RH, Liu HL, Luo HG. The pain incidence of the injection site and analgesic effect of quadratus lumborum block and transversus abdominis plane block for cesarean delivery. Asian J Surg 2022; 45:3014-3016. [PMID: 35794037 DOI: 10.1016/j.asjsur.2022.06.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Dong-Xia Yang
- Department of Anesthesiology, Nanchang First Hospital, The Third Clinical Medical College of Nanchang University, Nanchang, Jiangxi, 330008, China
| | - Rui-Hao Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, PR China
| | - Hai-Lin Liu
- Department of Anesthesiology, The Second Affifiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330008, China
| | - He-Guo Luo
- Department of Anesthesiology, Nanchang First Hospital, Nanchang, Jiangxi, 330008, China.
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Dai L, Ling X, Qian Y. Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia After Laparoscopic Cholecystectomy: a Double-Blind, Randomized Controlled Trial. J Gastrointest Surg 2022; 26:2542-2550. [PMID: 36100826 PMCID: PMC9674727 DOI: 10.1007/s11605-022-05450-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the effect of ultrasound-guided transversus abdominis plane block (TAPB) combined with patient-controlled intravenous analgesia (PCIA) and PCIA alone on analgesia after laparoscopic cholecystectomy (LC). METHODS In this double-blind, randomized controlled trial, 160 patients undergoing LC were randomized into the TAPB group (n = 80) and PCIA group (n = 80). Bilateral ultrasound-guided TAPB was performed with 20 mL 0.5% ropivacaine and the PCIA pump was given after LC in the TAPB group. The PCIA group received the PCIA pump alone as a control group. The primary outcome was postoperative pain, assessed by the visual analog scale (VAS). RESULTS VAS pain (including abdominal wall pain or visceral pain) scores at rest and coughing were significantly lower in the TAPB group at 1, 4, 12, 24, 36, and 48 h after LC (P < 0.05). Postoperative additional analgesic needs, analgesic pump compressions, and PCIA analgesic dosages, and total morphine equivalents were significantly reduced in the TAPB group, and postoperative hospital stay, total hospitalization expenses, expenses within 24 h or 48 h (from analgesia and adverse reactions), and patient satisfaction were significantly higher in the TAPB group than the PCIA group (all P < 0.05). No significant between-group differences were observed in operation time, intraoperative blood loss, unplugging the analgesic pump due to adverse reactions, first exhaust time, and postoperative adverse events between the two groups. CONCLUSIONS Ultrasound-guided TAPB combined with PCIA was an effective and safe perioperative analgesic technique for patients undergoing LC compared to PCIA only.
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Affiliation(s)
- Liming Dai
- Department of Anesthesiology, The Second Affiliated Hospital of Wannan Medical College, No.123 Kangfu Road, Jinghu District, Wuhu, 241000, Anhui, China.
| | - Xiangwei Ling
- Department of Anesthesiology, The Second Affiliated Hospital of Wannan Medical College, No.123 Kangfu Road, Jinghu District, Wuhu, 241000, Anhui, China
| | - Yuying Qian
- Department of Anesthesiology, The Second Affiliated Hospital of Wannan Medical College, No.123 Kangfu Road, Jinghu District, Wuhu, 241000, Anhui, China
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Du YT, Xue FS, Cheng Y. Letter to Editor on "Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia After Laparoscopic Cholecystectomy: a Double-Blind, Randomized Controlled Trial". J Gastrointest Surg 2022; 26:2626-7. [PMID: 36333641 DOI: 10.1007/s11605-022-05510-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
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Karadeniz MS, Atasever AG, Salviz EA, Bingül ES, Çiftçi HŞ, Dinçer MB, Sungur MO. Transversus abdominis plane block with different bupivacaine concentrations in children undergoing unilateral inguinal hernia repair: a single-blind randomized clinical trial. BMC Anesthesiol 2022; 22:355. [PMID: 36411426 PMCID: PMC9677701 DOI: 10.1186/s12871-022-01907-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Current knowledge on the ideal local anesthetic concentration for the ultrasound-guided transversus abdominis plane block (TAPB) in pediatrics is scarce. The purpose of this study is to compare the efficacy of US-guided TAPB at two different concentrations of bupivacaine in pediatrics undergoing unilateral inguinal hernia repair. METHODS After random allocation, 74 children aged 1-8 were randomized to receive US-guided TAPB by using 1 mg.kg- 1 bupivacaine as either 0,25% (0,4 ml.kg- 1) (Group 1) or 0,125% (0,8 ml.kg- 1) (Group 2) concentration. All blocks were performed under general anesthesia, immediately after the induction, unilaterally with a lateral approach. All subjects received intravenous 15 mg/kg paracetamol 0.15 mg/kg dexamethasone and 0.1 mg/kg ondansetron intraoperatively. The primary outcome was the efficacy which is assessed by postoperative FLACC behavioral pain assessment score at 15', 30', 45', 1 h, 2 h, 6 h, and 24 h. The secondary outcomes were to assess the total dose of rescue analgesic consumption, length of hospital stay, the incidence of side effects, complications and satisfaction levels of the patients' parents and the surgeons. RESULTS Sixty-four children were recruited for the study. Postoperative pain scores were equal between the two groups. There was no need for a rescue analgesic in any group after the postoperative 6thhour. No local or systemic complication or side effect related to anesthesia or surgery was reported. CONCLUSION TAPB using 1 mg.kg- 1 bupivacaine administered as either high volume/low concentration or low volume/high concentration was providing both adequate analgesia and no side effects. TRIAL REGISTRATION This trial was retrospectively registered at Clinicaltrals.gov , NCT04202367 .
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Affiliation(s)
- Meltem Savran Karadeniz
- grid.9601.e0000 0001 2166 6619Department of Anesthesiology and Intensive Care, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ayşe Gülşah Atasever
- grid.410569.f0000 0004 0626 3338Department of Anesthesiology, University Hospitals of the KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Emine Aysu Salviz
- grid.4367.60000 0001 2355 7002Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO USA
| | - Emre Sertaç Bingül
- grid.9601.e0000 0001 2166 6619Department of Anesthesiology and Intensive Care, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Hayriye Şentürk Çiftçi
- grid.9601.e0000 0001 2166 6619Department of Medical Biology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Müşerref Beril Dinçer
- grid.9601.e0000 0001 2166 6619Department of Anesthesiology and Intensive Care, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mukadder Orhan Sungur
- grid.9601.e0000 0001 2166 6619Department of Anesthesiology and Intensive Care, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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Xing R, Yang Y, Zhang M, Wang H, Tan M, Gao C, Yang C, Zhai M, Xie Y. Effect of Transcutaneous Electrical Acupoint Stimulation Combined with Transversus Abdominis Plane Block on Postoperative Recovery in Elderly Patients Undergoing Laparoscopic Gastric Cancer Surgery: A Randomized Controlled Trial. Pain Ther 2022. [PMID: 36098938 DOI: 10.1007/s40122-022-00429-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION This study assessed the influence of transcutaneous electrical acupoint stimulation (TEAS) combined with transversus abdominis plane block (TAPB) on the recovery of elderly patients undergoing laparoscopic gastric cancer surgery. METHODS Ninety patients (age ≥ 60 years) undergoing laparoscopic gastric cancer surgery were randomly divided into general anesthesia group (group G), TAPB group (group NG), and TEAS combined with TAPB group (group NTG). Patients in the NTG group received TEAS at PC6, LI4, and ST36 acupoints and TAPB. Patients in the NG group received TAPB. The quality of recovery (QoR) was assessed using the QoR-15 questionnaire. The percentages of T lymphocyte subsets were determined. Consumption of anesthetics, extubation time, visual analog scale (VAS) scores, time of first postoperative ambulation and flatus, and postoperative adverse events were also recorded. RESULTS QoR-15 scores on postoperative day (POD) 3 and POD 7 were higher in the NTG group than in the G and NG groups (P < 0.05). On POD 1 and POD 3, the percentages of CD3+ and CD4+ T cells and the CD4+/CD8+ ratio were higher and the percentage of CD8+ T cells was lower in the NTG group than in the G and NG groups (P < 0.05). Remifentanil consumption, and the incidence of postoperative nausea and vomiting (PONV) were lower and extubation time and time of first postoperative flatus were shorter in the NTG group than in the G and NG groups (P < 0.05). Compared with the G group, the VAS scores on POD 1 were lower in the NG group and those on POD 2 were lower in the NTG group (P < 0.05). CONCLUSION The combination of TEAS and TAPB ameliorated postoperative pain, improved immune and gastrointestinal function, reduced the incidence of PONV, and effectively promoted postoperative recovery in elderly patients undergoing laparoscopic gastric cancer surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100042119).
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Xue M, Guo C, Han K, Bai R, An R, Shen X. Analgesia Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Intravenous Analgesia After Cesarean Section: A Double-Blind Controlled Trial. Pain Ther 2022. [PMID: 35980557 DOI: 10.1007/s40122-022-00425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION Complete postoperative analgesia is very important for puerperae after cesarean section. The objective of this study was to explore the optimal postoperative analgesia after cesarean section. METHODS A total of 180 full-term puerperae who underwent cesarean section in Hanzhong People's Hospital from March 2019 to March 2020 were enrolled and were randomly divided into three groups. Group A was given 0.9% normal saline, group B and C were given 0.4% ropivacaine for transversus abdominis plane block (TAPB). Postoperative patient-controlled intravenous analgesia (PCIA) pumps were 2 μg/kg sufentanil + 2.5 mg droperidol, 1.5 μg/kg and 1.3 μg/kg sufentanil, respectively. All puerperae were given different but effective analgesia programs. The primary outcome indicators were visual analog scores (VAS), the first compression time of postoperative analgesia pump and the total number of compressions in 48 h. The secondary outcome indicators were vital signs, Ramsay sedation scores, comfort scores (BCS), the frequency of analgesic rescue, postoperative side effects and satisfaction. RESULTS The dynamic and static VAS scores of the puerperae in group B at T2 and T6 were significantly lower than group A and at T12, T24 and T48 were significantly lower than group C. Compared with group A, the dynamic and static VAS scores of puerperae in group C were lower at T2 and T6 and higher at T12, T24 and T48. The Ramsay score and BCS score of the puerperae in group C at T12, T24 and T48 were significantly lower than those in groups A and B. CONCLUSIONS PCIA with sufentanil alone or combined with TAPB can be safely and effectively used for postoperative analgesia after cesarean section. PCIA combined with TAPB had better analgesic effect and lower incidence of side effects while reducing the dose of opioids. The results of this study provide new ideas and insights for the choice of analgesia after cesarean section.
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Liu KY, Lu YJ, Lin YC, Wei PL, Kang YN. Transversus abdominis plane block for laparoscopic colorectal surgery: A meta-analysis of randomised controlled trials. Int J Surg 2022; 104:106825. [PMID: 35953018 DOI: 10.1016/j.ijsu.2022.106825] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The effectiveness of transversus abdominis plane block (TAP) on pain management after laparoscopic colorectal surgery (CRS) remains unclear since the only relevant meta-analysis on this topic did not separate laparoscopic CRS from open CRS. The aim of the study was to compare the analgesic efficacy and safety of TAP with non-TAP in patients undergoing laparoscopic CRS. METHODS Four databases were searched for randomized controlled trials (RCTs) on this topic using relevant keywords. Two authors independently completed evidence selection, data extraction, and critical appraisal. Available data were pooled in the random-effects model, and point estimates with 95% confidence interval (CI) were reported for postoperative pain at rest and on coughing, opioid consumption, length of hospital stay, and adverse events. RESULTS A total of 14 RCTs (n = 1216) contributed to the present synthesis. Pooled result showed that patients in the TAP group had lower pain at rest than those in the non-TAP group at postoperative 2-h (mean difference [MD] = -1.42; P < 0.05), 4-h (MD = -0.97; P < 0.05), 12-h (MD = -0.75; P < 0.05), and 24-h (MD = -0.61; P < 0.05). Patients in the TAP group also had lower postoperative pain on coughing than those in the non-TAP group on the first day (MD = -1.02; P < 0.05). Moreover, TAP had lesser postoperative opioid consumption than non-TAP (standardized mean difference, -0.26; P < 0.05; I-square = 20%), and there were non-significant differences in hospital stay and adverse event between the two groups. CONCLUSION Intraoperative TAP is a safe and feasible pain management for laparoscopic CRS, particularly it is recommended when patient-controlled analgesia is not delivered. Therefore, laparoscopic TAP block might be a favorable administered strategy.
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Affiliation(s)
- Kai-Yuan Liu
- Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yen-Jung Lu
- Division of Colorectal Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Cih Lin
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Po-Li Wei
- Department of Surgery, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Cancer Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Translational Laboratory, Department of Medical Research, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taipei, Taiwan 3. Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Yi-No Kang
- Evidence-based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Cevik J, Hunter-Smith DJ, Rozen WM. Anatomical differences in the abdominal wall between animal species with implications for the transversus abdominis plane block: a systematic review. Surg Radiol Anat 2022; 44:1171-1180. [PMID: 35864247 DOI: 10.1007/s00276-022-02991-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/07/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE With the increased use of simulation-based training using animal models for the education of surgical and anaesthetic techniques, an increased understanding of the anatomy of such models and how they compare to humans is required. The transversus abdominis plane block is a regional anaesthetic technique that requires an understanding of the abdominal wall anatomy along with proficient ultrasound use. The current review aims to compare the anatomy of the abdominal wall across species, particularly focussing on the pertinent differences within the class of mammals, and secondarily, it aims to address the implications of these differences for the use of simulation-based training of the transversus abdominis plane block. METHODS To achieve this, the PubMed, Web of Science and Google Scholar databases were searched for relevant literature. Studies pertaining to the musculature, vasculature or innervation of the anterolateral abdominal wall across species were included. RESULTS The mammalian abdominal wall differs in its musculature, vasculature or innervation from that of amphibians, birds or reptiles; however, among species of mammals, the structure of the abdominal wall follows a similar framework. Particular differences among mammals include the additional muscular layer of the panniculus carnosus found in most mammals other than humans, the variable arterial origins and dominant vascular supply of the abdominal wall and the number of thoracolumbar nerves innervating the abdominal wall. CONCLUSION When using animal models for simulation-based training, the pig is recommended for the transversus abdominis plane block given its closely homologous abdominal wall structure, availability and larger comparative size.
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Affiliation(s)
- Jevan Cevik
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, VIC, Australia. .,Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, VIC, Australia.
| | - David J Hunter-Smith
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, VIC, Australia.,Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, VIC, Australia
| | - Warren M Rozen
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, VIC, Australia.,Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, VIC, Australia
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Viñas J, Díaz E, Scaravonati R, Roche S, Brandi C, Campana J, Bertone S. Laparoscopic-guided distal loco-regional anesthetic infiltration technique in TAPP inguinal hernia repair: a double-blind randomized clinical trial. Surg Endosc 2022; 36:4312-4320. [PMID: 34668068 DOI: 10.1007/s00464-021-08775-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 10/12/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Ultrasound-guided transversus abdominis plane block (US-TAP) is an important component of multimodal analgesia in laparoscopic inguinal hernia repair, although it has certain limitations. To overcome them, surgeons have developed several techniques to perform local anesthetic infiltration under laparoscopic guidance, but no trials evaluating these in transabdominal preperitoneal (TAPP) hernia repair were conducted till the date. The aim of this study was to compare the efficacy of a novel laparoscopic-guided local anesthetic infiltration technique (LDAI) with US-TAP in postoperative pain control and analgesic consumption for patients undergoing elective TAPP hernia repair. METHODS This was a double-blind randomized controlled trial conducted at a single tertiary academic center between 2019 and 2020 on adult patients undergoing elective laparoscopic TAPP inguinal hernia repair. Postoperative pain and analgesic consumption were compared for LDAI vs. US-TAP up to 30 postoperative days. RESULTS 62 patients were included (31 LDAI, 31 US-TAP). Female gender was significantly higher in the LDAI group (8, 25.81%; US-TAP 0; p = 0.005). Mean anesthetic time (US-TAP group: 142.2 min, SD = 17.7; LDAI group: 127.1 min, SD = 15.5; p < 0.001) and mean operative time (US-TAP group: 117.2 min, SD = 15.9; LDAI group: 103.8 min, SD = 15.2; p < 0.001) were significantly shorter in the LDAI group. Pain scores assessed at the first-hour postoperative, at the moment of discharge, and at 8, 24, and 48 postoperative hours showed no significant differences between both groups. No significant difference was found regarding postoperative analgesic rescue administration in the recovery room and analgesic consumption after discharge between groups. CONCLUSION LDAI is a safe and effective local anesthetic technique in elective TAPP hernia repair. Pain control is similar to US-TAP block, with shorter anesthesthetic and surgical time and better health resources allocation.
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Affiliation(s)
- José Viñas
- General Surgery Department, Hospital Italiano de Buenos Aires, Tte. Gral Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Emilio Díaz
- Microsurgery and Abdominal Wall Reconstruction Section, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodolfo Scaravonati
- Microsurgery and Abdominal Wall Reconstruction Section, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sebastián Roche
- Microsurgery and Abdominal Wall Reconstruction Section, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Claudio Brandi
- Microsurgery and Abdominal Wall Reconstruction Section, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Campana
- Colorectal Surgery Section, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago Bertone
- Microsurgery and Abdominal Wall Reconstruction Section, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Han K, Zhang Y, Bai R, An R, Zhang S, Xue M, Shen X. Application of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Nalbuphine Patient-Controlled Intravenous Analgesia in Postoperative Analgesia After Laparotomy: A Randomized Controlled Trial. Pain Ther 2022; 11:627-641. [PMID: 35420393 PMCID: PMC9098735 DOI: 10.1007/s40122-022-00379-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/17/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Pain is a common postoperative complication. The ideal postoperative analgesia is awake, safe, mobile, and without side effects. The objective of this study is to provide new ideas for postoperative analgesia by observing the safety and analgesic effect of different analgesic methods in patients undergoing laparotomy after surgery. Methods Patients, who underwent laparotomy between September 2019 and December 2020, were randomly divided into three groups: group S received sufentanil, group N received nalbuphine, group T + N received postoperative bilateral transversus abdominis plane block (TAPB) and nalbuphine. The primary outcomes included visual analog scale (VAS) score and the use of postoperative analgesic pump. Secondary outcomes included quality of life recovery (QoR-15) scale score and incidence of postoperative adverse reactions. Results Compared with group S and N, there were significant differences in the resting VAS score within 48 h after surgery, dynamic VAS score within 12 h after surgery, the first compression time, and cumulative use of patient-controlled intravenous analgesia (PCIA) drugs at 24 h in group T + N (P < 0.05). The QoR-15 score within 48 h after surgery in group T + N was significantly higher than group N (P < 0.05). The first exhaust time and the incidence of nausea and vomiting in group T + N were significantly lower than those in group N (P < 0.05). Conclusions Sufentanil PCIA and nalbuphine PCIA have equivalent analgesic effects, while TAPB combined with nalbuphine PCIA can ensure a good analgesic effect, thereby reducing the incidence of adverse reactions.
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Affiliation(s)
- Kunyu Han
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yuhe Zhang
- Department of Anesthesiology, Xianyang Hospital of Yan'an University, Xianyang, 712000, Shaanxi, China
| | - Ruiping Bai
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Rui An
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Simei Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Mengwen Xue
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Xin Shen
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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Erten O, Isiktas G, Avci SN, Berber E. The efficacy of laparoscopic transversus abdominis plane block on reducing postoperative narcotic usage in patients undergoing minimally invasive adrenalectomy. Surg Endosc 2022; 36:7204-7209. [PMID: 35112141 DOI: 10.1007/s00464-022-09076-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Post-operative pain relief after abdominal operations is critical for patient satisfaction and rapid recovery. Narcotics have been a traditional part of postoperative analgesia, with transversus abdominis plane (TAP) block introduced recently. The aim of this study is to assess the efficacy of laparoscopic TAP block on postoperative pain control in patients undergoing minimally invasive adrenalectomy. METHODS This was an institutional review board-approved retrospective study. Parameters related to postoperative pain control were compared between patients who underwent robotic transabdominal lateral adrenalectomy with (after December 2018) or without laparoscopic TAP block (control group) (before December 2018) by one surgeon. Statistics were performed using Mann Whitney U and Chi-square tests. RESULTS There were 86 patients in the TAP and 83 patients in the control group. Groups were similar regarding demographic and clinical parameters. Despite the availability of intravenous acetaminophen to a higher percentage of patients in the control (31.3%) versus the TAP group (8.1%), 0-24 h lowest postoperative pain scores were significantly lower in the TAP group (P < 0.0001). In TAP versus control group, percentage of patients requiring narcotics and amount of narcotics used was lower (P = 0.04 vs P = 0.0004, respectively). Mainly due to less pain-related over-stay, percentage of patients requiring more than a day of hospital stay was less in the TAP (12%) versus control group (18%) (P = 0.01). CONCLUSION To our knowledge, the utility of TAP block in patients undergoing minimally invasive adrenalectomy has not been reported in the past. This study shows that there may be benefits of laparoscopic TAP block in reducing post-operative narcotic usage while improving pain control in these patients.
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Affiliation(s)
- Ozgun Erten
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Gizem Isiktas
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Seyma N Avci
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. .,Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Ren L, Qin P, Min S, Wang W, Jin J. Transversus Abdominis Plane Block Versus Local Wound Infiltration for Postoperative Pain After Laparoscopic Colorectal Cancer Resection: a Randomized, Double-Blinded Study. J Gastrointest Surg 2022; 26:425-32. [PMID: 34505222 DOI: 10.1007/s11605-021-05121-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite the extensive administration of the enhanced recovery after surgery (ERAS) program, postoperative pain remains a major concern for patients. Transversus abdominis plane (TAP) block and local wound infiltration (LWI) are two techniques that have been widely applied in abdominal surgery. However, these two techniques have rarely been compared in terms of their analgesic effects on patients that undergo laparoscopic colorectal surgery with the ERAS program. METHODS A randomized, double-blinded study was conducted in this study. Briefly, 174 patients that underwent colorectal surgery with the ERAS program were randomly allocated to TAP block treatment (TAP group) or local wound infiltration (LWI group). All patients were assessed for their pain scores at rest and in motion at 6, 24, 48, and 72 h after surgery. The administration frequency of bolus for PCIA and the use amount of rescue analgesics (parecoxib) were recorded. Finally, the patients were monitored with follow-up surveys on their postoperative function recovery, complications, lengths of stay, treatment cost, and satisfaction. RESULTS In terms of the pain scores at rest and in motion, the two groups revealed no significant difference throughout the study sessions, and no difference was found in the administration frequency of bolus and the use amount of parecoxib. Moreover, the two groups demonstrated similar results in their postoperative recovery, and no significant differences were found in terms of postoperative complications. CONCLUSIONS Compared with local wound infiltration, transversus abdominis plane block is not significantly advantageous for postoperative pain control and recovery in patients undergoing laparoscopic colorectal surgery with the ERAS program. However, local wound infiltration might be preferred since it is available with less technical difficulties.
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Terho A, Puhto T, Laru J, Uimari O, Ohtonen P, Rautio T, Koivurova S. Laparoscopically guided transversus abdominis plane block versus local wound analgesia in laparoscopic surgery for peritoneal endometriosis: study protocol for a prospective randomized controlled double-blinded LTAP-trial. Trials 2022; 23:55. [PMID: 35042563 PMCID: PMC8764771 DOI: 10.1186/s13063-022-06004-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/04/2022] [Indexed: 12/13/2022] Open
Abstract
Background Ultrasound-guided transversus abdominis plane block (TAP) performed by anesthesiologist has been shown to be an effective and safe analgesia method in abdominal surgery, reducing postoperative opioid consumption. Recently, there has been growing interest to insert TAP under laparoscopic vision (LTAP) by surgeon. LTAP has been used in laparoscopic gastrointestinal surgery, but studies on LTAP in gynecologic laparoscopic surgery are sparse and inconsistent. The purpose of this study is to compare the efficacy of LTAP and local wound analgesia in laparoscopic surgery due to suspected or diagnosed superficial peritoneal endometriosis. Methods The LTAP-trial is a prospective randomized controlled double-blinded study comparing the efficacy and safety of LTAP with local wound analgesia in laparoscopic endometriosis surgery. Patients are randomized to receive LTAP with levobupivacaine and wound infiltration with placebo or wound infiltration with levobupivacaine and LTAP with placebo. The primary outcome is postoperative opioid consumption measured by patient-controlled analgesia (PCA) pump. Secondly, subjective postoperative pain up to 24 h postoperatively will be measured by Numeric Rating Scale (NRS). Additional outcome measures are factors related to recovery and length of stay in the hospital as well as a 6-month follow-up survey regarding pain (NRS) and endometriosis-related wellbeing (endometriosis-related health profile, EHP-30) after surgery. A total of 46 patients will be randomized in a proportion of 1:1. Discussion Patients with peritoneal endometriosis are often prone to severe postoperative pain that may prohibit their enhanced recovery after laparoscopy. Thus, there is a need for effective postoperative pain management with minimal side-effects. This study focusing on laparoscopically inserted transversus abdominis plane block may provide new insight in dealing with postoperative pain after laparoscopic endometriosis surgery as well as after other gynecologic surgery. Trial registration The LTAP-trial -protocol has been prospectively registered to ClinicalTrials.gov, ID: NCT04735770. Registered on February 2021.
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Affiliation(s)
- Anna Terho
- Department of Obstetrics and Gynecology, Oulu University Hospital and PEDEGO Research Unit & Medical Research Center, University of Oulu, PL 23, 90029 OYS, Oulu, Finland.
| | - Terhi Puhto
- Oulu University Hospital and Research unit of Surgery, Anesthesia and Intensive Care, University of Oulu, PL 21, 90029 OYS, Oulu, Finland
| | - Johanna Laru
- Department of Obstetrics and Gynecology, Oulu University Hospital and PEDEGO Research Unit & Medical Research Center, University of Oulu, PL 23, 90029 OYS, Oulu, Finland
| | - Outi Uimari
- Department of Obstetrics and Gynecology, Oulu University Hospital and PEDEGO Research Unit & Medical Research Center, University of Oulu, PL 23, 90029 OYS, Oulu, Finland
| | - Pasi Ohtonen
- Oulu University Hospital and Research unit of Surgery, Anesthesia and Intensive Care, University of Oulu, PL 21, 90029 OYS, Oulu, Finland
| | - Tero Rautio
- Oulu University Hospital and Research unit of Surgery, Anesthesia and Intensive Care, University of Oulu, PL 21, 90029 OYS, Oulu, Finland
| | - Sari Koivurova
- Department of Obstetrics and Gynecology, Oulu University Hospital and PEDEGO Research Unit & Medical Research Center, University of Oulu, PL 23, 90029 OYS, Oulu, Finland
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Turan A, Cohen B, Elsharkawy H, Maheshwari K, Soliman LM, Babazade R, Ayad S, Hassan M, Elkassabany N, Essber HA, Kessler H, Mao G, Esa WAS, Sessler DI. Transversus abdominis plane block with liposomal bupivacaine versus continuous epidural analgesia for major abdominal surgery: The EXPLANE randomized trial. J Clin Anesth 2021; 77:110640. [PMID: 34969004 DOI: 10.1016/j.jclinane.2021.110640] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Compare transversus abdominis plane (TAP) blocks with liposomal bupivacaine were to epidural analgesia for pain at rest and opioid consumption in patients recovering from abdominal surgery. BACKGROUND ERAS pathways suggest TAP blocks in preference to epidural analgesia for abdominal surgery. However, the relative efficacies of TAP blocks and epidural analgesia remains unknown. METHODS Patients having major abdominal surgery were enrolled at six sites and randomly assigned 1:1 to thoracic epidural analgesia or bilateral/4-quadrant TAP blocks with liposomal bupivacaine. Intravenous opioids were used as needed. Non-inferiority margins were a priori set at 1 point on an 11-point pain numeric rating scale for pain at rest and at a 25% increase in postoperative opioid consumption. RESULTS Enrollment was stopped per protocol at 3rd interim analysis after crossing an a priori futility boundary. 498 patients were analyzed (255 had TAP blocks and 243 had epidurals). Pain scores at rest in patients assigned to TAP blocks were significantly non-inferior to those given epidurals, with an estimated difference of 0.09 points (CI: -0.12, 0.30; noninferiority P < 0.001). Opioid consumption during the initial 3 postoperative days in TAP patients was not non-inferior to epidurals, with an estimated ratio of geometric means of 1.37 (CI: 1.05, 1.79; non-inferiority P = 0.754). However, the absolute difference was only 21 mg morphine equivalents over the 3 days. Patients with epidurals were more likely to experience mean arterial pressures <65 mmHg than those given TAP blocks: 48% versus 31%, P = 0.006. CONCLUSION Pain scores at rest during the initial three days after major abdominal surgery were similar. Patients assigned to TAP blocks required more opioid then epidural patients but had less hypotension. Clinicians should reconsider epidural analgesia in patients at risk from hypotension. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02996227.
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Affiliation(s)
- Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, United States of America; Department of General Anesthesiology, Cleveland Clinic, United States of America.
| | - Barak Cohen
- Department of Outcomes Research, Cleveland Clinic, United States of America; Division of Anesthesiology, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hesham Elsharkawy
- Department of Outcomes Research, Cleveland Clinic, United States of America; Pain Center, Anesthesiology Department, MetroHealth, Case Western Reserve University, OH, United States of America
| | - Kamal Maheshwari
- Department of Outcomes Research, Cleveland Clinic, United States of America; Department of General Anesthesiology, Cleveland Clinic, United States of America
| | - Loran Mounir Soliman
- Department of General Anesthesiology, Cleveland Clinic, United States of America
| | - Rovnat Babazade
- Department of Anesthesiology, University of Texas Medical Branch of Galveston, TX, United States of America
| | - Sabry Ayad
- Department of Outcomes Research, Cleveland Clinic, United States of America; Department of General Anesthesiology, Cleveland Clinic, United States of America
| | - Manal Hassan
- Department of General Anesthesiology, Cleveland Clinic, United States of America
| | - Nabil Elkassabany
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, United States of America
| | - Hani A Essber
- Department of Outcomes Research, Cleveland Clinic, United States of America
| | - Hermann Kessler
- Department of Colorectal Surgery, Cleveland Clinic, United States of America
| | - Guangmei Mao
- Department of Outcomes Research, Cleveland Clinic, United States of America; Department of Quantitative Health Sciences, Cleveland Clinic
| | - Wael Ali Sakr Esa
- Department of Outcomes Research, Cleveland Clinic, United States of America; Department of General Anesthesiology, Cleveland Clinic, United States of America
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, United States of America
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Ergin A, Aydin MT, Çiyiltepe H, Karip AB, Fersahoğlu MM, Özcabi Y, Ağca B, İşcan AY, Güneş Y, Ar AY, Taşdelen İ, Memişoğlu K. Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial. Int J Surg 2021; 95:106134. [PMID: 34653721 DOI: 10.1016/j.ijsu.2021.106134] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/27/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy is a minimally invasive procedure that causes pain originating from parietal and visceral peritoneum. Many studies have been conducted to improve postoperative pain management and comfort of patients. Various methods such as local anesthetic injection (LAI) at trocar access points, intraperitoneal local anesthetic injection (IPLA), pneumoperitoneum pressure reduction, transversus abdominis plane block (TAPB), and reducing the number of trocars used during the operation were attempted to reduce postoperative pain. METHODS In this study, we compared LAI, TAPB and IPLA methods with the control group in which no local anesthetic was applied to reduce postoperative pain after laparoscopic cholecystectomy. We also demonstrated the effect of these methods on postoperative pain, need for additional analgesics, length of hospitalization, and patient satisfaction. RESULTS Overall, 160 patients aged 18-74 years who underwent laparoscopic cholecystectomy for cholelithiasis between October 2018 and August 2019 were included in the study and divided into four groups as follows: LAI group, TAPB group, IPLA group, and the control group without any intervention. Visual Analog Scale (VAS) values at 1, 2, 4, 6, 12, and 24 h in the control group were significantly higher than in the LAI, TAPB, and IPLA groups. Further, VAS values at 1, 2, 4, 6, 12, and 24 h in the IPLA group were significantly higher than in the LAI and TAPB groups. No significant difference was observed between the LAI and TAPB groups in terms of VAS values at 1, 2, 4, 6, and 24 h. VAS values at 12 h in the LAI group were significantly higher than in the TAPB group. CONCLUSIONS Peroperative local anesthetic administration methods were more effective in preventing pain after laparoscopic cholecystectomy compared to the control group. In addition to reducing postoperative pain, these methods reduced the need for postoperative analgesics and increased patient satisfaction.
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Affiliation(s)
- Anil Ergin
- Fatih Sultan Mehmet Training and Research Hospital, General Surgery Department, Hastane Street No: 1/8 Icerenkoy, Istanbul, 34752, Turkey Istanbul Oncology Hospital, Digestive Surgery Department, Cevizli, Toros Street No:86, 34846, Maltepe, İstanbul, Turkey Istanbul Unıversity Faculty of Medicine, General Surgery Department, Topkapı, Turgut Özal Millet Street, 34093, Fatih, İstanbul, Turkey Fatih Sultan Mehmet Training and Research Hospital, Department of Anesthesiology and Reanimation, Hastane Street No: 1/8 Icerenkoy, Istanbul, 34752, Turkey
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Mutlu M, Turkmen S. Evaluation of the Postoperative Analgesic Effect of 2 Different Blocks after Pediatric Circumcision Surgery. Urol Int 2021; 106:527-532. [PMID: 34718244 DOI: 10.1159/000519475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/29/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Circumcision is a painful day-case surgery. Regional anesthesia techniques are used effectively for anesthesia and postoperative analgesia after pediatric circumcision surgery. OBJECTIVE Our prospective observational study aimed to compare postoperative analgesic efficiency of a dorsal penile nerve (DPN) block with a transversus abdominis plane (TAP) block after male pediatric circumcision surgery and complications related to each block. STUDY DESIGN We enrolled 80 male children under the age of 10 years with American Society of Anesthesiologists I-II status scheduled for circumcision in this prospective observational study. A TAP or DPN block was performed after induction of general anesthesia before surgery with ultrasound (US) guidance. Postoperative pain was assessed with Faces Pain Scale-Revised and the Faces, Legs, Activity, Cry and Consolability scale. RESULTS There was no statistically significant difference between the groups regarding 30-min pain score levels (p > 0.05). But, the 1st hour, 2nd hour, 6th hour, 12th hour, and 24th-hour pain score levels in the TAP block group were statistically significantly higher than those of the DPN block group (p < 0.05). The 1st rescue analgesic requirement in the TAP block group was at the 6th hour postoperative. There was no need for rescue analgesia in the DPN block group during the postoperative 24-h follow-up. DISCUSSION A US-guided DPN block provided effective and long-lasting postoperative analgesia for circumcision surgery with statistically significantly lower pain score levels than a US-guided TAP block. CONCLUSION This study found that a TAP block alone was insufficient to provide adequate postoperative analgesia for circumcision surgery compared to DPN block.
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Affiliation(s)
- Mehmet Mutlu
- Department of Anesthesiology and Reanimation, Prof. Dr. Cemil Tascıoglu City Hospital, İstanbul, Turkey
| | - Seray Turkmen
- Department of Anesthesiology and Reanimation, Prof. Dr. Cemil Tascıoglu City Hospital, İstanbul, Turkey
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Peng L, Wei W. Anesthesia management in a pediatric patient with Becker muscular dystrophy undergoing laparoscopic surgery: A case report. World J Clin Cases 2021; 9:8852-8857. [PMID: 34734066 PMCID: PMC8546828 DOI: 10.12998/wjcc.v9.i29.8852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with Becker muscular dystrophy (BMD) have a high risk of developing hyperkalemia, rhabdomyolysis, and malignant hyperthermia when exposed to volatile anesthetics and depolarizing muscle relaxants. Patients with BMD are also prone to respiratory depression after general anesthesia. Thus, it is extremely challenging for anesthesiologists to manage anesthesia in BMD patients, particularly in pediatric BMD patients. Here, we present successful anesthesia management using transversus abdominis plane block (TAPB) combined with total intravenous anesthesia (TIVA) in a pediatric BMD patient undergoing laparoscopic inguinal hernia repair.
CASE SUMMARY A 2-year-old boy, weighing 15 kg, with BMD, was scheduled for laparoscopic inguinal hernia repair. TIVA was used for induction, and continuous infusions of short-acting intravenous anesthetics combined with TAPB were performed for anesthesia maintenance. Moreover, TAPB provided good postoperative analgesia. The patient underwent uneventful surgery and anesthesia, and over the 17 mo follow-up period showed no anesthesia-induced complications.
CONCLUSION TAPB combined with TIVA, using short-acting intravenous anesthetic agents, can provide safe and effective anesthesia management in pediatric BMD patients undergoing short-term abdominal surgery.
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Affiliation(s)
- Ling Peng
- Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wei Wei
- Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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Canakci E, Cihan M, Altinbas A, Cebeci Z, Gultekin A, Tas N. Efficacy of ultrasound-guided Transversus Abdominis Plane (TAP) block in inguinal hernia surgery and the immunomodulatory effects of proinflammatory cytokines: prospective, randomized, placebo-controlled study. Braz J Anesthesiol 2021; 71:538-44. [PMID: 34537124 DOI: 10.1016/j.bjane.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background Tumor Necrosis Factor-α (TNF-α) and Interleukin-1β (IL-1β) are among the cytokines released secondary to the surgical stress response. The objective of this study was to investigate the effect of a Transversus Abdominis Plane (TAP) block on postoperative pain and its immunomodulatory activity through proinflammatory cytokines. Methods TAP (study group; n = 40) or p-TAP (placebo group; n = 40). Patients in the TAP group underwent an Ultrasound (US) guided unilateral TAP block using 20-cc 0.5% bupivacaine solution. Patients in the p-TAP group underwent a sham block using 20-cc isotonic solution. The TNF-α and IL-1β levels were measured three times at preoperative hour-0 and postoperative hours 4 and 24. Visual Analog Scale (VAS) scores were recorded at 0-hours, 30-minutes, 4-hours, and 24-hours. Analgesic use within the first 24-hours following surgery was monitored. Results The postoperative VAS score was decreased in the TAP group at all time points (0, 4, and 24 hours), and the differences between groups were statistically significant (p < 0.001 for all comparisons). In the TAP group, the TNF-α and IL-1β levels at 4 and 24 hours post operation were significantly lower than the preoperative levels (p < 0.001 for all comparisons). Conclusion The TAP block for pre-emptive analgesia enabled effective hemodynamic control during the intraoperative period, provided effective pain control in the postoperative period, and decreased inflammation and surgical stress due to the decreased levels of the proinflammatory cytokines TNF-α and IL-1β in the first postoperative 24 hours, indicating immunomodulatory effect.
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Okur O, Karaduman D, Tekgul ZT, Koroglu N, Yildirim M. Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study. Braz J Anesthesiol 2021; 71:505-510. [PMID: 34537121 PMCID: PMC9373607 DOI: 10.1016/j.bjane.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 10/27/2020] [Accepted: 11/01/2020] [Indexed: 11/21/2022] Open
Abstract
Background and objectives We aimed to compare the analgesic effects of both posterior (type 2) Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) compared to spinal anesthesia alone for postoperative pain management in inguinal hernia repair. Methods This study enrolled 63 patients scheduled for open inguinal hernia repair. The eligibility criteria were undergoing elective unilateral inguinal hernia repair surgery, having an American Society of Anesthesiologists (ASA) physical status I, II, or III, and not suffering from any chronic pain condition. Group S patients received spinal anesthetics and no additional analgesic treatments. Group T patients received TAPB, and Group Q patients received QLB as analgesic technique in addition to spinal anesthetics. Results The pain scores at 6 hours (VAS 6) and 24 hours (VAS 24) were significantly different between groups (p < 0.01). Additionally, the sensory and motor block levels were significantly different between groups (p < 0.05). Multiple comparison tests showed that patients in Group Q had significantly higher sensory and motor block levels (p < 0.01 compared with Group S; p < 0.05 compared with Group T). Opioid consumption was significantly different between Groups Q and S (p < 0.01) after surgery. Conclusions Our findings show that both blocks are similarly effective for the management of postoperative pain compared to spinal anesthesia alone for inguinal hernia repair. We found that QLB resulted in a significant cranial spread compared to TAPB. Opioid consumption in QLB was significantly lower than that in controls but similar to that in TAPB.
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Affiliation(s)
- Onur Okur
- Istanbul Prof. Dr. Cemil Tascioglu City Hospital, Sisli, Istanbul.
| | | | | | - Noyan Koroglu
- Izmir Katip Celebi University Medical School, Ataturk Training and Research Hospital, Izmir, Turkey
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Bumblyte V, Rasilainen SK, Ehrlich A, Scheinin T, Kontinen VK, Sevon A, Vääräniemi H, Schramko AA. Purely ropivacaine-based TEA vs single TAP block in pain management after elective laparoscopic colon surgery within an upgraded institutional ERAS program. Surg Endosc 2021; 36:3323-3331. [PMID: 34480217 PMCID: PMC8415194 DOI: 10.1007/s00464-021-08647-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
Background The aim of this study was to compare thoracic epidural analgesia (TEA) with transversus abdominis plane (TAP) block in post-operative pain management after laparoscopic colon surgery. Methods One hundred thirty-six patients undergoing laparoscopic colon resection randomly received either TEA or TAP with ropivacaine only. The primary endpoint was opioid requirement up to 48 h postoperatively. Intensity of pain, time to onset of bowel function, time to mobilization, postoperative complications, length of hospital stay, and patients’ satisfaction with pain management were also assessed. Results We observed a significant decrease in opioid consumption on the day of surgery with TEA compared with TAP block (30 mg vs 14 mg, p < 0.001). On the first two postoperative days (POD), the balance shifted to opioid consumption being smaller in the TAP group: on POD 1 (15.2 mg vs 10.6 mg; p = 0.086) and on POD 2 (9.2 mg vs 4.6 mg; p = 0.021). There were no differences in postoperative nausea/vomiting or time to first postoperative bowel movement between the groups. No direct blockade-related complications were observed and the length of stay was similar between TEA and TAP groups. Conclusion TEA is more efficient for acute postoperative pain than TAP block on day of surgery, but not on the first two PODs. No differences in pain management-related complications were detected. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08647-z.
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Affiliation(s)
- Vilma Bumblyte
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Jorvi Hospital, P.O. Box 00029 HUS, Espoo, Finland
| | - Suvi K Rasilainen
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Jorvi Hospital, Espoo, Finland
| | - Anu Ehrlich
- Department of Surgery and Department of Anaesthesiology, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Tom Scheinin
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Jorvi Hospital, Espoo, Finland
| | - Vesa K Kontinen
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Jorvi Hospital, P.O. Box 00029 HUS, Espoo, Finland
| | - Aino Sevon
- Medical Faculty, University of Helsinki, Helsinki, Finland
| | - Heikki Vääräniemi
- Department of Surgery and Department of Anaesthesiology, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Alexey A Schramko
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Jorvi Hospital, P.O. Box 00029 HUS, Espoo, Finland.
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Morrell DJ, Doble JA, Hendriksen BS, Horne CM, Hollenbeak CS, Pauli EM. Comparative effectiveness of surgeon-performed transversus abdominis plane blocks and epidural catheters following open hernia repair with transversus abdominis release. Hernia 2021; 25:1611-1620. [PMID: 34319465 DOI: 10.1007/s10029-021-02454-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Recovery protocols aim to limit narcotic administration following ventral hernia repair (VHR). However, little is known about the contribution of a protocol's individual components on patient outcomes. We previously reported that surgeon-performed transversus abdominis plane block (TAP-block) is more effective than ultrasound-guided TAP-block following VHR. This study evaluates the effectiveness of two postoperative analgesia modalities: epidural catheter and surgeon-performed TAP-block following VHR performed with transversus abdominis release (TAR). METHODS A retrospective analysis was performed on data prospectively collected between 2012 and 2019. All patients undergoing open VHR with TAR performed by a single surgeon were identified. Parastomal hernia repairs and any patients receiving ultrasound-guided TAP blocks or paraspinal blocks were excluded. Primary outcome was length of stay (LOS) with secondary outcomes including pain scores, opioid requirements, and 30-day morbidity. Linear regression was used to model LOS. RESULTS One hundred thirty-five patients met inclusion criteria (63 epidural, 72 TAP-block). The majority (67.4%) of patients were modified ventral hernia working group grade 2. The only statistically significant difference in postoperative pain scores between the groups was on postoperative day 2 (TAP block 3.19 versus epidural 4.11, p = 0.0126). LOS was significantly shorter in the TAP block group (4.7 versus 6.2 days, p = 0.0023) as was time to regular diet (3.2 versus 4.7 days, p < 0.0001). After controlling for confounders, epidural was associated with increased LOS by 1.3 days (p = 0.0004). CONCLUSION Epidural use following VHR with TAR is associated with increased LOS and increased time to regular diet without reducing pain or opioid use when compared to surgeon-performed TAP block.
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Affiliation(s)
- D J Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - J A Doble
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - B S Hendriksen
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - C M Horne
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - C S Hollenbeak
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - E M Pauli
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
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Jadon A, Amir M, Sinha N, Chakraborty S, Ahmad A, Mukherjee S. Quadratus lumborum or transversus abdominis plane block for postoperative analgesia after cesarean: a double-blinded randomized trial. Braz J Anesthesiol 2021; 72:472-478. [PMID: 34246687 PMCID: PMC9373105 DOI: 10.1016/j.bjane.2021.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Multimodal analgesia (MMA) is the current standard practice to provide post-cesarean analgesia. The aim of this study was to compare the analgesic efficacy of quadratus lumborum (QL) block and transversus abdominis plane (TAP) block as an adjunct to MMA. Methods Eighty mothers undergoing cesarean delivery under spinal anesthesia were randomized to receive either TAP or transmuscular QL block (QLB) with 20 mL 0.375% ropivacaine on each side. Postoperatively, all the subjects were assessed at 2, 4, 6, 8, 12, 18, and 24 hours. The primary outcome was the time to first analgesic request. The secondary outcomes were the pain scores during rest and movement, number of doses of tramadol, postoperative nausea-vomiting, sedation, and mother’s satisfaction with the pain management. Results The median (IQR) time to first analgesic request was 12 (9.25, 13) hours in the QL group and 9 (8.25, 11.37) hours in the TAP group (p = 0.0008). Patients in QL group consumed less doses of tramadol than those in TAP group (p < 0.0001). Pain scores were significantly lower in the QL group at all time points (p < 0.0001) except at 8th hour when at rest, p = 0.0024, and on movement, p = 0.0028. The maternal satisfaction was significantly higher in the QL group (p = 0.0017). Conclusion Our study showed the significant delay in time to first analgesic request in QL group patients. Patients in the QL group had lower pain scores, required fewer analgesic supplements, and had more satisfaction. Nausea-vomiting and sedation were comparable.
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Affiliation(s)
- Ashok Jadon
- Tata Motors Hospital, Department of Anesthesia & Pain Relief Service, Jamshedpur, India.
| | - Mohammad Amir
- Tata Motors Hospital, Department of Anesthesia & Pain Relief Service, Jamshedpur, India
| | - Neelam Sinha
- Tata Motors Hospital, Department of Anesthesia & Pain Relief Service, Jamshedpur, India
| | - Swastika Chakraborty
- Tata Motors Hospital, Department of Anesthesia & Pain Relief Service, Jamshedpur, India
| | - Asif Ahmad
- Tata Motors Hospital, Department of Anesthesia & Pain Relief Service, Jamshedpur, India
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Yang TR, He XM, Li XH, Wang RR. Intrathecal morphine versus transversus abdominis plane block for caesarean delivery: a systematic review and meta-analysis. BMC Anesthesiol 2021; 21:174. [PMID: 34157985 PMCID: PMC8218454 DOI: 10.1186/s12871-021-01392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/02/2021] [Indexed: 02/08/2023] Open
Abstract
Background The number of caesarean deliveries has been increasing. Although intrathecal morphine (ITM) can relieve pain and is widely applied in caesarean deliveries, it is associated with many side effects. Transversus abdominis plane block (TAPB), a new analgesic technology, has also began playing a certain role after caesarean delivery, with fewer adverse effects. This study mainly compares the analgesic and adverse effects of ITM and TAPB in caesarean delivery. Methods We systematically searched PubMed, Cochrane Library, EMBASE, and Web of Science, for randomised controlled trials (RCTs) published before 9 October, 2020 to compare the effects of ITM and TAPB. Primary outcome of the study was the pain score at rest 24 h after caesarean delivery, whereas the secondary outcomes were the pain score at movement 24 h after operation, postoperative nausea and vomiting (PONV), itching, and morphine consumption. For the outcome assessment, we conducted a sensitivity analysis. Result Six RCTs involving 563 patients and meeting the study inclusion criteria were included in this study. Results indicated no significant difference in the pain score between ITM and TAPB at 24 h of rest or movement. The sensitivity analysis results indicated that the resting pain score (95% CI = − 1.27 to − 0.28; P = 0.002) and 24-h moving pain score (95% CI = − 1.8 to − 0.07; P = 0.03) of the ITM group were lower than those of the TAPB group. The consumption of morphine in the ITM group was lower than in the TAPB group (95% CI = 1.92 to 4.87; P < 0.00001); however, in terms of adverse reactions, the incidence of pruritus (95% CI = 1.17 to 8.26; P = 0.02) and PONV (95% CI = 1.92 to 4.87, P < 0.00001) in the ITM group was higher than in the TAPB group. Conclusion Parturients in the ITM and TAPB groups exhibited similar analgesic effects. However, in the sensitivity analysis performed by eliminating the studies causing heterogeneity, the ITM group was found to have superior analgesic effects compared with the TAPB group, with less morphine consumption. Differently, the TAPB group displayed less side effects such as PONV. Therefore, TAPB is still a valuable analgesia option for patients who cannot use ITM for analgesia after caesarean delivery or those having a high risk of PONV. Trial registration Registration number: Registered on Prospero with the registration number of CRD42020210135. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01392-9.
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Affiliation(s)
- Tao-Ran Yang
- Department of Anesthesiology, The Research Units of West China (2018RU12), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, No. 37, Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Xue-Mei He
- Department of Anesthesiology, The Research Units of West China (2018RU12), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, No. 37, Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Xue-Han Li
- Department of Anesthesiology, The Research Units of West China (2018RU12), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, No. 37, Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Ru-Rong Wang
- Department of Anesthesiology, The Research Units of West China (2018RU12), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, No. 37, Guoxue Xiang, Chengdu, 610041, Sichuan, China.
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Kalu R, Boateng P, Carrier L, Garzon J, Tang A, Reickert C, Stefanou A. Effect of preoperative versus postoperative use of transversus abdominis plane block with plain 0.25 % bupivacaine on postoperative opioid use: a retrospective study. BMC Anesthesiol 2021; 21:114. [PMID: 33845790 PMCID: PMC8040194 DOI: 10.1186/s12871-021-01333-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Enhanced recovery protocols optimize pain control via multimodal approaches that include transversus abdominis plane (TAP) block. The aim of this study was to evaluate the effect of preoperative vs. postoperative plain 0.25 % bupivacaine TAP block on postoperative opioid use after colorectal surgery. Methods A retrospective cohort study comparing postoperative opioid use in patients who received preoperative (n = 240) vs. postoperative (n = 22) plain 0.25 % bupivacaine TAP blocks. The study was conducted in a single tertiary care institution and included patients who underwent colorectal resections between August 2018 and January 2020. The primary outcome of the study was postoperative opioid use. Secondary outcomes included operative details, length of stay, reoperation, and readmission rates. Results Patients who received postoperative plain 0.25 % bupivacaine TAP blocks were less likely to require postoperative patient-controlled analgesia (PCA) (59.1 % vs. 83.3 %; p = 0.012) and opioid medications on discharge (6.4 % vs. 16.9 %; p = 0.004) relative to patients who received preoperative TAP. When needed, a significantly smaller amount of opioid was prescribed to the postoperative group (84.5 vs. 32.0 mg, p = 0.047). No significant differences were noted in the duration of postoperative PCA use, amount of oral opioid use, and length of stay. Conclusions Plain 0.25 % bupivacaine TAP block administered postoperatively was associated with significantly lower need for postoperative PCA and discharge opioid medications. The overall hospital length of stay was not affected by the timing of TAP block. Because of the limited sample size in this study, conclusions cannot be generalized, and more research will be required.
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Affiliation(s)
- Richard Kalu
- Department of Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, MI, 48202, Detroit, USA
| | - Peter Boateng
- Department of Anesthesiology, Henry Ford Hospital, 2799 W. Grand Blvd, 48202, Detroit, MI, USA
| | - Lauren Carrier
- Department of Anesthesiology, Henry Ford Hospital, 2799 W. Grand Blvd, 48202, Detroit, MI, USA
| | - Jaime Garzon
- Department of Anesthesiology, Henry Ford Hospital, 2799 W. Grand Blvd, 48202, Detroit, MI, USA
| | - Amy Tang
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, 48202, Detroit, MI, USA
| | - Craig Reickert
- Division of Colon and Rectal Surgery, Henry Ford Hospital, 2799 West Grand Blvd Detroit, 48202, Detroit, MI, USA
| | - Amalia Stefanou
- Division of Colon and Rectal Surgery, Henry Ford Hospital, 2799 West Grand Blvd Detroit, 48202, Detroit, MI, USA.
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Jiang XJ, Li Z, Li Q, Zhang HY, Tang XH, Zhu T. Comparison of single-injection ultrasound-guided thoracic paravertebral block with transversus abdominis plane block in peritoneal dialysis catheter implantation: a randomized controlled trial. Trials 2021; 22:266. [PMID: 33836814 PMCID: PMC8034131 DOI: 10.1186/s13063-021-05223-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/25/2021] [Indexed: 02/08/2023] Open
Abstract
Background Previous study indicated that transversus abdominis plane (TAP) block could be the principal anesthetic technique for peritoneal dialysis catheter (PDC) implantations. However, a TAP block could not provide an optimal anesthetic effect on catheter exit site during PDC implantation. We hypothesized that single-injection ultrasound-guided thoracic paravertebral block (US-TPVB) could be the principal anesthetic technique with better pain relief at catheter exit site during PDC implantation, compared to a TAP block. And anesthesia quality of a single-injection US-TPVB was compared with that of a TAP block and local anesthetic infiltration (LAI). Methods Patients undergoing PDC implantations were randomized into groups TPVB or TAP or LAI. In group TPVB, single-injection US-TPVB at T10-T11 level was performed with 20 ml of 0.25% ropivacaine. In group TAP, oblique subcostal TAP block was performed with 20 ml of 0.25% ropivacaine. In group LAI, 40 ml of 0.25% ropivacaine was used. Anesthesia quality was compared among the three groups, including general anesthesia conversion rate, cumulative rescuing sufentanil consumption, and satisfaction rate by nephrologists and patients. Results Eighty-eight eligible patients were enrolled. Visual analogue scale (VAS) at most time points (except for the catheter exit site) were lower in group TAP, compared with group TPVB. VAS at parietal peritoneum manipulation was 6 (5, 7), 3 (0, 6), and 7 (4.75, 9) in groups TPVB, TAP, and LAI, respectively (P < 0.001). VAS at catheter exit site was 4 (3, 4), 5.5 (4, 8), and 5 (3, 7.25) in groups TPVB, TAP, and LAI, respectively (P = 0.005). Lower general anesthesia conversion rate, less cumulative rescuing sufentanil consumption, and higher satisfaction rates by nephrologists and patients were recorded in group TAP, compared with groups TPVB and LAI. Conclusions Single-injection US-TPVB provided a better pain relief at catheter exit site. The quality and reliability of anesthesia after a single-injection US-TPVB was comparable to that of LAI, but not better than that of an oblique subcostal TAP block for PDC implantation. Trial registration TCTR20160911002. Registered on 8 September 2016.
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Affiliation(s)
- Xiao-Juan Jiang
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China
| | - Zi Li
- Department of Nephrology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China
| | - Qi Li
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China.
| | - Hai-Yan Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China
| | - Xiao-Hong Tang
- Department of Nephrology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, Sichuan, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yu Y, Gao S, Yuen VM, Choi SW, Xu X. The analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) block combined with oral multimodal analgesia in comparison with oral multimodal analgesia after caesarean delivery: a randomized controlled trial. BMC Anesthesiol 2021; 21:7. [PMID: 33413104 DOI: 10.1186/s12871-020-01223-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background The transversus abdominis plane (TAP) block is used increasingly in parturients after caesarean delivery. This is a randomized controlled trial to evaluate the effectiveness of bilateral single-shot of TAP blocks in patients who received multimodal oral analgesia for postoperative pain relief. Methods Parturients who were scheduled for elective caesarean delivery under spinal anaesthesia were recruited and randomized to receive bilateral single-shot of TAP blocks or placebo in addition to multimodal oral analgesia which consisted of regular tramadol, celecoxib and paracetamol, with oral oxycodone used as a rescue for breakthrough pain. Only parturients in the TAP group would receive the TAP blocks with an injection of 15 ml (0.25%) ropivacaine on each side under aseptic techniques. All the parturients were evaluated for pain or related complications in the first 24 h after surgery. The primary outcome is the percentage of parturients who required oxycodone as a rescue analgesia. Results Eighty and 79 parturients were allocated to the TAP and placebo group respectively. Nine out of 79 (11.4%) parturients in the TAP group and 15 out of 73 (20.5%) parturients in the placebo group required oxycodone for breakthrough pain, P = 0.122. Conclusions Bilateral single-shot of TAP blocks confer little additional benefit when a multimodal oral analgesic regimen is used for pain control after caesarean section under spinal anaesthesia. Trial registration Clinical Trial Registry of China (http://www.chictr.org.cn) identifier: ChiCTR-INR-16010130, retrospectively registered on Dec 12, 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-020-01223-3.
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Saito T, Iwamoto S, Murotani K, Hashimoto A, Kurahashi S, Fukami Y, Komatsu S, Kaneko K, Mishima H, Sano T. Efficacy of celecoxib as preemptive analgesia for patients undergoing laparoscopic inguinal hernia repair: a randomized trial. Surg Today 2021; 51:1118-1125. [PMID: 33389189 DOI: 10.1007/s00595-020-02199-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/07/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the efficacy and safety of preemptive analgesia with a transversus abdominis plane (TAP) block versus celecoxib for patients undergoing laparoscopic transabdominal preperitoneal inguinal hernia repair (LTAPP). METHODS Sixty patients scheduled for LTAPP were randomized into three groups: a celecoxib group, given 200 mg celecoxib 2 h before surgery; a celecoxib/diclofenac group, given 200 mg celecoxib 2 h before surgery and 50 mg rectal diclofenac sodium on recovery from general anesthesia; and a block group, given a TAP block with 60 mL 0.25% levobupivacaine after general anesthesia. We assessed the numerical rating scale (NRS) scores for pain at rest and with movement 24 h after surgery. Postoperative analgesia use and adverse events were also evaluated. RESULTS The NRS scores for pain at rest and with movement were lower in the celecoxib group than in the block group, 24 h postoperatively. The time to first request for analgesia tended to be longer in the block group than in the celecoxib group. No significant between-group differences were noted in analgesic use or adverse events. CONCLUSIONS Celecoxib was not inferior to the TAP block as preemptive analgesia. Thus, celecoxib could be given as simple preemptive analgesia for LTAPP by considering a multimodal analgesic strategy in the early postoperative period.
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Affiliation(s)
- Takuya Saito
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan.
| | - Shigeyoshi Iwamoto
- Cancer Center, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Atsushi Hashimoto
- Department of Anesthesiology, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Shintaro Kurahashi
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Yasuyuki Fukami
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Shunichiro Komatsu
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Hideyuki Mishima
- Cancer Center, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Sano
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
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Kadioglu E, Kaya M, Yildirim H. Transversus abdominis plane block: A new method in renal colic pain management. Am J Emerg Med 2020; 38:2116-2118. [PMID: 33071076 DOI: 10.1016/j.ajem.2020.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022] Open
Abstract
In recent decades, regional plane blocks via ultrasonography have become very popular in regional anesthesia and are more commonly used in pain management. The transversus abdominis plane (TAP) block is a procedure where local anesthetics are applied to block the anterior divisions of the tenth thoracic intercostal through the first lumbar nerves (T10-L1) into the anatomic space formed amidst the internal oblique and transversus abdominis muscles located in the antero-lateral part of the abdomen wall. The most important advantage of this block method is that ultrasonographic identification is easier and its complications are fewer compared with central neuroaxial or paravertebral blocks. Here, we describe three cases where pain management in renal colic was treated with the TAP block.
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Affiliation(s)
- Emine Kadioglu
- University of Kutahya Health Sciences, Medical Scholl, Department of Emergency Medicine, Kutahya, Turkey.
| | - Murtaza Kaya
- University of Kutahya Health Sciences, Medical Scholl, Department of Emergency Medicine, Kutahya, Turkey.
| | - Harun Yildirim
- University of Kutahya Health Sciences, Medical Scholl, Department of Emergency Medicine, Kutahya, Turkey.
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Mujukian A, Truong A, Tran H, Shane R, Fleshner P, Zaghiyan K. A Standardized Multimodal Analgesia Protocol Reduces Perioperative Opioid Use in Minimally Invasive Colorectal Surgery. J Gastrointest Surg 2020; 24:2286-2294. [PMID: 31515761 DOI: 10.1007/s11605-019-04385-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/27/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multimodal analgesia protocols are becoming a common part of enhanced recovery pathways after colorectal surgery. However, few protocols include a robust intraoperative component in addition to pre-operative and post-operative analgesics. METHOD A prospective cohort study was performed in an urban teaching hospital in patients undergoing minimally invasive colorectal surgery before and after implementation of a multimodal analgesia protocol consisting of pre-operative (gabapentin, acetaminophen, celecoxib), intraoperative (lidocaine and magnesium infusions, ketorolac, transversus abdominis plane block), and post-operative (gabapentin, acetaminophen, celecoxib) opioid-sparing elements. The main outcome measure was use of morphine equivalents in the first 24-h post-operative period. RESULTS The study cohort (n = 71) included 41 patients before and 30 patients after implementation of a multimodal analgesia protocol. Mean age of the entire study cohort was 47 ± 19.7 years and 46% were male. Patients undergoing surgery post-multimodal analgesia vs. pre-multimodal analgesia had significantly lower use of IV morphine equivalents in first 24-h post-operative period (5.8 ± 6.4 mg vs. 22.8 ± 21.3 mg; p = 0.005) and first 48-h post-operative period (7.6 ± 9.4 mg vs. 42 ± 52.9 mg; p = 0.0008). This reduction in IV morphine equivalent use post-multimodal analgesia was coupled with improved pain scores in the post-operative period. Post-operative hospital length of stay, post-operative ileus, and overall complications were not significantly different between groups. CONCLUSIONS Multimodal analgesia incorporating pre-operative, intraoperative, and post-operative opioid-sparing agents is an effective method for reducing perioperative opioid utilization and pain after minimally invasive colorectal surgery.
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Affiliation(s)
- Angela Mujukian
- Division of Colon & Rectal Surgery, Cedars Sinai Medical Center, 8737 Beverly Blvd., Suite 101, Los Angeles, CA, 90048, USA
| | - Adam Truong
- Division of Colon & Rectal Surgery, Cedars Sinai Medical Center, 8737 Beverly Blvd., Suite 101, Los Angeles, CA, 90048, USA
| | - Hai Tran
- Department of Pharmacy, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Rita Shane
- Department of Pharmacy, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Phillip Fleshner
- Division of Colon & Rectal Surgery, Cedars Sinai Medical Center, 8737 Beverly Blvd., Suite 101, Los Angeles, CA, 90048, USA
| | - Karen Zaghiyan
- Division of Colon & Rectal Surgery, Cedars Sinai Medical Center, 8737 Beverly Blvd., Suite 101, Los Angeles, CA, 90048, USA.
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Chiancone F, Fabiano M, Ferraiuolo M, de Rosa L, Prisco E, Fedelini M, Meccariello C, Visciola G, Fedelini P. Clinical implications of transversus abdominis plane block (TAP-block) for robot assisted laparoscopic radical prostatectomy: A single-institute analysis. Urologia 2020; 88:25-29. [PMID: 32945234 DOI: 10.1177/0391560320957226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the role of TAP block in improvement of anesthesiological management and perioperative surgical outcomes of robot-assisted laparoscopic radical prostatectomy (RALP). METHODS We consecutive enrolled 93 patients with prostate cancer whose underwent RALP at our department from January 2019 to December 2019. Group A included 45 patients who received bilateral TAP block, and Group B included 48 patients who did not received TAP block. TAP blocks were always performed by a single anesthesia team. An elastomeric pump device was used in all patients for post-operative pain management. TAP block was performed according to Rafi's technique, with Ropivacaine 0.375% and dexamethasone 4 mg. Mean values with standard deviations (±SD) were computed and reported for all items. Statistical significance was achieved if p-value was ⩽0.05 (two-sides). RESULTS The two groups showed no difference in the most important demographics and baseline characteristics (p > 0.05). Group A showed a significant longer time of anaesthesia. Moreover, Ketorolac doses (started dose plus continuous post-operative infusion via elastomeric pump) used in Group A were significantly lower than Group B. Despite this, Group B showed statistical significant higher value of NRS PACU and at 12, 24, 48, 72 h than Group A but not at 96 h. Rescue analgesic medication use was significantly higher in the Group B than Group A. Moreover, patency of the intestinal tract and time to ambulation was significantly lower in the Group A. DISCUSSION The use of TAP block during a RALP is a safe procedure that can be applied more appropriately to achieve better pain control. A multimodal protocol that includes locoregional anesthesia, reduction of intra and postoperative use of strong opiates, correct placing of the patient and the use of low pneumoperitoneum pressures should be implemented in order to reach a faster and better post-operative full recovery of patients whose underwent RALP.
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Affiliation(s)
| | - Marco Fabiano
- Urology Department, Antonio Cardarelli Hospital, Naples, Italy
| | - Maria Ferraiuolo
- Department of Anesthesiology, TIPO e OTI, Antonio Cardarelli Hospital, Naples, Italy
| | - Lucia de Rosa
- Department of Anesthesiology, TIPO e OTI, Antonio Cardarelli Hospital, Naples, Italy
| | - Elena Prisco
- Department of Anesthesiology, TIPO e OTI, Antonio Cardarelli Hospital, Naples, Italy
| | | | | | - Giulio Visciola
- General and Specialized Surgery for Women and Children, University of Campania Luigi Vanvitelli, Caserta, Campania, Italy
| | - Paolo Fedelini
- Urology Department, Antonio Cardarelli Hospital, Naples, Italy
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Haruethaivijitchock P, Ng JL, Taksavanitcha G, Theerawatanawong J, Rattananupong T, Lohsoonthorn V, Sahakitrungruang C. Postoperative analgesic efficacy of modified continuous transversus abdominis plane block in laparoscopic colorectal surgery: a triple-blind randomized controlled trial. Tech Coloproctol 2020; 24:1179-1187. [PMID: 32725352 DOI: 10.1007/s10151-020-02311-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 07/16/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The optimal opioid-sparing analgesic regimen following laparoscopic colorectal surgery (LCS) remains uncertain. We sought to determine the efficacy of low-dose bupivacaine infusion via surgeon-inserted modified continuous transversus abdominis plane (mcTAP) catheters after LCS. METHODS A parallel-group, placebo-controlled, randomized single-centre trial was conducted between April 2017 and February 2018. Block-of-four randomization and allocation concealment by sequentially-numbered, opaque sealed envelopes were used. Patients, surgeons and assessors were blinded. Fifty-two patients were randomized to receive either 0.2% bupivacaine or saline through mcTAP catheters. A 5 ml bolus followed by a 72 h infusion at 2 ml/h was started, with patient-controlled fentanyl analgesia and oral paracetamol given on demand. Primary outcomes were fentanyl consumptions in the first 24 h, second 24 h, and third 24 h following surgery. Secondary outcomes were pain numeric rating scores, recovery outcomes and complications. RESULTS Twenty-five patients in the bupivacaine group and 26 in the control group were analysed. Patients in the bupivacaine group required significantly less fentanyl overall (106.1 vs 484.5 mcg, p < 0.001) and at all time points (first 24 h: 61.0 vs 324.3 mcg, p < 0.001; second 24 h: 36.3 vs 119.0 mcg, p = 0.033; third 24 h: 8.8 vs 41.2, p = 0.030) when compared to placebo. Significantly lower pain scores at rest at 6 h (2.32 vs 4.0, p = 0.002), and 12 h (1.80 vs 3.08, p = 0.011) and on coughing at 6 h (4.56 vs 5.84, p = 0.019), 12 h (3.76 vs 4.96, p = 0.009), and 24 h (3.44 vs 4.24, p = 0.049) as well as significantly lower opioid-related complications such as nausea or vomiting (9 (36%) vs 1 (4%), p = 0.005) were observed in the bupivacaine group. There were no major block-related complications, and recovery outcomes were similar in both groups. CONCLUSIONS McTAP block reduces postoperative fentanyl consumption and pain scores after LCS, highlighting its role as a safe and useful opioid-sparing analgesia. REGISTRATION NUMBER TCTR20150831001 (Thai Clinical Trials Registry). Full trial protocol can be assessed at https://www.clinicaltrials.in.th/ .
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Affiliation(s)
- P Haruethaivijitchock
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - J L Ng
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - G Taksavanitcha
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - J Theerawatanawong
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - T Rattananupong
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - V Lohsoonthorn
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - C Sahakitrungruang
- Colorectal Surgery Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
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Zhu Y, Gong T. An invited commentary: The efficacy of transversus abdominis plane block with or without dexmedetomidine for postoperative analgesia in renal transplantation. A randomized controlled trial. Int J Surg 2020; 81:9-10. [PMID: 32707332 DOI: 10.1016/j.ijsu.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Yuhang Zhu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Guizhou, 563000, China.
| | - Taowu Gong
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Guizhou, 563000, China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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