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Sapisochin G, Goldaracena N, Laurence JM, Levy GA, Grant DR, Cattral MS. Right lobe living-donor hepatectomy-the Toronto approach, tips and tricks. Hepatobiliary Surg Nutr 2016; 5:118-26. [PMID: 27115005 DOI: 10.3978/j.issn.2304-3881.2015.07.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Living-donor liver transplantation (LDLT) is a well-established treatment for end-stage liver disease. Nevertheless, it has not been extensively accepted in North America or Europe as it has been in Asia. At the University of Toronto we initiated our LDLT program in 2000 and since then our program has grown each year, representing today the largest LDLT program in North America. Our right-lobe LDLT experience from 2000-2014 includes 474 right lobes. Only 30% of our grafts have included the middle hepatic vein. We present excellent outcomes in terms of graft and patient survival which is not different to that achieved with deceased donor liver transplantation. In the present study we will discuss the evolution, challenges and current practices of our LDLT program. We will discuss what is and has been the program philosophy. We will also discuss how we evaluate our donors and the extensive workup we do before a donor is accepted for live donation. Furthermore we will discuss some tips and tricks of how we perform the right hepatectomy for live donation.
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Affiliation(s)
- Gonzalo Sapisochin
- 1 Toronto General Hospital, University Health Network, Toronto, Ontario, Canada ; 2 Department of Surgery, 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas Goldaracena
- 1 Toronto General Hospital, University Health Network, Toronto, Ontario, Canada ; 2 Department of Surgery, 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jerome M Laurence
- 1 Toronto General Hospital, University Health Network, Toronto, Ontario, Canada ; 2 Department of Surgery, 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary A Levy
- 1 Toronto General Hospital, University Health Network, Toronto, Ontario, Canada ; 2 Department of Surgery, 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David R Grant
- 1 Toronto General Hospital, University Health Network, Toronto, Ontario, Canada ; 2 Department of Surgery, 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Cattral
- 1 Toronto General Hospital, University Health Network, Toronto, Ontario, Canada ; 2 Department of Surgery, 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Erdoğan Arı D, Yıldırım Ar A, Karadoğan F, Özcabı Y, Koçoğlu A, Kılıç F, Akgün FN. Ultrasound-guided transversus abdominis plane block in patients undergoing open inguinal hernia repair: 0.125% bupivacaine provides similar analgesic effect compared to 0.25% bupivacaine. J Clin Anesth 2016; 28:41-6. [DOI: 10.1016/j.jclinane.2015.07.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 05/20/2015] [Accepted: 07/15/2015] [Indexed: 11/25/2022]
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Abd El-Hamid A, Afifi E. Transversus abdominis plane block versus local anesthetic wound infiltration in patients undergoing open inguinal hernia repair surgery. AIN-SHAMS JOURNAL OF ANAESTHESIOLOGY 2016. [DOI: 10.4103/1687-7934.182269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gadsden J, Ayad S, Gonzales JJ, Mehta J, Boublik J, Hutchins J. Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries. Local Reg Anesth 2015; 8:113-7. [PMID: 26677342 PMCID: PMC4677765 DOI: 10.2147/lra.s96253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Transversus abdominis plane (TAP) infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by administration of a local anesthetic in close proximity, TAP infiltration involves administration and spread of local anesthetic within an anatomical plane of the surgical site.
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Affiliation(s)
- Jeffrey Gadsden
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Sabry Ayad
- Department of Anesthesiology and Pain Management, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffrey J Gonzales
- Department of Anesthesiology, University of Colorado Hospital, Aurora, CO, USA
| | - Jaideep Mehta
- Department of Anesthesiology, UT Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jan Boublik
- Department of Anesthesiology, NYU Langone Medical Center - Hospital for Joint Diseases, New York, NY, USA
| | - Jacob Hutchins
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA ; Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Mrunalini P, Raju NVR, Nath VN, Saheb SM. Efficacy of transversus abdominis plane block in patients undergoing emergency laparotomies. Anesth Essays Res 2015; 8:377-82. [PMID: 25886339 PMCID: PMC4258987 DOI: 10.4103/0259-1162.143153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Pain experienced following laparotomy is largely due to abdominal wall incision. Effective mitigation of this pain is vital to improve patient satisfaction and for early ambulation. We evaluated the efficacy of transversus abdominis plane (TAP) block for postoperative analgesia, as a component of multimodal analgesia. Materials and Methods: Sixty adult ASA physical status I to III patients undergoing emergency laparotomy under general anesthesia were recruited for this double-blind, randomized, controlled trial. The TAP block was performed before skin incision, using the double pop technique in the midaxillary line, at the level of the umbilicus with a 22 gauge blunt needle. The patients were randomly assigned to receive either 25 ml of 0.25% bupivacaine or normal saline (NS), bilaterally. Tramadol was used for postoperative analgesia via a patient-controlled analgesia pump (PCA) along with an intramuscular (IM) injection of diclofenac sodium, 12-hourly. Each patient was assessed in the Post Anesthesia Care Unit (PACU) immediately after shifting and every two hours thereafter, for 24 hours, for pain, nausea, sedation scores, and pruritus. The two-hourly and total tramadol consumption, over 24 hours, was assessed. Results: The mean total pain scores were significantly less in the TAP block group (48.07 ± 6.76) when compared to the control group (62.63 ± 6.66). The total tramadol consumption was decreased by 36% in the TAP block group (281.33 ± 69.66 mg) compared to the control group (439 ± 68.59 mg). Tramadol consumption measured every two hours was also less up to 18 hours postoperatively, after which, there was an increase in pain scores and tramadol consumption in the TAP block group. There was no statistically significant difference between the two groups in terms of nausea, vomiting, sedation or pruritis. Conclusion: TAP block is an effective component of the multimodal analgesia regimen for reducing postoperative pain and opioid requirement after emergency laparotomy.
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Affiliation(s)
- Parasa Mrunalini
- Department of Anesthesiology, NRI Medical College, Chinnakakani, Guntur, Andhra Pradesh, India
| | - N Vijaya Rama Raju
- Department of Anesthesiology, NRI Medical College, Chinnakakani, Guntur, Andhra Pradesh, India
| | - Vemuri Nagendra Nath
- Department of Anesthesiology, NRI Medical College, Chinnakakani, Guntur, Andhra Pradesh, India
| | - Shaik Mastan Saheb
- Department of Anesthesiology, NRI Medical College, Chinnakakani, Guntur, Andhra Pradesh, India
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SONDEKOPPAM RV, BROOKES J, MORRIS L, JOHNSON M, GANAPATHY S. Injectate spread following ultrasound-guided lateral to medial approach for dual transversus abdominis plane blocks. Acta Anaesthesiol Scand 2015; 59:369-76. [PMID: 25582299 DOI: 10.1111/aas.12459] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/30/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bilateral dual transversus abdominis plane (BD-TAP) injections were devised to cover the T7-8 and L1 dermatomes, which are usually spared with classical and mid-axillary TAP injections. The purpose of this study was to delineate the vertical and lateral extent of injectate spread following a lateral to medial approach for TAP injections in embalmed cadavers. METHODS Ultrasound-guided subcostal and lateral TAP injections were performed on nine embalmed cadavers using 30 ml of 0.5% methylcellulose (20 ml for subcostal and 10 ml for lateral injections) with a 12-cm Tuohy needle in the first six cadavers (nine hemi-abdomens). Vertical extent and the medial to lateral extent of the dye spread were recorded after dissections of the abdominal wall. In a pilot of three cadavers not receiving TAP injections, anatomical impediments to proximal injectate spread were explored separately. RESULTS The vertical spread of injectate was T7-L1 (n = 2/9), T8-L1 (n = 5/9) and T9-L1 (n = 2/9). None of the TAP injections extended beyond the mid-axillary line. No anatomical impediments for the flow of injectate to the T7 or T8 intercostal nerves were found at the level of the interdigitations of the transversus abdominis muscle and diaphragm. CONCLUSION A lateral to medial approach for TAP injection resulted in spread of the injectate ranging from T7/8-L1 dermatomes in the majority of the hemi-abdomens. Subcostal and lateral TAP injections do not cover the lateral cutaneous branches of the segmental nerves.
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Affiliation(s)
- R. V. SONDEKOPPAM
- Department of Anesthesiology and Perioperative Medicine; University of Western Ontario; London Ontario Canada
| | - J. BROOKES
- Department of Anesthesiology and Perioperative Medicine; University of Western Ontario; London Ontario Canada
| | - L. MORRIS
- Department of Anatomy and Cell Biology; University of Western Ontario; London Ontario Canada
| | - M. JOHNSON
- Department of Anatomy and Cell Biology; University of Western Ontario; London Ontario Canada
| | - S. GANAPATHY
- Department of Anesthesiology and Perioperative Medicine; University of Western Ontario; London Ontario Canada
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Dewinter G, Van de Velde M, Fieuws S, D'Hoore A, Rex S. Transversus abdominis plane block versus perioperative intravenous lidocaine versus patient-controlled intravenous morphine for postoperative pain control after laparoscopic colorectal surgery: study protocol for a prospective, randomized, double-blind controlled clinical trial. Trials 2014; 15:476. [PMID: 25472808 PMCID: PMC4289212 DOI: 10.1186/1745-6215-15-476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/18/2014] [Indexed: 02/04/2023] Open
Abstract
Background Despite the laparoscopic approach becoming the standard in colorectal surgery, postoperative pain management for minimally invasive surgery is still mainly based on strategies that have been established for open surgical procedures. Patient-controlled epidural and intravenous analgesia are considered standard postoperative analgesia regimens in colorectal surgery. Epidural analgesia provides excellent analgesia, but is increasingly scrutinized in laparoscopic surgery since postoperative pain after the laparoscopic approach is significantly reduced. Moreover, epidural analgesia can be associated with numerous complications. Therefore, epidural analgesia is no longer recommended for the management of postoperative pain in laparoscopic colorectal surgery. Likewise, patient-controlled intravenous analgesia is subject to significant side effects. Given these important limitations of the traditional strategies for postoperative analgesia, effective and efficient alternatives in patients undergoing laparoscopic colorectal surgery are needed. Both the transversus abdominis plane block and systemically administered lidocaine have already been reported to effectively reduce pain after laparoscopic colorectal surgery. We hypothesize that the transversus abdominis plane block is superior to perioperative intravenous lidocaine. Methods/design One hundred and twenty five patients undergoing laparoscopic colorectal surgery will be included in this prospective, randomized, double-blind controlled clinical trial. Patients will be randomly allocated to three different postoperative strategies: postoperative patient-controlled intravenous analgesia with morphine (control group, n = 25), a transversus abdominis plane block with ropivacaine 0.375% at the end of surgery plus postoperative patient-controlled intravenous analgesia with morphine (TAP group, n = 50), or perioperative intravenous lidocaine plus postoperative patient-controlled intravenous analgesia with morphine (LIDO group, n = 50). As the primary outcome parameter, we will evaluate the opioid consumption during the first 24 postoperative hours. Secondary endpoints include the Numeric Rating Scale, time to return of intestinal function, time to mobilization, inflammatory response, incidence of postoperative nausea and vomiting, length of hospital stay and postoperative morbidity as assessed with the Clavien-Dindo classification. Discussion Recognizing the importance of a multimodal approach for perioperative pain management, we aim to investigate whether a transversus abdominis plane block delivers superior pain control in comparison to perioperative intravenous lidocaine and patient-controlled intravenous analgesia with morphine alone. Trial registration EudraCT Identifier: 2014-001499-73; 31 July 2014.
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Affiliation(s)
- Geertrui Dewinter
- Department of Anaesthesiology, KU Leuven - University of Leuven, University Hospitals of Leuven, B-3000 Leuven, Belgium.
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Treatment of acute flares of chronic pancreatitis pain with ultrasound guided transversus abdominis plane block: a novel application of a pain management technique in the acute care setting. Case Rep Emerg Med 2014; 2014:759508. [PMID: 25328723 PMCID: PMC4190973 DOI: 10.1155/2014/759508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/29/2014] [Indexed: 11/17/2022] Open
Abstract
The use of transversus abdominis plane (TAP) block to provide either analgesia or anesthesia to the anterior abdominal wall is well described. The technique yields high analgesic effectiveness and is opioid sparing and potentially of long duration with reported analgesia lasting up to 36 hours. When compared to neuraxial analgesia, TAP blocks are associated with a lower incidence of hypotension and motor blockade. TAP blocks are typically described as providing somatic analgesia only without any effect on visceral pain. There may be, however, certain conditions in which TAP blocks can provide effective analgesia in pain of visceral or mixed somatic and visceral origin. We describe two cases in which TAP blockade provided complete control of pain considered to be of visceral origin.
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Ladak SS, Jiang J, Ojha M. Transversus Abdominis Plane Blocks: An Overview of Indication and Nursing Care. Pain Manag Nurs 2014; 15:588-92. [DOI: 10.1016/j.pmn.2013.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 11/16/2022]
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Abdul Jalil RM, Yahya N, Sulaiman O, Wan Mat WR, Teo R, Izaham A, Rahman RA. Comparing the effectiveness of ropivacaine 0.5% versus ropivacaine 0.2% for transabdominis plane block in providing postoperative analgesia after appendectomy. ACTA ACUST UNITED AC 2014; 52:49-53. [PMID: 25016507 DOI: 10.1016/j.aat.2014.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/17/2014] [Accepted: 04/22/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The basis for the transversus abdominis plane (TAP) block involves infiltration of a local anesthetic into the neurofascial plane between the internal oblique and the transversus abdominis muscles, causing a regional block that spreads between the L1 and T10 dermatomes. Thus, the TAP block is said to be suitable for lower abdominal surgery. This study was designed to compare the analgesic efficacy of two different concentrations of ropivacaine for TAP block in patients undergoing appendectomy. METHODS Fifty-six patients with American Society of Anesthesiologists physical status I or II, aged 18 years and above, undergoing appendectomy were recruited in this prospective, randomized, double-blind study. They were divided into two groups: Group A patients who received 0.5 mL/kg of ropivacaine 0.5% and Group B patients who received 0.5 mL/kg of ropivacaine 0.2% via TAP block under ultrasound guidance. Postoperative pain was assessed using the visual analog scale upon arrival at the recovery room in the operating theatre, just prior to being discharged to the ward, and at 6 hours, 12 hours, 18 hours, and 24 hours postoperatively to compare the effectiveness of analgesia. RESULTS Intraoperatively, patients in Group B required a significantly greater amount of additional intravenous fentanyl than those in Group A. There were no significant statistical differences in pain scores at rest and on movement at all assessment times as well as in the dose of 24-hour intravenous morphine consumption given via patient-controlled analgesia postoperatively between the two groups. CONCLUSION The effectiveness of two different concentrations of ropivacaine (0.5% versus 0.2%) given via TAP block was comparable in providing postoperative analgesia for patients undergoing appendectomy.
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Affiliation(s)
- Reymi Marseela Abdul Jalil
- Department of Anaesthesiology and Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Nurlia Yahya
- Department of Anaesthesiology and Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia.
| | - Omar Sulaiman
- Department of Anaesthesia and Intensive Care, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Wan Rahiza Wan Mat
- Department of Anaesthesiology and Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Rufinah Teo
- Department of Anaesthesiology and Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Azarinah Izaham
- Department of Anaesthesiology and Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Raha Abdul Rahman
- Department of Anaesthesiology and Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
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Transient femoral nerve palsy complicating "blind" transversus abdominis plane block. Case Rep Anesthesiol 2013; 2013:874215. [PMID: 24093065 PMCID: PMC3777211 DOI: 10.1155/2013/874215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/04/2013] [Indexed: 11/21/2022] Open
Abstract
We present two cases of patients who reported quadriceps femoris weakness and hypoesthesia over the anterior thigh after an inguinal hernia repair under transversus abdominis plane (TAP) block. Transient femoral nerve palsy is the result of local anesthetic incorrectly injected between transversus abdominis muscle and transversalis fascia and pooling around the femoral nerve. Although it is a minor and self-limiting complication, it requires overnight hospital stay and observation of the patients. Performing the block under ultrasound guidance and injecting the least volume of local anesthetic required are ways of minimizing its incidence.
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Affiliation(s)
- A. N. Rafi
- John L. McClellan Memorial Veterans Hospital; Little Rock, AR USA
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