101
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Wang X, Li T. Postoperative pain pathophysiology and treatment strategies after CRS + HIPEC for peritoneal cancer. World J Surg Oncol 2020; 18:62. [PMID: 32234062 PMCID: PMC7110707 DOI: 10.1186/s12957-020-01842-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/20/2020] [Indexed: 02/08/2023] Open
Abstract
Background Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment choice for peritoneal cancer. However, patients commonly suffer from severe postoperative pain. The pathophysiology of postoperative pain is considered to be from both nociceptive and neuropathic origins. Main body The recent advances on the etiology of postoperative pain after CRS + HIPEC treatment were described, and the treatment strategy and outcomes were summarized. Conclusion Conventional analgesics could provide short-term symptomatic relief. Thoracic epidural analgesia combined with opioids administration could be an effective treatment choice. In addition, a transversus abdominis plane block could also be an alternative option, although further studies should be performed.
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Affiliation(s)
- Xiao Wang
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing, 100038, China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing, 100038, China.
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Küls N, Trujanovic R, Otero PE, Larenza-Menzies MP. Ultrasound-Guided Transversus Abdominis Plane Block in Shetland Ponies: A Description of a Three-Point Injection Technique and Evaluation of Potential Analgesic Effects. J Equine Vet Sci 2020; 90:102994. [PMID: 32534772 DOI: 10.1016/j.jevs.2020.102994] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/03/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
Colic surgery is one of the most painful procedures carried out in horses. Common strategies to alleviate immediate postsurgical abdominal pain include the administration of potent systemic analgesics; however, these may cause unwanted adverse effects such as cardiovascular depression, ileus, and ataxia. The administration of local anesthetics at the incision site in form of an ultrasound-guided subcostal transversus abdominis plane (TAP) block may therefore be preferred to provide adequate analgesia without significant side effects. To date, no technique for a TAP block in horses undergoing median celiotomy has been described. The objective of the study was to develop a TAP block technique, which will lead to the desensitization of the ventrolateral abdominal wall and adjacent skin area of experimental Shetland Ponies using bupivacaine 0.125%. This is a prospective, blinded, self-controlled trial. A cadaver study was performed to determine the ideal injection points and the volume required to stain the nerves responsible for the sensation of the ventrolateral abdominal wall and skin in Shetland pony cadavers (i.e., T9-L 2). Subsequently, using the ideal injectate volume and the landmarks obtained in the first phase of the study, six Shetland ponies received a bilateral TAP injection, either with a local anesthetic solution (bupivacaine 0.125%) or with saline in a randomized, crossover, blinded fashion. Effectiveness was determined over a 4 hour postinjection time, by using a pinprick technique. Significant differences were found to the responses of the pinprick evaluation between the bupivacaine- and saline-treated sides after 30 minutes of TAP block injection. Reported "learned behavior" could have affected the results of the pinprick testing. The TAP block technique reported in this study using bupivacaine 0.125% appeared effective in desensitizing the lower abdomen of ponies for up to 2 hours. Further research is required to apply this technique in horses undergoing celiotomy. Potentially larger volumes and/or higher concentrations of bupivacaine may be necessary to provide longer duration of action of the block.
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Affiliation(s)
- Nina Küls
- Clinical Unit of Anaesthesiology and Perioperative Intensive-Care Medicine, Vetmeduni Vienna, Vienna, Austria.
| | - Robert Trujanovic
- Clinical Unit of Anaesthesiology and Perioperative Intensive-Care Medicine, Vetmeduni Vienna, Vienna, Austria
| | - Pablo E Otero
- Department of Anaesthesiology, Faculty of Veterinary Medicine, University of Buenos Aires, Argentina
| | - M Paula Larenza-Menzies
- Clinical Unit of Anaesthesiology and Perioperative Intensive-Care Medicine, Vetmeduni Vienna, Vienna, Austria
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103
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Unilateral transversus abdominis plane block and port-site infiltration. Anaesthesist 2020; 69:270-276. [DOI: 10.1007/s00101-020-00746-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/28/2019] [Accepted: 02/12/2020] [Indexed: 12/23/2022]
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104
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Cavaliere F, Allegri M, Apan A, Calderini E, Carassiti M, Coluzzi F, Di Marco P, Langeron O, Rossi M, Spieth P. A year in review in Minerva Anestesiologica 2018. Minerva Anestesiol 2020; 85:206-220. [PMID: 30773000 DOI: 10.23736/s0375-9393.19.13597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy -
| | - Massimo Allegri
- Unità Operativa Terapia del Dolore della Colonna e dello Sportivo, Policlinic of Monza, Monza, Italy.,Italian Pain Group, Milan, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Edoardo Calderini
- Unit of Women-Child Anesthesia and Intensive Care, IRCCS Cà Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, University Hospital School of Medicine Campus Bio-Medico of Rome, Rome, Italy
| | - Flaminia Coluzzi
- Unit of Anesthesia, Department of Medical and Surgical Sciences and Biotechnologies, Intensive Care and Pain Medicine, Sapienza University, Rome, Italy
| | - Pierangelo Di Marco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesiology and Intensive Care, Pitié-Salpètrière Hospital, Sorbonne University Paris, Paris, France
| | - Marco Rossi
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Dresden, Germany
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105
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Qin C, Liu Y, Xiong J, Wang X, Dong Q, Su T, Liu J. The analgesic efficacy compared ultrasound-guided continuous transverse abdominis plane block with epidural analgesia following abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2020; 20:52. [PMID: 32111162 PMCID: PMC7048149 DOI: 10.1186/s12871-020-00969-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/21/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This review and meta-analysis aims to evaluate the analgesic efficacy of continuous transversus abdominis plane (TAP) block compared with epidural analgesia (EA) in adults after abdominal surgery. METHODS The databases PubMed, Embase and Cochrane Central Register were searched from inception to June 2019 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy of continuous TAP block compared with EA after abdominal surgery. The weighted mean differences (WMDs) were estimates for continuous variables with a 95% confidence interval (CI) and risk ratio (RR) for dichotomous data. The pre-specified primary outcome was the dynamic pain scores 24 h postoperatively. RESULTS Eight trials including 453 patients (TAP block:224 patients; EA: 229 patients) ultimately met the inclusion criteria and seven trials were included in the meta-analysis. Dynamic pain scores after 24 h were equivalent between TAP block and EA groups (WMD:0.44; 95% CI: 0.1 to 0.99; I2 = 91%; p = 0.11). The analysis showed a significant difference between the subgroups according to regularly administering (4 trials; WMD:-0.11; 95% CI: - 0.32 to 0.09; I2 = 0%; p = 0.28) non-steroidal anti-inflammatory drugs (NSAIDs) or not (3 trials; WMD:1.02; 95% CI: 0.09 to 1.96; I2 = 94%; p = 0.03) for adjuvant analgesics postoperatively. The measured time of the urinary catheter removal in the TAP group was significantly shorter (3 trials, WMD:-18.95, 95% CI:-25.22 to - 12.71; I2 = 0%; p < 0.01), as was time to first ambulation postoperatively (4 trials, WMD:-6.61, 95% CI: - 13.03 to - 0.19; I2 = 67%; p < 0.05). CONCLUSION Continuous TAP block, combined with NSAIDs, can provide non-inferior dynamic analgesia efficacy compared with EA in postoperative pain management after abdominal surgery. In addition, continuous TAP block is associated with fewer postoperative side effects.
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Affiliation(s)
- Chaosheng Qin
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China
| | - Yuanming Liu
- Department of Ultrasound, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, 541001, People's Republic of China
| | - Jijun Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China
| | - Xiaogang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China
| | - Qinghua Dong
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China
| | - Tingshi Su
- Department of radiotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China
| | - Jingchen Liu
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China.
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106
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Patino M, Chandrakantan A. Midgestational Fetal Procedures. CASE STUDIES IN PEDIATRIC ANESTHESIA 2019:197-201. [DOI: 10.1017/9781108668736.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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107
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Neethirajan SGR, Kurada S, Parameswari A. Efficacy of Dexmedetomidine as an Adjuvant to Bupivacaine in Ultrasound-Guided Transverse Abdominis plane Block for Laparoscopic appendicectomy: A Randomised Controlled Study. Turk J Anaesthesiol Reanim 2019; 48:364-370. [PMID: 33103140 PMCID: PMC7556648 DOI: 10.5152/tjar.2019.67689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/10/2019] [Indexed: 12/19/2022] Open
Abstract
Objective Dexmedetomidine is an alpha 2-adrenergic agonist that prolongs analgesia as an adjuvant when added in neuraxial and peripheral nerve blocks. The aim of the present study was to evaluate the efficacy of dexmedetomidine as an adjuvant to bupivacaine in ultrasound (USG)-guided transverse abdominis plane (TAP) block for postoperative analgesia in laparoscopic appendicectomy. Methods A total of 60 American Society of Anesthesiologists I and II adult patients aged between 16 and 60 years planned for laparoscopic appendicectomy were randomised into two groups (A and B). Group A patients received 20 mL of 0.125% bupivacaine+1 μg kg−1 dexmedetomidine, whereas group B patients received 20 mL of 0.125% bupivacaine alone on both sides at the time of USG-guided TAP block. Haemodynamic variables, pain scores, sedation scores, time to first dose of rescue analgesic and side effects, if any, were assessed and compared between the groups. Results Demographic and operative characteristics were comparable in both groups. The mean duration of analgesia was more in group A (7.33 h) than in group B (4.8 h). The requirement of rescue analgesics was more in group B (80%) than in group A (56.7%). The sedation and pain scores at 2, 4 and 6 h were better in group A than in group B (p<0.05). The heart rate, systolic blood pressure and diastolic blood pressure were lower in group A during the postoperative period than in group B. Conclusion The addition of dexmedetomidine as an adjuvant to bupivacaine in TAP block provides prolonged postoperative analgesia and better pain control with reduced need for rescue analgesics than bupivacaine alone in patients undergoing laparoscopic appendicectomy.
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Affiliation(s)
| | - Santoshi Kurada
- Department of Anaesthesia and Pain Medicine, Sri Ramachandra Medical College, Chennai, India
| | - Aruna Parameswari
- Department of Anaesthesia and Pain Medicine, Sri Ramachandra Medical College, Chennai, India
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108
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Patel S, Sharawi N, Sultan P. Local anaesthetic techniques for post-caesarean delivery analgesia. Int J Obstet Anesth 2019; 40:62-77. [DOI: 10.1016/j.ijoa.2019.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 12/12/2022]
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109
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Mitchell KD, Smith CT, Mechling C, Wessel CB, Orebaugh S, Lim G. A review of peripheral nerve blocks for cesarean delivery analgesia. Reg Anesth Pain Med 2019; 45:rapm-2019-100752. [PMID: 31653797 PMCID: PMC7182469 DOI: 10.1136/rapm-2019-100752] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/20/2019] [Accepted: 10/11/2019] [Indexed: 11/03/2022]
Abstract
Peripheral nerve blocks have a unique role in postcesarean delivery multimodal analgesia regimens. In this review article, options for peripheral nerve blocks for cesarean delivery analgesia will be reviewed, specifically paravertebral, transversus abdominis plane, quadratus lumborum, iliohypogastric and ilioinguinal, erector spinae, and continuous wound infiltration blocks. Anatomy, existing literature evidence, and specific areas in need of future research will be assessed. Considerations for local anesthetic toxicity, and for informed consent for these modalities in the context of emergency cesarean deliveries, will be presented.
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Affiliation(s)
- Kelsey D Mitchell
- Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - C Tyler Smith
- Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Courtney Mechling
- Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Charles B Wessel
- Health Sciences Library, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven Orebaugh
- Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Grace Lim
- Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Anesthesiology, Perioperative Medicine, Obstetrics & Gynecology, UPMC Magee Womens Hospital, Pittsburgh, Pennsylvania, USA
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110
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Li X, Xu ZZ, Li XY, Jiang TT, Lin ZM, Wang DX. The analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic renal surgery: a randomized controlled study. BMC Anesthesiol 2019; 19:186. [PMID: 31627728 PMCID: PMC6800496 DOI: 10.1186/s12871-019-0850-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ultrasound-guided lateral transversus abdominis plane (TAP) block can provide definite analgesia to the anterior abdominal wall. However, whether this method is useful in renal surgery through the lateral abdominal wall pathway remains unknown. The study aimed to evaluate the analgesic efficacy of lateral TAP block for retroperitoneoscopic partial or radical nephrectomy. METHOD In this prospective, randomized, double-blind, placebo-controlled trial, eligible patients were randomized into two groups. After anaesthesia induction, ultrasound-guided lateral TAP block was performed with either 30 ml of 0.4% ropivacaine (Group T) or an equivalent volume of normal saline (Group C). The primary outcomes were opioid consumption during surgery and in the first 24 h after surgery. Secondary outcomes included postsurgical pain intensity immediately awakening from anaesthesia and at 0.5, 1, 2, 6, 12, and 24 h after surgery, as well as recovery variables including the incidence of postoperative nausea and vomiting (PONV), sleep quality, time to first ambulation, drainage and length of hospital stay. RESULTS A total of 104 patients were enrolled and randomized (53 in Group T and 51 in Group C). Laparoscopic surgery was converted to open surgery in one patient of Group T; this patient was excluded from the outcome analysis. The opioid consumption during surgery (intravenous morphine equivalent dose: median 35.0 mg [interquartile range 18.0, 49.6] in Group C vs. 40.3 mg [20.9, 59.0] in Group T, P = 0.281) and in the first 24 h after surgery (10.8 mg [7.8, 21.7] in Group C vs. 13.2 mg [8.0, 26.6] in Group T, P = 0.311) did not differ significantly between groups. There were no significant differences between groups regarding the pain intensity at all time points after surgery and the recovery variables (all P > 0.05). CONCLUSIONS Our results showed that, in patients undergoing retroperitoneoscopic renal surgery, preoperative lateral TAP did not decrease intra- and postoperative opioid consumption, nor did it relieve pain intensity or promote postoperative recovery in the first 24 h after surgery. However, the trial might be underpowered. TRIAL REGISTRATION This study was registered on November 4, 2017, in the Chinese Clinical Trail Registry with the identification number ChiCTR-INR-17013244 .
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Affiliation(s)
- Xue Li
- Department of Anesthesiology, Peking University First Hospital, No. 7 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Zhen-Zhen Xu
- Department of Anesthesiology, Peking University First Hospital, No. 7 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Xue-Ying Li
- Department of Biostatics, Peking University First Hospital, No. 7 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Ting-Ting Jiang
- Department of Anesthesiology, Peking University First Hospital, No. 7 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Zeng-Mao Lin
- Department of Anesthesiology, Peking University First Hospital, No. 7 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Dong-Xin Wang
- Department of Anesthesiology, Peking University First Hospital, No. 7 Xishiku Street, Xicheng District, Beijing, 100034, China
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111
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Verma K, Malawat A, Jethava D, Jethava DD. Comparison of transversus abdominis plane block and quadratus lumborum block for post-caesarean section analgesia: A randomised clinical trial. Indian J Anaesth 2019; 63:820-826. [PMID: 31649394 PMCID: PMC6798627 DOI: 10.4103/ija.ija_61_19] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/03/2019] [Accepted: 08/11/2019] [Indexed: 02/04/2023] Open
Abstract
Background and Aims: Effective post-operative analgesia after caesarean section (CS) is important because it facilitates early amelioration, ambulation and expedites breastfeeding. Quadratus lumborum (QL) block is an interfascial block providing effective visceral and somatic analgesia. We conducted this study to compare the analgesic efficacy of QL block and transversus abdominis plane (TAP) block after CS. Methods: In this single hospital-based, prospective double-blind study, 60 patients scheduled for an elective CS between December 2018 and January 2019 were randomised to receive ultrasound-guided TAP block (n = 30) or QL block (n = 30) bilaterally with 0.2% ropivacaine postoperatively. The primary objective was to measure the time for rescue analgesic requirement and secondary objectives included the total number of analgesic dose required over a period of 72 hours and severity of post-operative pain assessment via visual analogue scale (VAS) score at rest and with movement. Statistical analysis was done using SPSS version 21. Data were compared using the Chi-square test and students' t-test. Results: Time for rescue analgesic requirement was higher in the QL group than the TAP group (mean ± SD: 68.77 ± 1.74 h vs. 13.3 ± 1.21 h) (P < 0.001). The QL group had significantly less analgesic demand (P < 0.001) at 2, 4, 6, 12, 24, 36, 48 and 72 h post-CS. The VAS at rest and movement was significantly reduced in the QL group at all times. Conclusion: The QL block provided prolonged and effective analgesia in comparison to TAP block up to 72 hours post-CS.
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Affiliation(s)
- Kalpana Verma
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Aman Malawat
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Durga Jethava
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Dharam Das Jethava
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
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112
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Rajanbabu A, Puthenveettil N, Appukuttan A, Asok A. Efficacy of laparoscopic-guided transversus abdominis plane block for patients undergoing robotic-assisted gynaecologic surgery: A randomised control trial. Indian J Anaesth 2019; 63:841-846. [PMID: 31649397 PMCID: PMC6798625 DOI: 10.4103/ija.ija_471_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 01/17/2023] Open
Abstract
Background and Aims: Transverse abdominis plane (TAP) block has been used regularly as part of multimodal analgesia for caesarean sections and other lower abdominal surgeries. Adequate postoperative analgesia provided with regional blocks allows faster postoperative recovery and better patient satisfaction. In our study, we are comparing the analgesic efficacy of laparoscopic-guided TAP block with port infiltration using a local anaesthetic in patients undergoing gynaecologic robotic surgeries. Methods: After obtaining approval from the hospital ethics committee, Central Trial Registry of India (CTRI) clearance and written informed consent from patients, this prospective double-blinded randomised control trial was conducted on patients undergoing robotic-assisted gynaecologic surgery under general anaesthesia. Group B patients received bilateral TAP block under direct laparoscopic vision with 15 ml of 0.1% ropivacaine on each side and Group C patients received routine port site infiltration with 30 ml of 0.1% ropivacaine. Postoperative pain score was measured till 24 hours, need for rescue analgesics, complications associated were noted. Independent two sample 't' test, Mann Whitney u test, Chi-square and Fisher's exact test were used for statistical analysis. Results: Pain score was significantly lower in Group B patients up to 24h (P < 0.001). The use of rescue analgesic was also significantly less in group B compared to Group C (P < 0.001). No adverse events were noted in both groups. Conclusion: Laparoscopic-guided TAP block is effective and superior to port site infiltration in providing postoperative analgesia in patients undergoing robotic-assisted gynaecologic surgery.
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Affiliation(s)
- Anupama Rajanbabu
- Departments of Gynaecological Oncology, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Nitu Puthenveettil
- Departments of Anaesthesia and Critical Care, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Akhila Appukuttan
- Departments of Gynaecological Oncology, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Anjitha Asok
- Departments of Gynaecological Oncology, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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113
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Effect of Adding Dexmedetomidine to Local Anesthetic Agents for Transversus Abdominis Plane Block. Clin J Pain 2019; 35:844-854. [DOI: 10.1097/ajp.0000000000000742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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114
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Goyal R, Aggarwal A, Gupta T, Gulati A, Jaggi S, Mirjalili SA, Sahni D. Reappraisal of the classical abdominal anatomical landmarks using in vivo computerized tomography imaging. Surg Radiol Anat 2019; 42:417-428. [PMID: 31511961 DOI: 10.1007/s00276-019-02326-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/31/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION With expanding scope of interventions it becomes mandatory to have correct and evidence-based knowledge of surface anatomy of internal abdominal structures. Information available in text books is derived from work done on cadaveric studies. Current study was designed to provide data of key abdominal surface anatomical landmarks and their variations in living subjects using CT imaging of adult population. MATERIALS AND METHODS Cross-sectional study was conducted using 100 abdominopelvic CT scans of patients of Indian origin. RESULTS Vertebral levels of origin of celiac trunk varied from T11 to L1/2 intervertebral disc, superior mesenteric artery from T12 to L2, inferior mesenteric artery from L2 to L4 and aortic bifurcation from L3 to L5. Origin of both renal arteries varied between T12 and L2 and the formation of inferior vena cava varied from L3 to L5. Vertebral levels of upper pole of both kidneys ranged from T11 to upper L3. Spleen was related to 9th to 11th ribs in 36% and 10th to 12th ribs in 34% scans. Most common vertebral levels of subcostal plane, planum supracristale and planum intertuberculare noticed were lower L2, L4 and lower L5, respectively. CONCLUSIONS Data derived from imaging investigations of living subjects and variations from the conventional descriptions observed in the current study might be helpful for clinicians.
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Affiliation(s)
- Ruchi Goyal
- Department of Anatomy, PGIMER, #123-c Type V Flats, Sector 24 A, Chandigarh, 160023, India
| | - Anjali Aggarwal
- Department of Anatomy, PGIMER, #123-c Type V Flats, Sector 24 A, Chandigarh, 160023, India.
| | - Tulika Gupta
- Department of Anatomy, PGIMER, #123-c Type V Flats, Sector 24 A, Chandigarh, 160023, India
| | - Ajay Gulati
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, 160012, India
| | - Shallu Jaggi
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, 160012, India
| | - S Ali Mirjalili
- Anatomy and Medical Imaging Department, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Victoria Street West, Auckland, New Zealand
| | - Daisy Sahni
- Department of Anatomy, PGIMER, #123-c Type V Flats, Sector 24 A, Chandigarh, 160023, India
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115
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Mallan D, Sharan S, Saxena S, Singh TK, Faisal. Anesthetic techniques: focus on transversus abdominis plane (TAP) blocks. Local Reg Anesth 2019; 12:81-88. [PMID: 31564966 PMCID: PMC6734547 DOI: 10.2147/lra.s138537] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/12/2019] [Indexed: 12/12/2022] Open
Abstract
Transverse abdominis plane (TAP) blocks, over the past decade, have emerged as a reliable tool in multimodal analgesia. Although they block only the somatic component of pain, studies have still revealed a consistent benefit in the first 24-48 hours after surgery in terms of pain scores and overall opioid consumption. The safety and dependability has increased with ultrasound usage. The aim of this review is to help the reader appreciate the applied anatomy required for a TAP block and its congeners, to standardize its nomenclature, and to help choose between variants of a TAP block and its complications and safety profile.
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Affiliation(s)
- Deepanshu Mallan
- Department of Anaesthesiology and Critical Care, Saraswati Medical College, Lucknow, India
| | - Sandeep Sharan
- Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sumi Saxena
- Department of Anaesthesiology and Critical Care, TSM Medical College, Lucknow, Uttar Pradesh, India
| | - Tapas Kumar Singh
- Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Faisal
- Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Ruiz-Tovar J, Albrecht E, Macfarlane A, Coluzzi F. The TAP block in obese patients: pros and cons. Minerva Anestesiol 2019; 85. [DOI: 10.23736/s0375-9393.19.13545-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
Surgical procedure causes tissue damage which activates systemic inflammatory response and leads to changes in endocrine and metabolic system. Anaesthesia and pain can further disrupt immune performance. Regional anaesthesia causes afferent nerve blockade and in this way mediates immune protection. Thoracic epidural analgesia is the cornerstone of pain relief in thoracic and abdominal surgery. Alternatively thoracic paravertebral block can be used with less side effects and good analgesic properties. Drugs that interfere with blood coagulation obstruct the use of central regional blocks. Surgery has also changed recently from open to minimally invasive. Also pain treatment for this procedures has changed to less aggressive, systemic or locoregional techniques. It was shown that transversus abdominis plane block and epidural analgesia have the same effect on postoperative pain, but transversus abdominis plane block was better regarding hemodynamic stability and hospital stay. Multimodal approach combining regional and systemic analgesia is currently the most appropriate perioperative pain management strategy. More studies should be done to give recommendations.
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Affiliation(s)
| | - Jasmina Markovič-Božič
- Clinical department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
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118
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Bakshi SG. The subcostal nerve as the target for nerve stimulator-guided transversus abdominis plane blocks - Commentary. Indian J Anaesth 2019; 63:255-256. [PMID: 31000887 PMCID: PMC6460975 DOI: 10.4103/ija.ija_210_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sumitra G Bakshi
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India. E-mail:
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119
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Soens MA, He J, Bateman BT. Anesthesia considerations and post-operative pain management in pregnant women with chronic opioid use. Semin Perinatol 2019; 43:149-161. [PMID: 30791974 DOI: 10.1053/j.semperi.2019.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The prevalence of opioid use disorder in pregnancy has escalated markedly in recent years. Chronic opioid use during pregnancy poses several challenges for providing adequate analgesia and anesthesia in the peripartum period. These challenges include the potential for withdrawal, opioid tolerance and opioid-induced hyperalgesia. Here we discuss alterations in analgesic pharmacokinetics and pharmacodynamics that are associated with chronic opioid use. In addition, when treating pain in patients with opioid use disorder it is important to distinguish between different subgroups. In this review, we will discuss practical management strategies for parturients with (1) untreated opioid use disorder, (2) parturients on medication-assisted treatment (methadone, buprenorphine) and (3) patients recovering from opioid use disorder that are currently abstinent. Finally, we offer an overview of non-opioid strategies that may be utilized as part of a multimodal approach to providing optimal analgesia in this patient population.
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Affiliation(s)
- Mieke A Soens
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Jingui He
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Brian T Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Sun Q, Liu S, Wu H, Ma H, Liu W, Fang M, Liu K, Pan Z. Dexmedetomidine as an Adjuvant to Local Anesthetics in Transversus Abdominis Plane Block: A Systematic Review and Meta-analysis. Clin J Pain 2019; 35:375-384. [PMID: 30475260 PMCID: PMC6410974 DOI: 10.1097/ajp.0000000000000671] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/22/2018] [Accepted: 11/11/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The objective of this meta-analysis was to evaluate the analgesic effects of dexmedetomidine (DEX) in transversus abdominis plane (TAP) blocks for abdominal surgery. METHODS Electronic databases, including PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and the Cochrane Library, were conducted to collect the randomized controlled trials (RCTs) from inception to March 2018. RCTs investigating the impact of adding DEX to local anesthetics for TAP blocks were included in this analysis. Pain scores (at rest and movement), opioid consumption, the duration of the TAP block and the common adverse effects were analyzed. RESULTS Twenty published trials including 1212 patients met the inclusion criteria. The addition of DEX significantly reduced pain scores 8 hours postoperatively at rest (WMD, -0.78; 95% CI, -1.27 to -0.30; P=0.001), 4 hours postoperatively on movement (WMD, -1.13; 95% CI, -1.65 to -0.60; P<0.001), and opioid consumption (WMD, -13.71; 95% CI, -17.83 to -9.60; P<0.001) when compared with control group. Furthermore, perineural DEX significantly prolonged the duration of the TAP block (WMD, 3.33; 95% CI, 2.85 to 3.82; P<0.001). It did not affect the incidence of postoperative nausea and vomiting, hypotension, bradycardia, somnolence, or pruritus. CONCLUSIONS DEX is a potential anesthetic adjuvant that can facilitate better postoperative analgesia, reduce postoperative analgesic requirements, and prolong the local anesthetic effect when administered in TAP blocks.
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Affiliation(s)
| | | | | | - He Ma
- Department of Anesthesiology
| | - Wei Liu
- Department of Anesthesiology
| | | | - Kexiang Liu
- Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China
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Abstract
PURPOSE OF REVIEW The purposes of this review are to summarize the advantages and limitations of ultrasound-guided pain interventions, and to illustrate those interventions with peripheral, axial and musculoskeletal pain procedures. RECENT FINDINGS With the capability of locating the interfascial plane, ultrasonography has led to the emergence of a series of plane blocks for the thoracoabdominal region in the recent decade.Ultrasonography for musculoskeletal procedures has been of growing interest because of the major advantage of direct visualization and scanning of various soft tissues and real-time spread in the injectate, thereby enhancing precision and efficacy, reducing risk of trauma and avoidance of radiation. For spine and intra-articular structures, ultrasonography is complicated by the bony shadow artefact and often deep location of the structure, making acquisition of ultrasound image challenging. Despite these difficulties, there is growing interest in applying ultrasonography for cervical spine and sacroiliac joint procedures. SUMMARY Pain intervention under ultrasound guidance is particularly valuable in peripheral and musculoskeletal procedures. There is growing interest of its application in cervical spine and sacroiliac joint. More outcome studies are required in the future to make ultrasound-guided pain intervention as the established procedure.
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Nair A, Amula VE, Naik V, Kodisharapu PK, Poornachand A, Shyam Prasad MS, Saifuddin MS, Rayani BK. Comparison of Postoperative Analgesia in Patients Undergoing Ileostomy Closure with and Without Dual Transversus Abdominis Plane (TAP) Block: A Randomized Controlled Trial. Rambam Maimonides Med J 2019; 10:RMMJ.10356. [PMID: 30304665 PMCID: PMC6363374 DOI: 10.5041/rmmj.10356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND AIMS Multimodal analgesia comprising opioid, paracetamol, and non-steroidal anti-inflammatory drugs is used for managing postoperative surgical pain after ileostomy closure (IC). We investigated the efficacy of unilateral dual transversus abdominis plane (TAP) block to reduce morphine consumption in the first 24 hours along with a reduction in visual analogue score for pain and in postoperative nausea/vomiting. METHODS This was a single-center, investigator-initiated, prospective, parallel-group, placebo-controlled randomized study involving patients undergoing IC under general anesthesia. We recruited 55 patients in two groups: 28 in a TAP group and 27 in a placebo group. The TAP group patients received 30 mL of 0.375% bupivacaine: 15 mL by a posterior TAP approach and 15 mL by a subcostal approach using ultrasonography. Patients in the placebo group received 30 mL normal saline (placebo) using the same approaches. Blocks were administered at the end of surgery before extubation. To monitor for the primary outcome-24-hour morphine consumption for both groups-patients were transferred to a high-dependency unit. The secondary outcome was to compare postoperative nausea/vomiting in both groups. RESULTS The demographic data, gender distribution, ASA physical status, duration of surgery, and time of first morphine dose was comparable in both groups. The 24-hour morphine consumption was 3.29±2.78 mg and 9.23±2.94 mg for the TAP and placebo groups, respectively, which was statistically significant (P=0.001). CONCLUSION Dual TAP block reduces opioid consumption in the first 24 hours after an IC and can facilitate early recovery with less adverse effects seen than with opioids and NSAIDs.
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Affiliation(s)
- Abhijit Nair
- To whom correspondence should be addressed. E-mail:
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Vadhanan P, Hussain M, Prakash R. The subcostal nerve as the target for nerve stimulator guided transverse abdominis plane blocks - A feasibility study. Indian J Anaesth 2019; 63:265-269. [PMID: 31000889 PMCID: PMC6460979 DOI: 10.4103/ija.ija_782_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: Transverse Abdominis Plane (TAP) block was originally described as a landmark-based technique. Peripheral nerve stimulator (PNS) guided blocks are still widely performed, where ultrasound is unavailable. Methods: Cadaveric dissections were performed which showed the subcostal nerve following a predictable course at the lateral abdominal wall in the TAP. The subcostal nerve was identified by ultrasound in three volunteers. Stimulation of the subcostal nerve was performed using PNS and landmarks as guidance in and 20 patients. Twitches of the anterior abdominal wall muscles were elicited, and needle position and drug dispersion were confirmed using ultrasound. Results: Out of 32 attempts made, the drug dispersion was appropriate in 24, not appropriate on four insertions and twitches were not elicited in 4 attempts. Conclusion: Nerve stimulator can be used as a guidance for TAP blocks where the availability of ultrasound is limited.
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Affiliation(s)
- Prasanna Vadhanan
- Department of Anaesthesiology, Vinayaka Missions Medical College, Karaikal, Puducherry, India
| | - Mohammed Hussain
- Department of Anaesthesiology, Vinayaka Missions Medical College, Karaikal, Puducherry, India
| | - Revathy Prakash
- Department of Anaesthesiology, Vinayaka Missions Medical College, Karaikal, Puducherry, India
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Aditianingsih D, Mochtar CA, Chandra S, Sukmono RB, Soamole IW. Comparison of Three-Quadrant Transversus Abdominis Plane Block and Continuous Epidural Block for Postoperative Analgesia After Transperitoneal Laparoscopic Nephrectomy. Anesth Pain Med 2018; 8:e80024. [PMID: 30533391 PMCID: PMC6240789 DOI: 10.5812/aapm.80024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/20/2018] [Accepted: 08/24/2018] [Indexed: 12/18/2022] Open
Abstract
Background Postoperative pain management is important for the early recovery of the living donor patient. Patient-controlled opioid analgesia, epidural analgesia, or a combination of both is the preferred pain management after abdominal surgery although these approaches have serious side effects. The transversus abdominis plane (TAP) block has been increasingly used for postoperative pain management and the addition of dexamethasone to local anesthetic can prolong the duration of action. Objectives This study evaluated the efficacy of ultrasound-guided three-quadrant TAP block analgesia with the addition of dexamethasone, compared to the continuous epidural analgesia in postoperative cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic living donor nephrectomy. Methods A prospective randomized control study was conducted on 50 patients with ASA I-II, 18 - 65 years old, BMI 18 - 30, and undergoing transperitoneal laparoscopic donor nephrectomy under general anesthesia. The patients were randomly assigned into either a three-quadrant TAP block group (n = 25) with 20 mL of 0.25% bupivacaine plus dexamethasone 8 mg or a continuous epidural group (n = 25) using 0.125% bupivacaine postoperatively. The morphine consumption and the numerical rating scale (NRS) at rest and movement were evaluated at 2, 6, 12, and 24 hours postoperatively. The postoperative first-time mobilization and duration of urinary catheter usage were recorded. Results Patients demographic characteristics were similar in the two groups. During 24 hours after the surgery, cumulative morphine consumption (P = 0.232), the NRS at rest and movement (P > 0.05), and the first-time mobilization (P = 0.075) were not significantly different between the groups, except that the NRS during movement at 12 hours was significantly lower in the TAP block group (P = 0.004). The duration of urinary catheterization was significantly longer as a side effect in the continuous epidural group (P < 0.001). Conclusions The three-quadrant TAP block with the addition of dexamethasone showed comparable analgesic effects as the continuous epidural analgesia in cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic donor nephrectomy.
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Affiliation(s)
- Dita Aditianingsih
- Department of Anesthesiology and Intensive Care, Universitas Indonesia, Jakarta, Indonesia
- Corresponding Author: Department of Anesthesiology and Intensive Care, Universitas Indonesia, Jakarta, Indonesia. Tel: +62-62213143736,
| | | | - Susilo Chandra
- Department of Anesthesiology and Intensive Care, Universitas Indonesia, Jakarta, Indonesia
| | - Raden Besthadi Sukmono
- Department of Anesthesiology and Intensive Care, Universitas Indonesia, Jakarta, Indonesia
| | - Ilham Wahyudi Soamole
- Department of Anesthesiology and Intensive Care, Universitas Indonesia, Jakarta, Indonesia
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Peng W, Huang S, Zhou S, Yang N, Zuo M. Case report: life-threatening coronary artery spasm under transversus abdominis plane block in combination with general anesthesia. BMC Anesthesiol 2018; 18:148. [PMID: 30342470 PMCID: PMC6195710 DOI: 10.1186/s12871-018-0616-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/10/2018] [Indexed: 12/02/2022] Open
Abstract
Background Many cases of coronary artery spasm (CAS) during general plus epidural anesthesia have been reported. But transversus abdominis plane(TAP) block in combination with general anesthesia has not been reported to be a cause of CAS, let alone a life-threatening CAS. Case presentation In this case report, we present a case of a patient with CAS accompanied by ventricular fibrillation under general anesthesia with TAP block. Conclusion Coronary artery spasm, even life-threatening CAS, may occur during TAP block in combination with general anesthesia.
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Affiliation(s)
- Wenping Peng
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, China, No.1 DaHua Road, DongDan, Beijing, 100730, China.
| | - Shun Huang
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, China, No.1 DaHua Road, DongDan, Beijing, 100730, China
| | - Shuzhen Zhou
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, China, No.1 DaHua Road, DongDan, Beijing, 100730, China
| | - Ning Yang
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, China, No.1 DaHua Road, DongDan, Beijing, 100730, China
| | - Mingzhang Zuo
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, China, No.1 DaHua Road, DongDan, Beijing, 100730, China
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Modified half-the-air technique for continuous pressure monitoring during lumbar plexus block. Eur J Anaesthesiol 2018; 35:803-805. [PMID: 30192264 DOI: 10.1097/eja.0000000000000831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koh WU, Lee JH. Ultrasound-guided truncal blocks for perioperative analgesia. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.2.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Won Uk Koh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Hyuk Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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