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Sobhani K, Hocevar M, Hanchuk S, Press B, He Z, Lin HM, Li J. Fascial Plane Blocks With Glucocorticoids or Liposomal Bupivacaine Versus Local Infiltration for Laparoscopic Non-donor Nephrectomy: A Propensity Score-Weighted Study. Cureus 2024; 16:e66005. [PMID: 39221354 PMCID: PMC11366221 DOI: 10.7759/cureus.66005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
Study objective The purpose of this study is to investigate the analgesic efficacy of ultrasound-guided fascial plane blocks (FPBs) versus local infiltration in patients undergoing laparoscopic non-donor nephrectomy. This study specifically compares the efficacy of FPBs with liposomal bupivacaine (LB) versus FPBs with dexamethasone sodium phosphate (DXP) and methylprednisolone acetate (MPA) versus surgical site local anesthetic infiltration without FPBs. Design This is a retrospective cohort study conducted over a five-year period (January 2018-December 2022). Setting The study was conducted in a tertiary care, academic, multi-hospital healthcare system. Participants Patients who underwent elective radical or partial laparoscopic non-donor nephrectomy were included in the study. Intervention Patients either received preoperative FPBs without intraoperative surgical site local anesthetic infiltration or received surgical site local anesthetic infiltration without FPBs (n = 141) at participating hospitals. Measurements The primary endpoint of this study was postoperative opioid use, measured as oral milligram morphine equivalents (MME). Secondary endpoints included postoperative pain scores, length of hospital stays, and significant adverse events within 30 days. The impact of medications utilized in FPBs was determined by univariate and multivariable analyses with covariates balancing propensity score weighting. Main results Patients undergoing non-donor laparoscopic radical or partial nephrectomy who received FPBs with bupivacaine or ropivacaine plus glucocorticoids DXP and MPA were more likely to be opioid-free 24-48 hours postoperatively compared to those who received FPBs with LB or surgical site local anesthetic infiltration without FPBs (40.5% vs. 30% vs. 13.9%, respectively; p = 0.017). Patients who received FPBs with glucocorticoids also reported the lowest pain scores at rest and with activity 0-12 hours postoperatively as compared to patients who received LB or local infiltration (p = 0.006 and p = 0.014, respectively). Additionally, patients who received FPBs with glucocorticoids received over 30% fewer opioids during the first 48 hours postoperatively compared to patients who received surgical site local anesthetic infiltration alone (30 MME vs. 44 MME, respectively). However, there was no significant difference in total opioid use during the first 48 hours postoperatively between patients who received FPBs with bupivacaine plus glucocorticoids and those who received FPBs with bupivacaine plus LB (mean ratio: 0.91, (95% CI: 0.05 ~ 15.97); p = 0.948). There was also no difference in the length of hospital stays or rate of adverse events between the groups. Conclusion Perioperative FPBs for non-donor laparoscopic nephrectomy using glucocorticoids as an adjuvant to long-acting local anesthetics may decrease postoperative opioid use and reduce pain scores as compared to FPBs with LB or surgical site local anesthetic infiltration. Bupivacaine or ropivacaine combined with DXP and MPA is a safe and effective alternative to LB for FPBs in laparoscopic nephrectomy.
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Affiliation(s)
| | - Mark Hocevar
- Anesthesiology, Yale School of Medicine, New Haven, USA
| | | | | | - Zili He
- Yale Center for Analytical Sciences (YCAS), Yale School of Medicine, New Haven, USA
| | - Hung-Mo Lin
- Anesthesiology, Yale School of Medicine, New Haven, USA
| | - Jinlei Li
- Anesthesiology, Yale School of Medicine, New Haven, USA
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Nag DS, Gehlot P, Sharma P, Kumar H, Kumar Singh U. Comparative Study of Ropivacaine and Ropivacaine With Dexmedetomidine in Transversus Abdominis Plane (TAP) Block for Post-operative Analgesia in Patients Undergoing Cesarean Sections. Cureus 2024; 16:e65588. [PMID: 39192898 PMCID: PMC11349148 DOI: 10.7759/cureus.65588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2024] [Indexed: 08/29/2024] Open
Abstract
Background Adequate post-operative analgesia in the obstetric patient is necessary to facilitate breastfeeding and the care of the newborn. Considering the limitations of intravenous analgesic options such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, other alternatives have been tried for offering better analgesia with fewer potential side effects. Transversus abdominis plane (TAP) block is one such option that has been tried with various local anesthetic drugs, either alone or in combination with other adjuvants. The addition of dexmedetomidine to bupivacaine in TAP block has been shown to prolong the duration of post-operative analgesia when compared to local anesthetic alone. This study was conducted to determine the efficacy of dexmedetomidine, as an adjuvant to ropivacaine, when administered in TAP block in patients undergoing cesarean section. Methodology The study was a prospective, randomized, parallel assignment, triple-blinded controlled trial. Hundred patients posted for elective lower segment cesarean section, fulfilling the inclusion criteria, were randomly divided into two equal groups, group R and group RD, comprising 50 patients each. Patients in group R were administered bilateral TAP block by landmark technique using ropivacaine alone, whereas patients in group RD were administered TAP block with dexmedetomidine 1 micrograms/kg, in addition to a similar dose of ropivacaine. Mean arterial pressure (MAP), heart rate (HR), visual analog scale (VAS)-R (pain score on VAS scale at rest), VAS-C (pain score on VAS scale on coughing), nausea and vomiting, and Ramsay sedation score were recorded on admission to post-operative care unit (PACU), and at first, fourth, eighth, 12th, 18th, and 24th hours post-operatively. Rescue analgesia was provided with intravenous morphine. Short Assessment of Patient Satisfaction Score (SAPS) was noted on a five-point scale after 24 hours based on patient satisfaction regarding the quality of post-operative analgesia. Results While there was no significant difference between groups R and RD with respect to VAS-C and VAS-R immediately after shifting and at the first, fourth, and eighth hours, a significant difference was observed at the 12th and 18th hours post-operatively. After 24 hours, no significant difference was observed between groups R and RD with respect to VAS-C and VAS-R. While 50% of patients needed rescue analgesia in group R, only 28% of patients needed rescue analgesia in group RD. There was significantly better patient satisfaction measured by the Short Assessment of Patient Satisfaction Score (SAPS) with respect to the quality of analgesia in patients in group RD as compared to those in group R. Conclusions The addition of dexmedetomidine to ropivacaine increased the duration of post-operative analgesia up to 18 hours post-operatively in cases of elective lower segment cesarean section. Also, the quality of post-operative analgesia is better in such patients, as shown by a significant difference in patient satisfaction scores between the two groups.
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Affiliation(s)
| | - Priti Gehlot
- Anesthesiology, Steel City Clinic and Research Center, Jamshedpur, IND
| | - Prashant Sharma
- Anesthesiology, Tata Main Hospital, Jamshedpur, IND
- Anesthesiology, Manipal Tata Medical College, Jamshedpur, IND
| | - Himanshu Kumar
- Anesthesiology, Tata Main Hospital, Jamshedpur, IND
- Anesthesiology, Manipal Tata Medical College, Jamshedpur, IND
| | - Umesh Kumar Singh
- Anesthesiology, Tata Main Hospital, Jamshedpur, IND
- Anesthesiology, Manipal Tata Medical College, Jamshedpur, IND
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Slopnick E. Response to Letter to the Editor re: "Pudendal Nerve Block Analgesia at the Time of Vaginal Surgery: A Randomized, Double-Blinded, Sham-Controlled Trial". UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:401-402. [PMID: 38564626 DOI: 10.1097/spv.0000000000001486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Emily Slopnick
- Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH
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Torosis M, Fullerton M, Kaefer D, Nitti V, Ackerman AL, Grisales T. Pudendal Nerve Block Analgesia at the Time of Vaginal Surgery: A Randomized, Double-Blinded, Sham-Controlled Trial. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:827-835. [PMID: 37093572 PMCID: PMC10919352 DOI: 10.1097/spv.0000000000001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
IMPORTANCE Effective opioid-sparing postoperative analgesia requires a multimodal approach. Regional nerve blocks augment pain control in many surgical fields and may be applied to pelvic floor reconstruction. OBJECTIVE This study aimed to evaluate the impact of pudendal nerve block on postoperative pain control and opioid consumption after vaginal surgery. STUDY DESIGN In this randomized, double-blind, sham-controlled trial, we enrolled women undergoing pelvic reconstruction, excluding patients with chronic pelvic pain or contraindications to nonnarcotic analgesia. Patients were randomized to transvaginal pudendal nerve block (9 mL 0.25% bupivacaine and 1 mL 40 mg/mL triamcinolone) or sham injection (10 mL normal saline). Primary outcomes were pain scores and opioid requirements. Sixty patients were required to show a 20-mm difference on a 100-mm visual analog scale (VAS). RESULTS We randomized 71 patients: 36 pudendal block and 35 sham. Groups were well matched in baseline characteristics and surgery type. Prolapse repairs were most common (n = 63 [87.5%]), and there was no difference in anesthetic dose or operative time. Pain scores were equivalent in the postanesthesia care unit (mean VAS, 53.1 [block] vs 56.4 [sham]; P = 0.517) and on postoperative day 4 (mean VAS, 26.7 [block] vs 35.5 [sham]; P = 0.131). On postoperative day 1, the intervention group reported less pain, but this did not meet our 20 mm goal for clinical significance (mean VAS, 29.2 vs 42.5; P = 0.047). A pudendal block was associated with lower opioid consumption at all time points, but this was not statistically significant. CONCLUSIONS Surgeon-administered pudendal nerve block at the time of vaginal surgery may not significantly improve postoperative pain control or decrease opioid use.
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Affiliation(s)
- Michele Torosis
- Department of Obstetrics and Gynecology, UCLA, Los Angeles, CA
| | - Morgan Fullerton
- Department of Obstetrics and Gynecology, Kaiser Permanente, Panorama City, CA
| | | | | | | | - Tamara Grisales
- Department of Obstetrics and Gynecology, UCLA, Los Angeles, CA
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Gedda C, Nygren J, Garpenbeck A, Hoffström L, Thorell A, Soop M. Multimodal Analgesia Bundle and Postoperative Opioid Use Among Patients Undergoing Colorectal Surgery. JAMA Netw Open 2023; 6:e2332408. [PMID: 37672272 PMCID: PMC10483316 DOI: 10.1001/jamanetworkopen.2023.32408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/30/2023] [Indexed: 09/07/2023] Open
Abstract
Importance A key objective in contemporary surgery is to reduce or eliminate the usage of opioids to minimize gastrointestinal adverse effects, fatigue, and long-term opioid dependency. Objectives To evaluate the association of the implementation of a care bundle of 3 opioid-sparing interventions with the amount of opioids consumed postoperatively among patients undergoing major abdominal surgery and to examine the respective associations of the 3 components. Design, Setting, and Participants This retrospective cohort study was performed at Ersta Hospital, an elective teaching hospital in Stockholm, Sweden. All patients undergoing major colorectal surgery between January 1, 2016, through December 31, 2019, were included. Data analysis was conducted from February 1, 2020, to May 30, 2022. Exposures A care bundle consisting of an individualized opioid regimen, regular gabapentinoids, and clonidine as a rescue analgesic was gradually introduced early in the study period. Main Outcomes and Measures Amount of in-hospital administered intravenous and oral opioids on the day of surgery and the first 5 postoperative days (morphine milligram equivalents [MME]). The association between exposure and outcome was examined using multivariable linear regression. Results Overall, 842 patients had major colorectal surgery in the study period (mean [SD] age, 64.6 [15.5] years; 421 [50%] men). Median (range) opioid usage decreased from 75 (0-796) MME in 2016 to 22 (0-362) MME in 2019 (P < .001), and the proportion of patients receiving 45 MME or less increased from 35% to 66% (P < .001). On multivariable analysis (F5, 836 = 57.5; P < .001), an individualized opioid strategy (β = -11.6; SE = 3.8; P = .003), the use of gabapentin (β = -39.1; SE = 4.5; P < .001), and increasing age (β = -1.0; SE = 0.11; P < .001) were associated with less opioid consumption, while the use of clonidine was associated with more opioid intake (β = 11.6; SE = 3.6; P = .001). Conclusions and Relevance In this cohort study of 842 patients undergoing colorectal surgery, a care bundle consisting of an individualized opioid regimen, regular gabapentin, and clonidine as a rescue analgesic was found to be associated with a significant decrease in opioids consumed postoperatively. Regular gabapentin and an individualized opioid regimen were particularly strongly associated with this decrease and should be further evaluated as components of multimodal, opioid-free postoperative analgesia.
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Affiliation(s)
- Claes Gedda
- Department of Surgery and Anesthesiology, Ersta Hospital, Stockholm, Sweden
- Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Jonas Nygren
- Department of Surgery and Anesthesiology, Ersta Hospital, Stockholm, Sweden
- Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Anna Garpenbeck
- Department of Surgery and Anesthesiology, Ersta Hospital, Stockholm, Sweden
| | - Linda Hoffström
- Department of Surgery and Anesthesiology, Ersta Hospital, Stockholm, Sweden
| | - Anders Thorell
- Department of Surgery and Anesthesiology, Ersta Hospital, Stockholm, Sweden
- Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Mattias Soop
- Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
- Department of Inflammatory Bowel Disease and Intestinal Failure Surgery, Karolinska University Hospital, Stockholm, Sweden
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La Regina D, Popeskou SG, Saporito A, Gaffuri P, Tasciotti E, Dossi R, Christoforidis D, Mongelli F. Laparoscopic versus ultrasound-guided transversus abdominis plane block in colorectal surgery: a non-inferiority, multicentric randomized double-blinded clinical trial. Colorectal Dis 2023; 25:1921-1928. [PMID: 37525414 DOI: 10.1111/codi.16689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/03/2023] [Accepted: 04/25/2023] [Indexed: 08/02/2023]
Abstract
AIM The aim of this study was to assess if laparoscopic-assisted transversus abdominis plane (TAP) block (L-TAPB) is as efficient as ultrasound-guided TAP block (U-TAPB) in postoperative pain control. METHOD In all, 112 patients scheduled for elective laparoscopic colon resection from February 2018 to December 2021 at two Swiss hospitals were included and randomized in a 1:1 ratio before surgery with either L-TAPB or U-TAPB. The primary end-point was the non-inferiority of the L-TAPB compared to U-TAPB with regard to the total opioid consumption within the first 24 h after surgery. Data regarding patients' characteristics, opioid consumption, pain on the visual analogue scale, operative and anaesthesia induction time, complications and length of stay were collected and analysed. RESULTS Fifty-five patients were allocated to the L-TAPB and fifty-seven to the U-TAPB. No significant difference was found in the overall dose of opioids within 24 h, and the non-inferiority of the L-TAPB was confirmed. There were almost twice as many patients in the L-TAPB group requesting opioid reserves compared to the U-TAPB group (54.5% vs. 29.8%, P = 0.008). The anaesthesia induction time was significantly longer in the U-TAPB group (17 ± 11 min vs. 23 ± 12 min, P = 0.014). For all other variables (pain on the visual analogue scale, opioid consumption, need of epidural analgesia, operating time, postoperative complications and hospital stay) no statistically significant difference between the L-TAPB and the U-TAPB groups was noted. CONCLUSION Our results showed the non-inferiority of the laparoscopic delivery compared to ultrasound-guided administration of the TAP block, with the advantage of not affecting anaesthesia times. STUDY REGISTRATION NUMBER 2017-02017 CE 3294, ClinicalTrials.gov identifier NCT04575233.
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Affiliation(s)
- Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Sotirios Georgios Popeskou
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Surgery, Lugano Regional Hospital, EOC, Lugano, Switzerland
| | - Andrea Saporito
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Paolo Gaffuri
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Edoardo Tasciotti
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Roberto Dossi
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Dimitri Christoforidis
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Surgery, Lugano Regional Hospital, EOC, Lugano, Switzerland
- Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Singh J, Saini S, Bhau S, Gupta A. Evaluation of the Analgesic Efficacy of Surgically Assisted Linea Semilunaris Block for Post-operative Analgesia in Patients Undergoing Caesarean Section Under Spinal Anaesthesia. Cureus 2023; 15:e43900. [PMID: 37746438 PMCID: PMC10512102 DOI: 10.7759/cureus.43900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Post-operative pain following a caesarean section has been described as moderate to severe. If left untreated, the pain has a negative impact on maternal recovery and psychology. Surgically assisted linea semilunaris anterior abdominal block has been proposed to be an efficacious analgesic modality in such cases. AIM The study aims to evaluate the efficacy of post-operative analgesia provided by linea semilunaris block in patients undergoing caesarean section under spinal anaesthesia. METHODS Eighty parturients planned for elective caesarean section under spinal anaesthesia were randomised into two groups. In group B, a surgically assisted Linea semilunaris anterior abdominal block was given bilaterally after the closure of the uterine incision using 20 mL of 0.375% ropivacaine with 1:200,000 adrenaline. For group C, conventional analgesia protocols were followed in the post-op period. Inj. paracetamol 1 g i.v. was routinely administered, and inj. tramadol 50 mg i.v. was given as a rescue analgesic in both groups. The primary outcome of the present study was the total amount of rescue analgesia consumed over 24 hours. Secondary outcomes included resting and dynamic pain scores [Numerical Rating Scale (NRS)], time to first rescue analgesia, quality of sleep, and patient satisfaction using the Likert scale. RESULTS The mean total amount of rescue analgesia consumed over 24 hours was significantly higher in group C (150.00 ± 0.00) than in group B (125.75 ± 25.32); p = 0.001. The mean NRS at 2, 4, 12, and 24 hours was significantly higher in group B than in group C. The time to first rescue analgesia was longer in group B, with better sleep quality, patient satisfaction, and fewer complications. CONCLUSION The linea semilunaris block provided effective analgesia and can be considered an alternative analgesic modality to other conventional abdominal wall blocks for post-caesarean pain relief.
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Affiliation(s)
- Jitendra Singh
- Department of Anaesthesiology and Critical Care, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, IND
| | - Suman Saini
- Department of Anaesthesiology and Critical Care, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, IND
| | - Swati Bhau
- Department of Anaesthesiology and Critical Care, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, IND
| | - Anju Gupta
- Department of Anaesthesiology, Pain Medicine, and Critical Care, AIl India Institute of Medical Sciences, New Delhi, IND
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Moon AS, Andikyan V, Agarwal R, Stroever S, Misita D, Laibangyang A, Doo D, Chuang LT. Incisional infiltration versus transversus abdominis plane block of liposomal bupivacaine after midline vertical laparotomy for suspected gynecologic malignancy: a pilot study. Gynecol Oncol Rep 2023; 47:101203. [PMID: 37251783 PMCID: PMC10220396 DOI: 10.1016/j.gore.2023.101203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023] Open
Abstract
Background To evaluate whether incisional infiltration of liposomal bupivacaine would decrease opioid requirement and pain scores after midline vertical laparotomy for suspected or known gynecologic malignancy compared with transversus abdominis plane (TAP) block with liposomal bupivacaine. Methods A prospective, single blind randomized controlled trial compared incisional infiltration of liposomal bupivacaine plus 0.5% bupivacaine versus TAP block with liposomal bupivacaine plus 0.5% bupivacaine. In the incisional infiltration group, patients received 266 mg free base liposomal bupivacaine with 150 mg bupivacaine hydrochloride. In the TAP block group, 266 mg free base bupivacaine with 150 mg bupivacaine hydrochloride was administered bilaterally. The primary outcome was total opioid use during the first 48-hour postoperative period. Secondary outcomes included pain scores at rest and with exertion at 2, 6, 12, 24 and 48 h after surgery. Results Forty three patients were evaluated. After interim analysis, a three-fold higher sample size than originally calculated was required to detect a statistically significant difference. There was no clinical difference between the two arms in mean opioid requirement (morphine milligram equivalents) for the first 48 h after surgery (59.9 vs. 80.8, p = 0.13). There were no differences in pain scores at rest or with exertion between the two groups at pre-specified time intervals. Conclusion In this pilot study, incisional infiltration of liposomal bupivacaine and TAP block with liposomal bupivacaine demonstrated clinically similar opioid requirement after gynecologic laparotomy for suspected or known gynecologic cancer. Given the underpowered study, these findings cannot support the superiority of either modality after open gynecologic surgery.
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Affiliation(s)
- Ashley S. Moon
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - Vaagn Andikyan
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - Rakhee Agarwal
- Department of Research and Innovation, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - Stephanie Stroever
- Department of Research and Innovation, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - David Misita
- Department of Anesthesiology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - Anya Laibangyang
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - David Doo
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - Linus T. Chuang
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Danbury/Norwalk Hospitals, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, United States
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Zwolinski NM, Patel KS, Vadivelu N, Kodumudi G, Kaye AD. ERAS Protocol Options for Perioperative Pain Management of Substance Use Disorder in the Ambulatory Surgical Setting. Curr Pain Headache Rep 2023; 27:65-79. [PMID: 37079258 PMCID: PMC10116112 DOI: 10.1007/s11916-023-01108-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
Even prior to the COVID-19 pandemic, rates of ambulatory surgeries and ambulatory patients presenting with substance use disorder were increasing, and the end of lockdown has further catalyzed the increasing rates of ambulatory patients presenting for surgery with substance use disorder (SUD). Certain subspecialty groups of ambulatory procedures have already established protocols to optimize early recovery after surgery (ERAS), and these groups have subsequently enjoyed improved efficiency and reduced adverse outcomes as a result. In this present investigation, we review the literature as it relates to substance use disorder patients, with a particular focus on pharmacokinetic and pharmacodynamic profiles, and their resulting impact on the acute- or chronic user ambulatory patient. The systematic literature review findings are organized and summarized. We conclude by identifying areas of opportunity for further study, specifically with the aim of developing a dedicated ERAS protocol for substance use disorder patients in the ambulatory surgery setting. - Healthcare in the USA has seen an increase in rates of both substance use disorder patients and separately in ambulatory surgery cases. - Specific perioperative protocols to optimize outcomes for patients who suffer from substance use disorder have been described in recent years. - Agents of interest like opioids, cannabis, and amphetamines are the top three most abused substances in North America. - A protocol and recommend further work should be done to integrate with concrete clinical data, in which strategies should be employed to confer benefits to patient outcomes and hospital quality metrics like those enjoyed by ERAS protocol in other settings.
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Affiliation(s)
- Nicholas M Zwolinski
- Department of Anesthesiology, Yale University School of Medicine, 333, Cedar Street, New Haven, CT, 06520, USA
| | - Kaiwal S Patel
- Department of Anesthesiology, Yale University School of Medicine, 333, Cedar Street, New Haven, CT, 06520, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, 333, Cedar Street, New Haven, CT, 06520, USA
| | - Gopal Kodumudi
- Department of Anesthesiology, LSU School of Medicine, 1542 Tulane Avenue Room 659, New Orleans, LA, 70112, USA
| | - Alan David Kaye
- Department of Anesthesiology, LSU School of Medicine, 1542 Tulane Avenue Room 659, New Orleans, LA, 70112, USA.
- Department of Anesthesiology, Louisiana State University Health Sciences Center, 1501 Kings Hwy, Shreveport, LA, 71103, USA.
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Tsai HI, Lu YC, Zheng CW, Yu MC, Chou AH, Lee CH, Kou HW, Lin JR, Lai YH, Chang LL, Lee CW. A Retrospective Comparison of Three Patient-Controlled Analgesic Strategies: Intravenous Opioid Analgesia Plus Abdominal Wall Nerve Blocks versus Epidural Analgesia versus Intravenous Opioid Analgesia Alone in Open Liver Surgery. Biomedicines 2022; 10:2411. [PMID: 36289673 PMCID: PMC9598303 DOI: 10.3390/biomedicines10102411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Adequate pain control is of crucial importance to patient recovery and satisfaction following abdominal surgeries. The optimal analgesia regimen remains controversial in liver resections. Methods: Three groups of patients undergoing open hepatectomies were retrospectively analyzed, reviewing intravenous patient-controlled analgesia (IV-PCA) versus IV-PCA in addition to bilateral rectus sheath and subcostal transversus abdominis plane nerve blocks (IV-PCA + NBs) versus patient-controlled thoracic epidural analgesia (TEA). Patient-reported pain scores and clinical data were extracted and correlated with the method of analgesia. Outcomes included total morphine consumption and numerical rating scale (NRS) at rest and on movement over the first three postoperative days, time to remove the nasogastric tube and urinary catheter, time to commence on fluid and soft diet, and length of hospital stay. Results: The TEA group required less morphine over the first three postoperative days than IV-PCA and IV-PCA + NBs groups (9.21 ± 4.91 mg, 83.53 ± 49.51 mg, and 64.17 ± 31.96 mg, respectively, p < 0.001). Even though no statistical difference was demonstrated in NRS scores on the first three postoperative days at rest and on movement, the IV-PCA group showed delayed removal of urinary catheter (removal on postoperative day 4.93 ± 5.08, 3.87 ± 1.31, and 3.70 ± 1.30, respectively) and prolonged length of hospital stay (discharged on postoperative day 12.71 ± 7.26, 11.79 ± 5.71, and 10.02 ± 4.52, respectively) as compared to IV-PCA + NBs and TEA groups. Conclusions: For postoperative pain management, it is expected that the TEA group required the least amount of opioid; however, IV-PCA + NBs and TEA demonstrated comparable postoperative outcomes, namely, the time to remove nasogastric tube/urinary catheter, to start the diet, and the length of hospital stay. IV-PCA with NBs could thus be a reliable analgesic modality for patients undergoing open liver resections.
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Affiliation(s)
- Hsin-I Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Chieh Lu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Chih-Wen Zheng
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ming-Chin Yu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), Tu-Cheng, New Taipei City 236, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Cheng-Han Lee
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Hao-Wei Kou
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Hua Lai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Li-Ling Chang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Chao-Wei Lee
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
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11
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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] [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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12
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Pai Bh P, Jinadu S. Anesthesiologist Provided Regional Nerve Block Against Surgeon Provided Infiltration Block for Abdominal Surgery: Case Series. Cureus 2021; 13:e19606. [PMID: 34926075 PMCID: PMC8674117 DOI: 10.7759/cureus.19606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
We present two patients who underwent double mastectomy and breast reconstruction with deep inferior epigastric artery perforator (DIEP) flap. The goal of this case series was to compare surgeon-provided infiltration block against anesthesiologist-provided regional nerve block, focusing on abdominal analgesia. This case report highlights that pain control for a patient could be successful when done collaboratively. To achieve this, it is important for both the surgical and anesthesia team to discuss the best analgesic plan for the patient while taking into consideration the confidence, experience, and technique that both the surgical and anesthesiology team can offer.
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Affiliation(s)
- Poonam Pai Bh
- Anesthesiology, Mount Sinai Hospital, New York City, USA
| | - Samiat Jinadu
- Anesthesiology, Oregon Health & Science University, Portland, USA
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13
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Daghmouri MA, Chaouch MA, Oueslati M, Rebai L, Oweira H. Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review. Ann Med Surg (Lond) 2021; 72:103124. [PMID: 34925820 PMCID: PMC8648937 DOI: 10.1016/j.amsu.2021.103124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Pain management is an integral part of Enhanced Recovery After Surgery (ERAS) following laparoscopic colonic resection. A variety of regional and neuraxial techniques were proposed, but their efficacy is still controversial. This systematic review evaluates published evidence on analgesic techniques and their impact on postoperative analgesia and recovery for laparoscopic colonic surgery patients. Methods We conducted bibliographic research on May 10, 2021, through PubMed, Cochrane database, and Google scholar. We retained meta-analysis and randomized clinical trials. We graded the strength of clinical data and subsequent recommendations according to the Oxford Centre for Evidence-Based Medicine. Results Twelve studies were included. Thoracic epidural analgesia improved postoperative analgesia and bowel function following laparoscopic colectomy. However, it lengthens the hospital stay. Transversus abdominis plane block was as effective as thoracic epidural analgesia concerning pain control but with better postoperative recovery and lower length of hospital stay. Moreover, Lidocaine intravenous infusion improved postoperative pain management and recovery; Quadratus lumborum block provided similar postoperative analgesia and recovery. Finally, wound infiltration reduced postoperative pain without improving recovery of bowel function, and it could be proposed as an alternative to thoracic epidural analgesia. Conclusions Several analgesic techniques have been investigated. We found that abdominal wall blocks were as effective as thoracic epidural analgesia for pain management but with lower hospital stay and better recovery. We registered this review on PROSPERO (ID: CRD42021279228). First systematic review assessing the efficacy of analgesic techniques following laparoscopic elective colonic resection. Only colonic resection was evaluated contrary to other studies, including rectal surgery. High-quality studies (randomized controlled trials and meta-analyses) were assessed.
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Affiliation(s)
| | - Mohamed Ali Chaouch
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, University of Monastir, Tunisia
| | - Maroua Oueslati
- Department of Anesthesia, Trauma Center of Ben Arrous, University of Manar, Tunisia
| | - Lotfi Rebai
- Department of Anesthesia, Trauma Center of Ben Arrous, University of Manar, Tunisia
| | - Hani Oweira
- Department of Surgery, Universitätsmedizin Mannheim, S, Heidelberg University, Mannheim, Germany
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14
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Aleman R, Blanco DG, Funes DR, Montorfano L, Semien G, Szomstein S, Lo Menzo E, Rosenthal RJ. Does Transverse Abdominis Plane Block Increase the Risk of Postoperative Urinary Retention after Inguinal Hernia Repair? JSLS 2021; 25:JSLS.2021.00015. [PMID: 34803366 PMCID: PMC8580164 DOI: 10.4293/jsls.2021.00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objective: Postoperative urinary retention (POUR) is a common adverse event after inguinal hernia repair (IHR), with an incidence of up to 22.2%. The aim of this study is to determine if pre-operative transverse abdominis plane (TAP) block increases the incidence of POUR. Methods: A retrospective review was performed for all patients who underwent IHR (open or laparoscopic) at this institution, from January 1, 2016 to December 31, 2017. Patients were divided into two groups: Patients that had a TAP block before surgery (group 1) and patients with no TAP block (group 2). Common demographics and comorbidities were collected along with postoperative outcomes and POUR incidence rates for every group to determine procedural influence. Results: From 276 patients reviewed, 28.2% (N = 78) underwent TAP block before surgery. The patient cohort mean age was 61.1 ± 14.4 years. Most the interventions were laparoscopic (81.2%) and an overall POUR incidence rate of 7.6% (N = 21) was observed. Comparatively, common demographics and comorbidities were statistically similar for both groups, with the exception of type 2 diabetes mellitus (p = 0.049). Individually, group 1 and 2 presented POUR incidence rates of 14.1% and 5.05%, respectively. While intraoperative fluid administration, early readmission rate, and length were similar in both groups, there was a significant difference in POUR incidence rates (p = 0.01). Conclusion: Patients undergoing TAP block during IHR might have an increased risk of developing POUR. Further larger, prospective, and randomized controlled studies are necessary to better assess these findings.
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Affiliation(s)
- Rene Aleman
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - David Gutierrez Blanco
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - David Romero Funes
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - Lisandro Montorfano
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - George Semien
- Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL
| | - Samuel Szomstein
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - Emanuele Lo Menzo
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - Raul J Rosenthal
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
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15
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Wang W, Wang L, Gao Y. A Meta-Analysis of Randomized Controlled Trials Concerning the Efficacy of Transversus Abdominis Plane Block for Pain Control After Laparoscopic Cholecystectomy. Front Surg 2021; 8:700318. [PMID: 34422893 PMCID: PMC8371254 DOI: 10.3389/fsurg.2021.700318] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background and Purpose: Transverse abdominis plane (TAP) block has been suggested to reduce post-operative pain after laparoscopic cholecystectomy (LC). However, the literature is divided on whether ultrasound (USG)-guided TAP block is effective for pain control after LC. The present meta-analysis therefore evaluated the efficacy of USG-guided TAP block vs. controls and port site infiltration for pain control after LC. Methods: A comprehensive literature search of online academic databases was performed for published randomized controlled trials (RCTs) for studies published to January 31, 2021. The primary outcome analyzed was post-operative pain score at 0, 6, 12, and 24 h post-surgery, both during rest and while coughing. Secondary outcomes included morphine consumption and post-operative nausea and vomiting (PONV) incidence. Results: A total of 23 studies with data on 1,450 LC patients were included in our meta-analysis. A reduction in pain intensity at certain post-operative timepoints was observed for USG-guided TAP block patients compared to control group patients. No reduction in pain intensity was observed for patients receiving USG-guided TAP block patients vs. conventional Port site infiltration. Conclusion: This meta-analysis concludes that TAP block is more effective than a conventional pain control, but not significatively different from another local incisional pain control that is port site infiltration. Additional prospective randomized controlled trials are required to further validate our findings.
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Affiliation(s)
- Weihua Wang
- Department of Thoracic Surgery, Weifang Second People's Hospital, Weifang, China
| | - Lishan Wang
- Department of Oral and Maxillofacial Surgery, Weifang Second People's Hospital, Weifang, China
| | - Yan Gao
- Department of Thoracic Surgery, Weifang Second People's Hospital, Weifang, China
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16
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Kim DH, Kim SJ, Liu J, Beathe J, Memtsoudis SG. Fascial plane blocks: a narrative review of the literature. Reg Anesth Pain Med 2021; 46:600-617. [PMID: 34145072 DOI: 10.1136/rapm-2020-101909] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022]
Abstract
Fascial plane blocks (FPBs) are increasingly numerous and are often touted as effective solutions to many perioperative challenges facing anesthesiologists. As 'new' FPBs are being described, questions regarding their effectiveness remain unanswered as appropriate studies are lacking and publications are often limited to case discussions or technical reports. It is often unclear if newly named FPBs truly represent a novel intervention with new indications, or if these new publications describe mere ultrasound facilitated modifications of existing techniques. Here, we present broad concepts and potential mechanisms of FPB. In addition, we discuss major FPBs of (1) the extremities (2) the posterior torso and (3) the anterior torso. The characteristics, indications and a brief summary of the literature on these blocks is included. Finally, we provide an estimate of the overall level of evidence currently supporting individual approaches as FPBs continue to rapidly evolve.
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Affiliation(s)
- David H Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Sang Jo Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan Beathe
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
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17
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A Narrative Review on Perioperative Pain Management Strategies in Enhanced Recovery Pathways-The Past, Present and Future. J Clin Med 2021; 10:jcm10122568. [PMID: 34200695 PMCID: PMC8229260 DOI: 10.3390/jcm10122568] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 12/14/2022] Open
Abstract
Effective pain management is a key component in the continuum of perioperative care to ensure optimal outcomes for surgical patients. The overutilization of opioids in the past few decades for postoperative pain control has been a major contributor to the current opioid epidemic. Multimodal analgesia (MMA) and enhanced recovery after surgery (ERAS) pathways have been repeatedly shown to significantly improve postoperative outcomes such as pain, function and satisfaction. The current review aims to examine the history of perioperative MMA strategies in ERAS and provide an update with recent evidence. Furthermore, this review details recent advancements in personalized pain medicine. We speculate that the next important step for improving perioperative pain management could be through incorporating these personalized metrics, such as clinical pharmacogenomic testing and patient-reported outcome measurements, into ERAS program.
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18
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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] [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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19
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Berhe S, Kraus F, Hanifi MT, Vlassakov K, Stopfkuchen-Evans M. Use of Transversus Abdominis Plane (TAP) Blocks for Postoperative Pain Management in a Patient With an Open Abdomen: A Case Report and Review of Literature. Cureus 2021; 13:e12739. [PMID: 33614341 PMCID: PMC7883565 DOI: 10.7759/cureus.12739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/06/2022] Open
Abstract
In light of the superior analgesia and opioid sparing effects provided by transversus abdominis plane (TAP) blocks, numerous new techniques and applications have evolved. However, TAP blocks are still underutilized in the critical care setting, and PubMed‑listed reports on the relevance of TAP integrity for TAP block efficacy are lacking. Here, we report bilateral TAP blocks delivering quick, potent and durable pain relief to a patient with open abdomen (OA) after prior management with opioids and epidural anesthesia had failed. Extending TAP block application to OA patients even in the post‑operative setting might hence reduce opioid consumption and quicken reconvalescence.
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Affiliation(s)
- Simon Berhe
- Department of Surgery, Columbia University Irving Medical Center, New York, USA
| | - Fabian Kraus
- Department of Obstetrics and Gynecology, Klinikum der Universität München, München, DEU
| | - Mohammed Tariq Hanifi
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, USA
| | - Kamen Vlassakov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, USA
| | - Matthias Stopfkuchen-Evans
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, USA
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20
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Role of para-cervical block in reducing immediate postoperative pain after total laparoscopic hysterectomy: a prospective randomized placebo-controlled trial. Obstet Gynecol Sci 2021; 64:122-129. [PMID: 33430576 PMCID: PMC7834753 DOI: 10.5468/ogs.20271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022] Open
Abstract
Objective To study the efficacy and safety of 0.5% bupivacaine in paracervical block to reduce immediate postoperative pain after total laparoscopic hysterectomy. Methods A prospective, randomized, double-blind, placebo-controlled study was conducted at a tertiary referral center involving thirty women each in the treatment and placebo groups. Paracervical block with 10 mL of 0.5% bupivacaine (treatment group) or 0.9% saline (placebo group) was administered following general anesthesia and prior to proceeding with total laparoscopic hysterectomy. Visual analogue scale (VAS) scores at 30 and 60 minutes post extubation and mean VAS score (average VAS score at 30 and 60 minutes) were compared. Adequate pain control was defined as mean VAS score ≤5. Additional postoperative opioid requirement, hospital stay, and readmissions were also compared. Results Baseline variables such as age, previous history of cesarean section, operating time, and weight of the specimen were comparable in both groups. VAS scores at 30 (5.0±2.8 vs. 7.0±1.4) and 60 minutes (5.2±2.8 vs. 7.0±0.8) and the mean VAS score (5.1±2.7 vs. 6.8±0.9) were significantly lower in the treatment group. Adequate pain control (mean VAS score ≤5) was 57% higher and additional opioid consumption was 47% lower in the treatment group. No significant difference was found in the duration of hospital stay and readmission rate. Conclusion Paracervical block with bupivacaine was useful in reducing immediate postoperative pain with a 25% reduction in mean VAS score and a 47% reduction in opioid consumption in the first hour after total laparoscopic hysterectomy.
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21
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Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a
Technical Description and Evidence Review. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00351-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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22
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Qin Z, Xiang C, Li H, Liu T, Zhan L, Xia Z, Zhang M, Lai J. The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial. BMC Anesthesiol 2019; 19:181. [PMID: 31604428 PMCID: PMC6790018 DOI: 10.1186/s12871-019-0859-7] [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: 01/27/2019] [Accepted: 09/30/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Intravenous dexmedetomidine is known to attenuate stress response in patients undergoing laparoscopic surgery. We investigated whether the addition of the highly selective alpha-2 adrenergic agonist dexmedetomidine into ropivacaine for ultrasound-guided transversus abdominis plane block could inhibit stress response during laparoscopic surgery, and determined the optimal dose of dexmedetomidine in it. METHODS One hundred and twenty-five patients undergoing laparoscopic gynecological surgery were included in this prospective and randomized double-blind study. Patients received general anesthesia with or without a total of 60 ml of 0.2% ropivacaine in combination with low (0.25 μg/kg), medium (0.50 μg/kg) or high dose (1.0 μg/kg) of dexmedetomidine for the four-quadrant transversus abdominis plane block (n = 25). The primary outcomes were stress marker levels during the operation. RESULTS One hundred and twenty patients completed the study protocol. Dexmedetomidine added to ropivacaine for transversus abdominis plane block significantly reduced serum levels of cortisol, norepinephrine, epinephrine, interleukin-6, blood glucose, mean arterial pressure and heart rate in a dose-dependent manner (P < 0.05), accompanied with decreased anesthetic and opioid consumption during the operation (P < 0.05), but the high dose of dexmedetomidine induced higher incidences of bradycardia than low or medium dose of dexmedetomidine (P < 0.05). CONCLUSION The addition of dexmedetomidine at the dose of 0.5 μg/kg into ropivacaine for ultrasound-guided transversus abdominis plane block is the optimal dose to inhibit stress response with limited impact on blood pressure and heart rate in patients undergoing laparoscopy gynecological surgery. TRIAL REGISTRATION This study was registered at www.chictr.org.cn on November 6th, 2016 (ChiCTR-IOR-16009753).
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Affiliation(s)
- Zhaojun Qin
- Department of Anesthesiology, the People's Hospital of China Three Gorges University & the First People's Hospital of Yichang, Yichang, Hubei, China
| | - Chunyan Xiang
- Department of Pharmacy, the People's Hospital of China Three Gorges University & the First People's Hospital of Yichang, Yichang, Hubei, China
| | - Hongbo Li
- Department of Anesthesiology, the People's Hospital of Yuan'an County, Yichang, China
| | - Tingting Liu
- Department of Anesthesiology, the People's Hospital of China Three Gorges University & the First People's Hospital of Yichang, Yichang, Hubei, China
| | - Leyun Zhan
- Department of Anesthesiology, the People's Hospital of China Three Gorges University & the First People's Hospital of Yichang, Yichang, Hubei, China
| | - Zhengyuan Xia
- Department of Anesthesiology, the University of Hong Kong, Hong Kong, China
| | - Min Zhang
- Department of Anesthesiology, the People's Hospital of China Three Gorges University & the First People's Hospital of Yichang, Yichang, Hubei, China
| | - Jianping Lai
- Department of Nuclear Medicine, the People's Hospital of China Three Gorges University & the First People's Hospital of Yichang, 2 Jiefang Road, Xiling District, Yichang City, Hubei, China.
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Paracervical Block as a Strategy to Reduce Postoperative Pain after Laparoscopic Hysterectomy: A Randomized Controlled Trial. J Minim Invasive Gynecol 2019; 26:1164-1168. [DOI: 10.1016/j.jmig.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/19/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
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Peršec J, Šerić M. Regional analgesia modalities in abdominal and lower limb surgery - comparison of efficacy. Acta Clin Croat 2019; 58:101-107. [PMID: 31741567 PMCID: PMC6813478 DOI: 10.20471/acc.2019.58.s1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A significant component of all surgical procedures and postoperative treatment is pain management.Due to the physiological and psychological advantages of pain relief, it is one of the foremost indicators of quality of care. Today, there are various modalities of pain reduction, aimed to reduce patient discomfort andminimize side effects, which can be divided by therapeutic agents used (opioid or non-opioid), route of administration (intravenous, regional, oral, etc.) and modality (controlled by patients or "as needed"). Although opioids have proven to be very effective pain relief agents and are commonly used in postoperative analgesia, concerns about their side effects have spurred the development of modified, multimodal treatments that seek to minimize opioid use and associated drawbacks. Enhanced recovery protocols that emphasize sparing administration of opioids are growing in importance, andresulting in reduced length of hospital stay after abdominal and lower limb surgery. To further improve such protocols and optimize postoperative care for individual patient needs, it is imperative to fully assess the efficacy of available drugs and analgesia modalities.
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Affiliation(s)
| | - Monika Šerić
- 1Clinic for Anesthesiology, Reanimatology and Intensive Care Medicine, Clinical Hospital Dubrava; 2School of Dental Medicine, University of Zagreb, Croatia
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Turi S, Gemma M, Braga M, Monzani R, Radrizzani D, Beretta L. Epidural analgesia vs systemic opioids in patients undergoing laparoscopic colorectal surgery. Int J Colorectal Dis 2019; 34:915-921. [PMID: 30927065 DOI: 10.1007/s00384-019-03284-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE A well-controlled pain is one of the most important targets of enhanced recovery after surgery (ERAS) protocols. Recent studies questioned the role of TEA (thoracic epidural analgesia) in support of less invasive techniques, in particular in laparoscopic mini-invasive surgery. The aim of this study is to compare patients undergoing laparoscopic mini-invasive colorectal surgery and receiving different analgesic techniques. METHODS Prospectively collected data entered in the electronic registry of POIS (Perioperative Italian Society) specifically designed for ERAS were reviewed. Patients undergoing colorectal laparoscopic surgery were divided in two groups according to TEA or parenteral opioid administration. In comparing TEA and opioid groups, propensity score weights were obtained. Postoperative pain control and time to readiness for discharge (TRD) were considered as primary endpoints of the study. Secondary endpoints were postoperative morbidity, PONV (postoperative nausea and vomiting), hours of mobilization, length of hospital stay (LOS), timing of fluid and solid re-assumption, and recovery of bowel function. RESULTS Fourteen Italian hospitals reported data on 560 patients (283 TEA, 277 opioid group). Patients of the opioid group were able to mobilize for a longer period than TEA group patients but presented a higher incidence of PONV. Pain intensity and TRD were similar in both groups. LOS was significantly reduced in TEA patients; also, this result was clinically irrelevant (5.7 ± 3.21 days TEA group vs 5.8 ± 2.92 opioid group). CONCLUSION In patients undergoing laparoscopic colorectal surgery, TEA was not associated to a better pain control or to an improvement in postoperative outcome compared with opioid administration.
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Affiliation(s)
- Stefano Turi
- Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - Marco Gemma
- Anesthesia and Intensive Care Unit-Fatebenefratelli Hospital, Piazzale Principessa Clotilde, 20121, Milano, Italy
| | - Marco Braga
- Department of Surgery-San Gerardo Hospital, Milano-Bicocca University, Milano, Italy
| | - Roberta Monzani
- Department of Anesthesia, Humanitas Research Hospital, Rozzano, Milano, Italy
| | | | - Luigi Beretta
- Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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Abstract
Postoperative ileus (POI) is a common complication following colon and rectal surgery, with reported incidence ranging from 10 to 30%. It can lead to increased morbidity, cost, and length of stay. Although definitions vary considerably in the literature, in its pathologic form, it can be characterized by a temporary inhibition of gastrointestinal motility after surgical intervention due to nonmechanical causes that prevents sufficient oral intake. Various risk factors for development of POI have been identified including increasing age, American Society of Anesthesiologists scores 3 to 4, open approach, operative difficulty, operative duration more than 3 hours, bowel handling, drop in hematocrit or need for a transfusion, increasing crystalloid administration, and delayed mobilization. While treatment is expectant and supportive, significant investigations into strategies to mitigate development of POI or shorten its duration have been undertaken with mixed results. There is significant evidence to suggest that a minimally invasive approach and multimodal pain regimens reduce the development of POI. The beneficial effect of chewing gum, alvimopan, and enhanced recovery after surgery protocols may decrease development of POI in selected groups of patients who undergo elective colorectal surgery, and shorten time to return of bowel function, but overall, the data remain inconclusive.
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Affiliation(s)
- Cristina R Harnsberger
- Division of Colon and Rectal Surgery, University of Massachusetts, Boston, Massachusetts
| | - Justin A Maykel
- Division of Colon and Rectal Surgery, University of Massachusetts, Boston, Massachusetts
| | - Karim Alavi
- Division of Colon and Rectal Surgery, University of Massachusetts, Boston, Massachusetts
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Seyedhejazi M, Motarabbesoun S, Eslampoor Y, Taghizadieh N, Hazhir N. Appendectomy Pain Control by Transversus Abdominis Plane (TAP) Block in Children. Anesth Pain Med 2019; 9:e83975. [PMID: 30881907 PMCID: PMC6412316 DOI: 10.5812/aapm.83975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/23/2018] [Accepted: 11/30/2018] [Indexed: 12/18/2022] Open
Abstract
Background Pain control after surgery in children is very important. Despite having good analgesic effects, the use of opioids is, however, limited due to side effects. Objectives This study was aimed to investigate the effect of transverse abdominis plane (TAP) block on the intensity and frequency of pain after appendectomy in children. Methods In a single-blinded clinical trial, 40 children aged from 4 to 16 years, candidates for the appendectomy, were divided randomly to intervention and control groups. The intervention group received ultrasound-guided TAP block using 0.25 mL/kg of 0.25% bupivacaine in the Petit triangle after general anesthesia. Postoperative pain was assessed within the first 24 hours after surgery based on the Wong-Baker FACES Pain Rating Scale (WBFP). Results There was a reduction in WBFP scores at 2 hours after appendectomy in the intervention group compared with the control group (5.05 ± 2.83 vs 6.30 ± 2.2063). Also, the pain intensity within 24 hours after surgery in the intervention and control groups was 3.10 ± 1.33, and 3.60 ± 1.63 respectively according to WBFP scale (P > 0.05). Conclusions The TAP block was effective to reduce pain after appendectomy in children, however, there was no significant difference between intervention and control groups. Further studies with larger sample sizes are needed to be done in this area of research.
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Affiliation(s)
- Mahin Seyedhejazi
- Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samira Motarabbesoun
- Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yashar Eslampoor
- Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Taghizadieh
- Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazanin Hazhir
- Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Sheshgelan st., Tabriz, Iran. Tel: +98-9146303383,
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Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS ®) Society Recommendations: 2018. World J Surg 2019; 43:659-695. [PMID: 30426190 DOI: 10.1007/s00268-018-4844-y] [Citation(s) in RCA: 1056] [Impact Index Per Article: 211.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. METHODS A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS® protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly. CONCLUSIONS The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS® Society in this comprehensive consensus review.
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Affiliation(s)
- U O Gustafsson
- Department of Surgery, Danderyd Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - M J Scott
- Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, VA, USA
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, USA
| | - M Hubner
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - J Nygren
- Department of Surgery, Ersta Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - N Demartines
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - N Francis
- Colorectal Unit, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
- University of Bath, Wessex House Bath, BA2 7JU, UK
| | - T A Rockall
- Department of Surgery, Royal Surrey County Hospital NHS Trust, and Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - T M Young-Fadok
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - A G Hill
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland Middlemore Hospital, Auckland, New Zealand
| | - M Soop
- Irving National Intestinal Failure Unit, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - H D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital, Groningen, The Netherlands
| | - R D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G J Chang
- Department of Surgical Oncology and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - A Fichera
- Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - F Grass
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - E E Whang
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - W J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust and University of Surrey, Guildford, UK
| | - F Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - K E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - A Balfour
- Department of Colorectal Surgery, Surgical Services, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - G Baldini
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - B Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - O Ljungqvist
- Department of Surgery, Örebro University and University Hospital, Örebro & Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Simpson JC, Bao X, Agarwala A. Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols. Clin Colon Rectal Surg 2019; 32:121-128. [PMID: 30833861 DOI: 10.1055/s-0038-1676477] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pain control is an integral part of Enhanced Recovery after Surgery (ERAS) protocols for colorectal surgery. While opioid therapy remains the mainstay of therapy for postsurgical pain, opioids have undesired side effects including delayed recovery of bowel function, respiratory depression, and postoperative nausea and vomiting. A variety of nonopioid systemic medical therapies as well as regional and neuraxial techniques have been described as improving pain control while reducing opioid use. Multimodal and preemptive analgesia as part of an ERAS protocol facilitates early mobility and early return of bowel function and decreases postoperative morbidity. In this review, we examine several multimodal therapies and their impact on postoperative analgesia, opioid use, and recovery for patients undergoing colorectal surgery.
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Affiliation(s)
- J Creswell Simpson
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Xiaodong Bao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Aalok Agarwala
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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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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31
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[Evidence-based perioperative medicine]. Chirurg 2019; 90:357-362. [PMID: 30627766 DOI: 10.1007/s00104-018-0776-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Perioperative medical interventions are an integral part of modern surgical management. In addition to the main manual aspects of surgical interventions, surgeons must also be familiar with preoperative and postoperative medical interventions. This ranges from the indications for perioperative anticoagulation, handling of drainage, adjusting the perioperative analgesia, prescribing an antibiotic prophylaxis to deciding whether a preoperative bowel preparation is necessary. Therefore, this article exemplifies some areas in perioperative medicine. Based on the best available evidence, it should always be critically assessed whether these perioperative interventions really contribute to the success of the treatment.
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Gupta A, Gupta A, Yadav N. Effect of dexamethasone as an adjuvant to ropivacaine on duration and quality of analgesia in ultrasound-guided transversus abdominis plane block in patients undergoing lower segment cesarean section - A prospective, randomised, single-blinded study. Indian J Anaesth 2019; 63:469-474. [PMID: 31263299 PMCID: PMC6573046 DOI: 10.4103/ija.ija_773_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background and Aims: Ultrasound guided transversus abdominis plane block is an efficacious abdominal field block. The aim was to determine the effect of dexamethasone to 0.375% ropivacaine on the analgesic duration of TAP block in patients undergoing lower segment cesarean section (LSCS). Methods: A single-blinded randomised control study was conducted on 90 patients, who were divided in two groups of 45 each. Group R received 0.375% ropivacaine (25 ml) with normal saline (1 ml) each side and group D received 0.375% ropivacaine (25 ml) with dexamethasone 4 mg (1 ml) each side in transversus abdominis plane block after lower segment cesarean section. Primary objective was to compare time to first rescue analgesia and secondary objectives to compare the total amount of analgesia required in first 24 h postoperatively, visual analog scale scores for somatic and visceral pain and incidence of nausea and vomiting, between the two groups. Student's t test, Chi-square, or Fisher's exact test were performed using SPSS 17.0. Results: Time to first rescue analgesia was significantly less in group R (11.62 ± 3.80 h) compared to group D (19.04 ± 4.13 h) (P < 0.001). Total tramadol consumed in 24 h was significantly higher in group R (86.67 ± 30.55 mg) than group D (35.56 ± 39.54 mg) (P < 0.001). Visual analog scale scores for both somatic and visceral pain were significantly higher in group R than group D at 8 h, 12 h, and 24 h postoperatively. Conclusion: Addition of dexamethasone to ropivacaine in transversus abdominis plane block significantly prolongs the duration of postoperative analgesia.
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Affiliation(s)
- Anie Gupta
- Department of Anaesthesia and Pain Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Alok Gupta
- Department of Anaesthesia and Pain Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Neeraj Yadav
- Department of Anaesthesia and Pain Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
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Hosalli V, Ayyanagouda B, Hiremath P, Ambi U, Hulkund SY. Comparative efficacy of postoperative analgesia between ultrasound-guided dual transversus abdominis plane and Ilioinguinal/Iliohypogastric nerve blocks for open inguinal hernia repair: An open label prospective randomised comparative clinical trial. Indian J Anaesth 2019; 63:450-455. [PMID: 31263296 PMCID: PMC6573039 DOI: 10.4103/ija.ija_153_19] [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] [Indexed: 11/05/2022] Open
Abstract
Background and Aims: Transversus abdominis plane (TAP) and Ilioinguinal/Iliohypogastric (IL/IH) nerve blocks have been advocated in reducing postoperative pain and additional analgesic requirement following lower abdominal surgeries with varied effect. The aim of this study was to determine post-operative analgesic efficacy by comparing dual TAP [combining TAP and IL/IH nerve blocks] and IL/IH nerve block alone for open inguinal hernia repair. Methods: Two hundred patients undergoing elective primary unilateral open inguinal hernia repair with a mesh were included in to this trial. Ultrasound-guided dual TAP (D-TAP Group) or IL/IH (IL/IH Group) nerve block were administered to patients following subarachnoid block according to their group allocation, with 0.5% ropivacaine. Post operatively patients were monitored for visual analogue scale (VAS) scores at rest (at 4, 12, 24 and 48h) and during movement (at 24, 48 h, 3 and 6 months). Pain scores at 3 and 6 months were assessed by telephonic interview, using the DN4 questionnaire for neuropathic pain. The statistics was obtained using Chi-square test for proportions in qualitative data and student's unpaired t test for quantitative data. P value <0.05 was considered significant. Results: The pain scores at rest (VAS-R) were significantly lower at 12 hours and 24 hours (P < 0.001) in D-TAP group, while pain scores at movement were significantly lower (P < 0.001) in D-TAP group at 24 and 48 hours compared to IL/IH group. The mean time required for first rescue analgesic was longer in D-TAP group (5.590 ± 2.386 hr) in comparison to IL/IH group (3.1053 ± 1.1822h). Conclusion: Ultrasound-guided dual TAP block provides more effective post-operative analgesia in open inguinal hernia repair.
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Affiliation(s)
- Vinod Hosalli
- Department of Anaesthesiology, S N Medical College and HSK Hospital, Navanagar, Bagalkot, Karnataka, India
| | - Basavaraja Ayyanagouda
- Department of Anaesthesiology, S N Medical College and HSK Hospital, Navanagar, Bagalkot, Karnataka, India
| | - Preetika Hiremath
- Department of Anaesthesiology, S N Medical College and HSK Hospital, Navanagar, Bagalkot, Karnataka, India
| | - Uday Ambi
- Department of Anaesthesiology, S N Medical College and HSK Hospital, Navanagar, Bagalkot, Karnataka, India
| | - S Y Hulkund
- Department of Anaesthesiology, S N Medical College and HSK Hospital, Navanagar, Bagalkot, Karnataka, India
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Jain S, Kalra S, Sharma B, Sahai C, Sood J. Evaluation of Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Intraperitoneal Onlay Mesh Repair. Anesth Essays Res 2019; 13:126-131. [PMID: 31031492 PMCID: PMC6444957 DOI: 10.4103/aer.aer_176_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Ventral hernia is a commonly performed surgical procedure in adults. Laparoscopic intraperitoneal onlay mesh repair (IPOM) of ventral hernia is procedure of choice. IPOM of ventral hernia is associated with significant pain. Hence, our aim was to study the efficacy of instilling preemptive local analgesia for reducing postoperative pain in patients undergoing laparoscopic ventral hernia repairs. Objective: To study the role of local infiltration of 10 ml of 0.5% ropivacaine in the anterior abdominal wall preoperatively to improve pain scores compared to conventional intravenous systemic analgesia. Materials and Methods: The study pool consists of two groups of patients (25 in each group) admitted for laparoscopic uncomplicated ventral hernia repair. Analysis was performed by the SPSS program (Company – International Business Machines Corporation, headquartered at Armonk, New York, USA) for Windows, version 17.0. Normally distributed continuous variables were compared using ANOVA. Categorical variables were analyzed using the Chi-square test. Results: Both groups were matching in terms of demographic features. Postoperatively, pain assessment was performed every 30 min for the first 2 h and was followed up for a period of 24 h at intervals (4, 6, 12, and 24 h). Postoperatively, patients were also assessed for time of ambulation, time of return of bowel sounds at 6, 12, and 24 h, and length of hospital stay. Side effects and complication were noted. Conclusion: Our study demonstrated that supplementing US-guided transversus abdominis plane (TAP) block to conventional systemic analgesics resulted in decreased VAS scores and decreased requirement of rescue analgesics. The patients ambulated early had earlier appearance of bowel sounds and decreased length of hospital stay. There was also decreased incidence of nausea and vomiting. TAP block for laparoscopic IPOM surgery significantly decreases postoperative pain and opioid requirement in patients.
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Affiliation(s)
- Swati Jain
- Department of Anaesthesiology, PGIMER and Dr. RML Hospital, New Delhi, India
| | - Sumit Kalra
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Bimla Sharma
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Chand Sahai
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayashree Sood
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Pain control in laparoscopic surgery: a case–control study between transversus abdominis plane-block and trocar-site anesthesia. Updates Surg 2018; 71:717-722. [DOI: 10.1007/s13304-018-00615-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 12/10/2018] [Indexed: 01/11/2023]
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Zhou H, Ma X, Pan J, Shuai H, Liu S, Luo X, Li R. Effects of transversus abdominis plane blocks after hysterectomy: a meta-analysis of randomized controlled trials. J Pain Res 2018; 11:2477-2489. [PMID: 30425560 PMCID: PMC6204870 DOI: 10.2147/jpr.s172828] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transversus abdominis plane (TAP) block can provide effective analgesia for abdominal surgery. However, many randomized controlled trials (RCTs) have shown controversial results in hysterectomy. We conducted a meta-analysis of RCTs to investigate the effectiveness of TAP block after hysterectomy. METHODS Studies were gathered from PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov databases up to March 2018. RCTs involving TAP blocks in women undergoing hysterectomy were selected. The primary outcome of mean 24 hours morphine consumption and other outcomes, such as time to first request for analgesic, rest, and pain scores on movement at different times, and rates of nausea and vomiting, were compared between TAP block and no or sham block groups. RESULTS A total of 841 participants were included in the 13 selected RCTs. Compared with no or sham blocks, TAP block reduced mean 24-hour morphine consumption in abdominal hysterectomy (AH) (weighted mean difference [WMD] -10.77 mg, P=0.04) but not in laparoscopic hysterectomy (LH)/robotic-assisted hysterectomy (RH) (WMD -1.39 mg, P=0.24). TAP block in AH prolonged analgesic time and reduced nausea and vomiting rates. TAP block also reduced the postoperative pain score at rest and on movement at different times in the AH subgroup, but it did not significantly reduce the postoperative pain score at rest, 6-8, and 24 hours, as well as the pain score on movement at 2, 6-8, and 24 hours in the LH/RH subgroup. CONCLUSION TAP block is an effective analgesic for AH. TAP block can reduce postoperative morphine consumption in AH and pain scores at rest and on movement for AH without increasing side effects. However, TAP block has limited analgesic effects for women undergoing LH/RH, as it does not reduce postoperative morphine consumption and pain scores at rest and on movement.
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Affiliation(s)
- Hong Zhou
- Department of Obstetrics and Gynecology, ;
| | - Xuefeng Ma
- Department of Obstetrics and Gynecology, ;
| | - Jinghua Pan
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
| | | | - Shanshan Liu
- Gynecology Department, Guangdong Women and Children Hospital, Guangzhou 511442, China
| | - Xin Luo
- Department of Obstetrics and Gynecology, ;
| | - Ruiman Li
- Department of Obstetrics and Gynecology, ;
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Lee CS, Lee JY, Ro S, Choi S, Moon JY. Comparison of effectiveness of epidural analgesia and monitored anesthesia care for high-intensity focused ultrasound treatment of adenomyosis. Int J Hyperthermia 2018; 35:617-625. [DOI: 10.1080/02656736.2018.1516300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Chang-Soon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Integrated Cancer Care Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soohan Ro
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seungeun Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Integrated Cancer Care Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea
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Lau LLN, Li CY, Lee A, Chan SKC. The use of 5% lidocaine medicated plaster for acute postoperative pain after gynecological surgery: A pilot randomized controlled feasibility trial. Medicine (Baltimore) 2018; 97:e12582. [PMID: 30278568 PMCID: PMC6181576 DOI: 10.1097/md.0000000000012582] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To examine the feasibility and potential efficacy of 5% lidocaine medicated plaster for acute postoperative pain in a parallel, blinded, randomized controlled pilot trial. METHODS Twenty-eight women undergoing elective gynecological surgery with midline incisions were randomly allocated 5% lidocaine medicated patch (Lignopad) or placebo plasters. Postoperative pain at rest and on movement at 24 hours were the primary study endpoints, with secondary endpoints of postoperative pain within the first 48 hours, cumulative morphine consumption (mg), predicted peak flow rate (PFR) (%) and adverse effects. We assessed pain scores at rest and on movement using the visual analogue scale (0-100). RESULTS The lidocaine patch group had lower postoperative pain scores at rest at 24 hours (mean difference [MD] -15.1, 95% confidence interval [95% CI] -28.3 to -2.0; P = .024) but not on movement at 24 hours (MD -6.4, 95% CI -22.7 to 9.9; P = .445). Compared to placebo, lidocaine may slightly lower cumulative morphine consumption (mg) over time (MD -3.4, 95% CI -6.9 to 0.2; group*time interaction P = .065). The difference in improvement in the PFR over time after surgery between groups appeared small (group*time P = .0980). No adverse effects occurred. CONCLUSIONS Lidocaine patch may provide a clinically important reduction in postoperative pain intensity. A larger trial to confirm the efficacy and safety of lidocaine patch is feasible after modifying the inclusion criteria and collecting patient-centered outcomes, such as quality of recovery and patient satisfaction.
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Affiliation(s)
- Lydia LN Lau
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital
| | - Cheuk Yin Li
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Simon KC Chan
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital
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Parikh RP, Myckatyn TM. Paravertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives. J Pain Res 2018; 11:1567-1581. [PMID: 30197532 PMCID: PMC6112815 DOI: 10.2147/jpr.s148544] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The management of postoperative pain is of critical importance for women undergoing breast reconstruction after surgical treatment for breast cancer. Mitigating postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative opiate use. Multimodal analgesia pain management strategies with nonopioid analgesics have improved the value of surgical care in patients undergoing various operations but have only recently been reported in reconstructive breast surgery. Regional anesthesia techniques, with paravertebral blocks (PVBs) and transversus abdominis plane (TAP) blocks, and enhanced recovery after surgery (ERAS) pathways have been increasingly utilized in opioid-sparing multimodal analgesia protocols for women undergoing breast reconstruction. The objectives of this review are to 1) comprehensively review regional anesthesia techniques in breast reconstruction, 2) outline important components of ERAS protocols in breast reconstruction, and 3) provide evidence-based recommendations regarding each intervention included in these protocols. The authors searched across six databases to identify relevant articles. For each perioperative intervention included in the ERAS protocols, the literature was exhaustively reviewed and evidence-based recommendations were generated using the Grading of Recommendations, Assessment, Development, and Evaluation system methodology. This study provides a comprehensive evidence-based review of interventions to optimize perioperative care and postoperative pain control in breast reconstruction. Incorporating evidence-based interventions into future ERAS protocols is essential to ensure high value care in breast reconstruction.
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Affiliation(s)
- Rajiv P Parikh
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA,
| | - Terence M Myckatyn
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA,
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Holmes R, Smith SR, Carroll R, Holz P, Mehrotra R, Pockney P. Randomized clinical trial to assess the ideal mode of delivery for local anaesthetic abdominal wall blocks. ANZ J Surg 2017; 88:786-791. [DOI: 10.1111/ans.14317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Ryan Holmes
- The University of Newcastle; Newcastle New South Wales Australia
| | - Stephen R. Smith
- The University of Newcastle; Newcastle New South Wales Australia
- Department of Colorectal Surgery; John Hunter Hospital; Newcastle New South Wales Australia
| | - Rosemary Carroll
- Department of Surgery; John Hunter Hospital; Newcastle New South Wales Australia
| | - Phillip Holz
- Department of Anaesthesia and Intensive Care; John Hunter Hospital; Newcastle New South Wales Australia
| | - Rahul Mehrotra
- Department of Surgery; John Hunter Hospital; Newcastle New South Wales Australia
| | - Peter Pockney
- The University of Newcastle; Newcastle New South Wales Australia
- Department of Surgery; John Hunter Hospital; Newcastle New South Wales Australia
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Pehora C, Pearson AME, Kaushal A, Crawford MW, Johnston B. Dexamethasone as an adjuvant to peripheral nerve block. Cochrane Database Syst Rev 2017; 11:CD011770. [PMID: 29121400 PMCID: PMC6486015 DOI: 10.1002/14651858.cd011770.pub2] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Peripheral nerve block (infiltration of local anaesthetic around a nerve) is used for anaesthesia or analgesia. A limitation to its use for postoperative analgesia is that the analgesic effect lasts only a few hours, after which moderate to severe pain at the surgical site may result in the need for alternative analgesic therapy. Several adjuvants have been used to prolong the analgesic duration of peripheral nerve block, including perineural or intravenous dexamethasone. OBJECTIVES To evaluate the comparative efficacy and safety of perineural dexamethasone versus placebo, intravenous dexamethasone versus placebo, and perineural dexamethasone versus intravenous dexamethasone when added to peripheral nerve block for postoperative pain control in people undergoing surgery. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, DARE, Web of Science and Scopus from inception to 25 April 2017. We also searched trial registry databases, Google Scholar and meeting abstracts from the American Society of Anesthesiologists, the Canadian Anesthesiologists' Society, the American Society of Regional Anesthesia, and the European Society of Regional Anaesthesia. SELECTION CRITERIA We included all randomized controlled trials (RCTs) comparing perineural dexamethasone with placebo, intravenous dexamethasone with placebo, or perineural dexamethasone with intravenous dexamethasone in participants receiving peripheral nerve block for upper or lower limb surgery. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 35 trials of 2702 participants aged 15 to 78 years; 33 studies enrolled participants undergoing upper limb surgery and two undergoing lower limb surgery. Risk of bias was low in 13 studies and high/unclear in 22. Perineural dexamethasone versus placeboDuration of sensory block was significantly longer in the perineural dexamethasone group compared with placebo (mean difference (MD) 6.70 hours, 95% confidence interval (CI) 5.54 to 7.85; participants1625; studies 27). Postoperative pain intensity at 12 and 24 hours was significantly lower in the perineural dexamethasone group compared with control (MD -2.08, 95% CI -2.63 to -1.53; participants 257; studies 5) and (MD -1.63, 95% CI -2.34 to -0.93; participants 469; studies 9), respectively. There was no significant difference at 48 hours (MD -0.61, 95% CI -1.24 to 0.03; participants 296; studies 4). The quality of evidence is very low for postoperative pain intensity at 12 hours and low for the remaining outcomes. Cumulative 24-hour postoperative opioid consumption was significantly lower in the perineural dexamethasone group compared with placebo (MD 19.25 mg, 95% CI 5.99 to 32.51; participants 380; studies 6). Intravenous dexamethasone versus placeboDuration of sensory block was significantly longer in the intravenous dexamethasone group compared with placebo (MD 6.21, 95% CI 3.53 to 8.88; participants 499; studies 8). Postoperative pain intensity at 12 and 24 hours was significantly lower in the intravenous dexamethasone group compared with placebo (MD -1.24, 95% CI -2.44 to -0.04; participants 162; studies 3) and (MD -1.26, 95% CI -2.23 to -0.29; participants 257; studies 5), respectively. There was no significant difference at 48 hours (MD -0.21, 95% CI -0.83 to 0.41; participants 172; studies 3). The quality of evidence is moderate for duration of sensory block and postoperative pain intensity at 24 hours, and low for the remaining outcomes. Cumulative 24-hour postoperative opioid consumption was significantly lower in the intravenous dexamethasone group compared with placebo (MD -6.58 mg, 95% CI -10.56 to -2.60; participants 287; studies 5). Perinerual versus intravenous dexamethasoneDuration of sensory block was significantly longer in the perineural dexamethasone group compared with intravenous by three hours (MD 3.14 hours, 95% CI 1.68 to 4.59; participants 720; studies 9). We found that postoperative pain intensity at 12 hours and 24 hours was significantly lower in the perineural dexamethasone group compared with intravenous, however, the MD did not surpass our pre-determined minimally important difference of 1.2 on the Visual Analgue Scale/Numerical Rating Scale, therefore the results are not clinically significant (MD -1.01, 95% CI -1.51 to -0.50; participants 217; studies 3) and (MD -0.77, 95% CI -1.47 to -0.08; participants 309; studies 5), respectively. There was no significant difference in severity of postoperative pain at 48 hours (MD 0.13, 95% CI -0.35 to 0.61; participants 227; studies 3). The quality of evidence is moderate for duration of sensory block and postoperative pain intensity at 24 hours, and low for the remaining outcomes. There was no difference in cumulative postoperative 24-hour opioid consumption (MD -3.87 mg, 95% CI -9.93 to 2.19; participants 242; studies 4). Incidence of severe adverse eventsFive serious adverse events were reported. One block-related event (pneumothorax) occurred in one participant in a trial comparing perineural dexamethasone and placebo; however group allocation was not reported. Four non-block-related events occurred in two trials comparing perineural dexamethasone, intravenous dexamethasone and placebo. Two participants in the placebo group required hospitalization within one week of surgery; one for a fall and one for a bowel infection. One participant in the placebo group developed Complex Regional Pain Syndrome Type I and one in the intravenous dexamethasone group developed pneumonia. The quality of evidence is very low due to the sparse number of events. AUTHORS' CONCLUSIONS Low- to moderate-quality evidence suggests that when used as an adjuvant to peripheral nerve block in upper limb surgery, both perineural and intravenous dexamethasone may prolong duration of sensory block and are effective in reducing postoperative pain intensity and opioid consumption. There is not enough evidence to determine the effectiveness of dexamethasone as an adjuvant to peripheral nerve block in lower limb surgeries and there is no evidence in children. The results of our review may not apply to participants at risk of dexamethasone-related adverse events for whom clinical trials would probably be unsafe.There is not enough evidence to determine the effectiveness of dexamethasone as an adjuvant to peripheral nerve block in lower limb surgeries and there is no evidence in children. The results of our review may not be apply to participants who at risk of dexamethasone-related adverse events for whom clinical trials would probably be unsafe. The nine ongoing trials registered at ClinicalTrials.gov may change the results of this review.
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Affiliation(s)
- Carolyne Pehora
- The Hospital for Sick Children, University of TorontoDepartment of Anesthesia and Pain Medicine555 University AvenueTorontoONCanadaM5G 1X8
| | - Annabel ME Pearson
- The Hospital for Sick Children, University of TorontoDepartment of Anesthesia and Pain Medicine555 University AvenueTorontoONCanadaM5G 1X8
| | - Alka Kaushal
- Max Rady College of Medicine, University of ManitobaDepartment of Family MedicineWinnipegManitobaCanada
| | - Mark W Crawford
- The Hospital for Sick Children, University of TorontoDepartment of Anesthesia and Pain Medicine555 University AvenueTorontoONCanadaM5G 1X8
| | - Bradley Johnston
- Dalhousie UniversityDepartment of Community Health and Epidemiology5790 University AvenueHalifaxNSCanadaB3H 1V7
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Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines. Anesthesiol Clin 2017; 35:e115-e143. [PMID: 28526156 DOI: 10.1016/j.anclin.2017.01.018] [Citation(s) in RCA: 240] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Perioperative multimodal analgesia uses combinations of analgesic medications that act on different sites and pathways in an additive or synergistic manner to achieve pain relief with minimal or no opiate consumption. Although all medications have side effects, opiates have particularly concerning, multisystemic, long-term, and short-term side effects, which increase morbidity and prolong admissions. Enhanced recovery is a systematic process addressing each aspect affecting recovery. This article outlines the evidence base forming the current multimodal analgesia recommendations made by the Enhanced Recovery After Surgery Society (ERAS). We describe current evidence and important future directions for effective perioperative multimodal analgesia in enhanced recovery pathways.
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Chesov I, Belîi A. Postoperative analgesic efficiency of transversus abdominis plane block after ventral hernia repair: a prospective, randomized, controlled clinical trial. Rom J Anaesth Intensive Care 2017; 24:125-132. [PMID: 29090265 DOI: 10.21454/rjaic.7518.242.chv] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND AIMS Effective postoperative analgesia is a key element in reducing postoperative morbidity, accelerating recovery and avoiding chronic postoperative pain. The aim of this study was to evaluate the effectiveness of ultrasound-guided Transversus Abdominis Plane (TAP) block, performed before surgical incision, in providing postoperative analgesia for patients undergoing open ventral hernia repair under general anaesthesia. METHODS Seventy elective patients scheduled for open ventral hernia repair surgery under general anaesthesia were divided randomly into two equal groups: Group I received bilateral TAP block performed before surgical incision (n = 35); Group II received systemic postoperative analgesia with parenteral opioid (morphine) alone (n = 35). Postoperatively pain scores at rest and with movement, total morphine consumption and opioid related side effects were recorded. RESULTS Postoperative pain scores at rest and mobilization/cough were significantly higher in patients without TAP block (p < 0.05). Mean intraoperative fentanyl consumption was comparable between the two groups: 0.75 ± 0.31 mg in group I (TAP) and 0.86 ± 0.29 mg in group II (MO), p = 0.1299. Patients undergoing preincisional TAP block had reduced morphine requirements during the first 24 hours after surgery, compared to patients from group II, without TAP block (p = 0.0001). There was no difference in the incidence of opioid related side effects (nausea, vomiting) in the both groups during the first 24 postoperative hours. CONCLUSION The use of preincisional ultrasound guided TAP block reduced the pain scores at rest and with movement/cough, opioid consumption and opioid-related side effects after ventral hernia repair when compared with opioid-only analgesia.
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Affiliation(s)
- Ion Chesov
- "Valeriu Ghereg" Department of Anaesthesiology and Reanimatology, "Nicolae Testemitanu" State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Adrian Belîi
- "Valeriu Ghereg" Department of Anaesthesiology and Reanimatology, "Nicolae Testemitanu" State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
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Transversus abdominis plane (TAP) block versus thoracic epidural analgesia (TEA) in laparoscopic colon surgery in the ERAS program. Surg Endosc 2017; 32:376-382. [PMID: 28667547 DOI: 10.1007/s00464-017-5686-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/19/2017] [Indexed: 12/20/2022]
Abstract
AIM The enhanced recovery after surgery (ERAS) pathway and laparoscopic approach had been proven beneficial for patients and should now be considered as a standard of care in colorectal surgery. Multimodal analgesia is the gold standard in the ERAS program with the use of thoracic epidural analgesia (TEA). Few data are available on Transversus abdominis plane (TAP) blocks in laparoscopic colorectal surgery and ERAS pathway. The aim of this study is to evaluate the efficacy of TAP block compared to TEA in the management of postoperative pain and the impact on the recurrence of postoperative nausea, vomiting and ileus in laparoscopic colorectal surgery in the ERAS program. METHOD From October 2014 to October 2016, 182 patients underwent elective colon surgical interventions in enhanced recovery after surgery pathway. The patients were divided into two groups: Group 1 (n = 92) and Group 2 (n = 91) who received TEA and TAP block, respectively, with a standardized postoperative analgesic regimen consisting of regular 1 g of paracetamol every 8 h and a rescue dose with intravenous non-steroidal anti-inflammatory drugs infusion for both groups. RESULTS No differences were observed in baseline patient characteristics, clinical variables and surgical procedures between the two groups, as well as in the postoperative complications rate (p = 0.515) in accordance with Clavien-Dindo classification, 90-day mortality (p = 0.319), hospital stay (p = 0.469) and 30-day readmission rate (p = 0.711). Patients in the TAP block group showed lower postoperative nausea and vomiting rates (p = 0.025), as well as lower ileus (p = 0.031) and paraesthesia rates (p = 0.024). No differences were found in urinary retention (p = 0.157). Despite the "opioid-free" analgesia protocol in the TAP block group, pain intensity was comparable between the two groups (p = 0.651). CONCLUSION TAP block combined with an opioid-sparing analgesia in the setting of the laparoscopic colorectal surgery and ERAS program is feasible and effective in postoperative pain control.
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The effect of morphine added to bupivacaine in ultrasound guided transversus abdominis plane (TAP) block for postoperative analgesia following lower abdominal cancer surgery, a randomized controlled study. J Clin Anesth 2017; 39:4-9. [DOI: 10.1016/j.jclinane.2017.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 02/13/2017] [Accepted: 03/04/2017] [Indexed: 11/22/2022]
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McEvoy MD, Scott MJ, Gordon DB, Grant SA, Thacker JKM, Wu CL, Gan TJ, Mythen MG, Shaw AD, Miller TE. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1-from the preoperative period to PACU. Perioper Med (Lond) 2017; 6:8. [PMID: 28413629 PMCID: PMC5390366 DOI: 10.1186/s13741-017-0064-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 03/14/2017] [Indexed: 01/01/2023] Open
Abstract
Background Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver “optimal analgesia,” which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects. Methods With input from a multi-disciplinary, international group of clinicians, and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients. Discussion As a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery ERP. The goal was two-fold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus from the preoperative period to the post-anesthesia care unit. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of optimal analgesia as set forth in this document.
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Affiliation(s)
- Matthew D McEvoy
- Department of Anesthesiology, CIPHER (Center for Innovation in Perioperative Health, Education, and Research) Vanderbilt University Medical Center, 2301VUH, Nashville, TN 37232 USA
| | - Michael J Scott
- Anaesthesia & Intensive Care Medicine, Royal Surrey County NHS Foundation Hospital, Surrey, UK.,Department of Anaesthesia, University of Surrey, Surrey, UK.,University College London, London, UK
| | - Debra B Gordon
- Harborview Integrated Pain Care Program, Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, USA
| | - Stuart A Grant
- Division of Regional Division, Department of Anesthesiology, Duke University Medical Center, Durham, USA
| | - Julie K M Thacker
- Division of Advanced Oncologic and GI Surgery, Department of Surgery, Duke University Medical Center, Durham, USA
| | - Christopher L Wu
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University School of Medicine, Suffolk, USA
| | - Monty G Mythen
- UCL/UCLH National Institute of Health Research Biomedical Research Centre, London, UK
| | - Andrew D Shaw
- Department of Anesthesiology, Vanderbilt University, Nashville, USA
| | - Timothy E Miller
- Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Durham, USA
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Iyer SS, Bavishi H, Mohan CV, Kaur N. Comparison of Epidural Analgesia with Transversus Abdominis Plane Analgesia for Postoperative Pain Relief in Patients Undergoing Lower Abdominal Surgery: A Prospective Randomized Study. Anesth Essays Res 2017; 11:670-675. [PMID: 28928569 PMCID: PMC5594788 DOI: 10.4103/0259-1162.206856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Anesthesiologists play an important role in postoperative pain management. For analgesia after lower abdominal surgery, epidural analgesia and ultrasound-guided transversus abdominis plane (TAP) block are suitable options. The study aims to compare the analgesic efficacy of both techniques. Materials and Methods: Seventy-two patients undergoing lower abdominal surgery under spinal anesthesia were randomized to postoperatively receive lumbar epidural catheter (Group E) or ultrasound-guided TAP block (Group T) through intravenous cannulas placed bilaterally. Group E received 10 ml 0.125% bupivacaine stat and 10 ml 8th hourly for 48 h. Group T received 20 ml 0.125% bupivacaine bilaterally stat and 20 ml bilaterally 8th hourly for 48 h. Pain at rest and on coughing, total paracetamol and tramadol consumption were recorded. Results: Analgesia at rest was comparable between the groups in the first 16 h. At 24 and 48 h, Group E had significantly better analgesia at rest (P = 0.001 and 0.004 respectively). Patients in Group E had significantly higher number of patients with nil or mild pain on coughing at all times. Paracetamol consumption was comparable in both groups, but tramadol consumption was significantly higher in Group T at the end of 48 h (P = 0.001). Conclusion: For lower abdominal surgeries, analgesia provided by intermittent boluses of 0.125% is comparable for first 16 h between epidural and TAP catheters. However, the quality of analgesia provided by the epidural catheter is superior to that provided by TAP catheters beyond that both at rest and on coughing with reduced opioid consumption.
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Affiliation(s)
- Sadasivan Shankar Iyer
- Department of Anesthesiology and Pain Medicine, M. S. Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - Harshit Bavishi
- Department of Anesthesiology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Chadalavada Venkataram Mohan
- Department of Anesthesiology and Pain Medicine, M. S. Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - Navdeep Kaur
- Department of Anesthesiology and Pain Medicine, M. S. Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
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Qazi N, Bhat WM, Iqbal MZ, Wani AR, Gurcoo SA, Rasool S. Postoperative Analgesic Efficacy of Bilateral Transversus Abdominis Plane Block in Patients Undergoing Midline Colorectal Surgeries Using Ropivacaine: A Randomized, Double-blind, Placebo-controlled Trial. Anesth Essays Res 2017; 11:767-772. [PMID: 28928585 PMCID: PMC5594804 DOI: 10.4103/0259-1162.194577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Ultrasound-guided transversus abdominis plane (TAP) block is done as a part of multimodal analgesia for pain relief after abdominal surgeries. This prospective randomized, double-blind, placebo-controlled trial was conducted to evaluate the postoperative analgesic efficacy of bilateral TAP block in patients undergoing midline colorectal surgeries using ropivacaine. Materials and Methods: Eighty patients scheduled for elective colorectal surgeries involving midline abdominal wall incision under general anesthesia were enrolled in this prospective randomized controlled trial. Group A received TAP block with 20 ml of 0.2% ropivacaine on either side of the abdominal wall, and Group B received 20 ml of normal saline. The time to request for rescue analgesia, total analgesic consumption in 24 h, and satisfaction with the anesthetic technique were assessed. Results: The mean visual analog scale scores at rest and on coughing were higher in control group (P > 0.05). Time (min) to request for the first rescue analgesia was prolonged in study group compared to control group (P < 0.001). The total tramadol consumption in 24 h postoperatively was significantly high in control group (P < 0.001). Nausea/vomiting was more common in control group (P > 0.05). The level of satisfaction concerning postoperative pain control/anesthetic technique was higher in study group (P < 0.001). Conclusion: TAP block produces effective and prolonged postoperative analgesia in patients undergoing midline colorectal surgery. It is a technically simple block to perform with a high margin of safety. It produces a considerable reduction in mean intravenous postoperative tramadol requirements, reduction in postoperative pain scores, and increased time to first request for further analgesia, both at rest and on movement.
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Affiliation(s)
- Nahida Qazi
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Wasim Mohammad Bhat
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Malik Zaffar Iqbal
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Anisur Rehman Wani
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Showkat A Gurcoo
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sahir Rasool
- Department of Anaesthesia and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Efficacy of transversus abdominis plane block and rectus sheath block in laparoscopic inguinal hernia surgery. Int Surg 2016; 100:666-71. [PMID: 25875548 DOI: 10.9738/intsurg-d-14-00193.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We aimed to assess the efficacy of transversus abdominis plane (TAP) block and rectus sheath (RS) block in patients undergoing laparoscopic inguinal hernia surgery. Few studies have addressed the efficacy and safety associated with TAP block and RS block for laparoscopic surgery. Thirty-two patients underwent laparoscopic inguinal hernia surgery, either with TAP and RS block (Block(+) group, n = 18) or without peripheral nerve block (Block(-) group, n = 14). Preoperatively, TAP and RS block were performed through ultrasound guidance. We evaluated postoperative pain control and patient outcomes. The mean postoperative hospital stays were 1.56 days (Block+ group) and 2.07 days (Block(-) group; range, 1-3 days in both groups; P = 0.0038). A total of 11 patients and 1 patient underwent day surgery in the Block(+) and Block(-) groups, respectively (P = 0.0012). Good postoperative pain control was more commonly observed in the Block(+) group than in the Block(-) group (P = 0.011). TAP and RS block was effective in reducing postoperative pain and was associated with a fast recovery in patients undergoing laparoscopic inguinal hernia surgery.
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Frassanito L, Pitoni S, Gonnella G, Alfieri S, Del Vicario M, Catarci S, Draisci G. Utility of ultrasound-guided transversus abdominis plane block for day-case inguinal hernia repair. Korean J Anesthesiol 2016; 70:46-51. [PMID: 28184266 PMCID: PMC5296387 DOI: 10.4097/kjae.2017.70.1.46] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/18/2016] [Accepted: 08/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The transversus abdominis plane (TAP) block is a regional anesthesia technique that effectively reduces the pain intensity and use of analgesia in abdominal surgery. The aim of this study was to determine the utility of the ultrasound-guided TAP block in improving the efficacy of the ultrasound-guided ilioinguinal/iliohypogastric nerve (IIN/IHN) block for intraoperative anesthesia and postoperative pain control in day-case inguinal hernia repair (IHR). METHODS We conducted a descriptive study of patients undergoing elective primary unilateral open IHR. Fifty-nine patients were divided into two groups according to the anesthetic technique used: ultrasound-guided TAP block plus ultrasound-guided IIN/IHN block (TAP group) vs. ultrasound-guided IIN/IHN block alone (IIN/IHN group). The outcome measures were the adequacy of anesthesia during surgery and postoperative analgesia. RESULTS Four patients (12.5%) in the TAP group and 10 patients (37.0%) in the IIN/IHN group experienced inadequate anesthesia and needed systemic sedation (P < 0.05). No significant differences in additional local anesthetic volume were found between the two groups. Patients in the TAP group reported lower pain scores at the end of surgery (0.4 ± 0.8 vs. 2.1 ± 2.5, P < 0.01), at 2 hours after surgery (0.8 ± 1.3 vs. 3.0 ± 2.2, P < 0.01), at discharge (1.4 ± 1.2 vs. 4.3 ± 2.2, P < 0.01), and at 24 hours (1.5 ± 1.1 vs. 4.5 ± 2.3, P < 0.01). CONCLUSIONS The combination of the TAP and IIN/IHN blocks is associated with better intraoperative anesthesia and lower postoperative pain scores compared with the IIN/IHN block alone.
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Affiliation(s)
- Luciano Frassanito
- Institute of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Sara Pitoni
- Institute of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Gianluigi Gonnella
- Institute of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Sergio Alfieri
- Institute of Digestive Surgery, Catholic University of the Sacred Heart, "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Miryam Del Vicario
- Institute of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Stefano Catarci
- Institute of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Gaetano Draisci
- Institute of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, "A. Gemelli" University Polyclinic Foundation, Rome, Italy
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