A randomized clinical study on postoperative pain comparing between the supraglottic airway device and endotracheal tubing in transabdominal preperitoneal repair (TAPP)

Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair Under Combined Spinal Epidural Anesthesia Versus General Anesthesia

BACKGROUND

Inguinal hernia repair is one of the most frequently used elective surgical operations in the world. General anesthesia (GA) has risks and routine postoperative complications, such as nausea, vomiting, throat irritation, and postoperative pain. Regional anesthesia (RA) has many advantages over GA, such as faster recovery, less postoperative pain, nausea, and vomiting, and less hemodynamic compromise. We aimed to investigate the efficacy and safety of combined spinal and epidural anesthesia (CSEA) in preventing shoulder pain in patients undergoing totally extraperitoneal herniorrhaphy (TEP).

MATERIALS AND METHODS

The files of patients who had undergone the TEP method under GA and CSEA due to inguinal hernia between April 2020 and November 2021 at the Bakirköy Dr. Sadi Konuk Training and Research Hospital were reviewed retrospectively.

RESULTS

A total of 81 patients were included in the study. The number of patients operated on GA (group 1) was 40, and the number of patients operated under CSEA (group 2) was 41. There was no significant difference in the demographic characteristics of the patients. The surgical time was 42.9 and 42.5 minutes in groups 1 and 2, respectively (P=0.970). The mean operative time was recorded as 60.1 and 80.2 minutes in groups 1 and 2, respectively, and it was statistically significantly shorter in group 1 (P<0.001). A peritoneal tear was seen in 18 patients (43.90%) in the GA group and 16 patients (40%) in the CSEA group, but no significant difference was found between the groups (P=0.823). Mild shoulder pain that did not require intervention was observed in 1 patient (2.5%) in the CSEA group. In group 2, the VAS scores at all times and the need for postoperative analgesia were statistically significantly lower (P<0.001). In terms of anesthesia complications, headache was not observed in group 1, while it was seen in 6 (15%) patients in group 2 (P=0.012).

CONCLUSIONS

In laparoscopic TEP surgeries, CSEA may be an alternative anesthesia method to GA anesthesia due to the low VAS score, less need for analgesia, and fewer postoperative pulmonary complications.

The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery

BACKGROUND

Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique.

METHODS

The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications.

RESULTS

The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 ( P <0.001). Postoperative pain was significantly less in group 2 for the 4th hour ( P <0.0001) and the 12th hour ( P =0.047). There was no difference between the 2 groups in terms of peritoneal tear ( P =0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 ( P =0.038, P =0015, respectively).

CONCLUSION

CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.

Effect of facemask oxygenation with and without positive pressure ventilation on gastric volume during anesthesia induction in patients undergoing laparoscopic cholecystectomy or partial hepatectomy: a randomized controlled trial

BACKGROUND

Studies focusing on the relationship between gastric volume and facemask oxygenation without ventilation during apnea in anesthesia induction are scarce. This study compared the change in gastric volume during apnea in anesthesia induction using facemask ventilation and facemask oxygenation without ventilation in adults undergoing laparoscopic surgery.

METHODS

In this prospective, randomized, double-blinded trial, 70 adults undergoing laparoscopic surgery under general anesthesia were divided into two groups to receive facemask oxygenation with and without ventilation for 60 seconds after loss of consciousness. Before anesthesia induction and after endotracheal intubation, the gastric antral cross-sectional area was measured with ultrasound imaging. Arterial blood gases were tested at baseline (T1), after preoxygenation (T2), after loss of consciousness (T3), and before and after endotracheal intubation (T4 and T5, respectively).

RESULTS

Sixty patients were included (ventilation n = 30; non ventilation n = 30, 10 patients were excluded). The median [IQR] change of gastric antral cross-sectional area in ventilation group was significantly higher than in non ventilation group (0.83 [0.20 to 1.54] vs. 0.10 [- 0.11 to 0.56] cm₂, P = 0.001). At T4 and T5, the PaO₂ in ventilation group was significantly higher than in non ventilation group (T4: 391.83 ± 61.53 vs. 336.23 ± 74.99 mmHg, P < 0.01; T5: 364.00 ± 58.65 vs. 297.13 ± 86.95 mmHg, P < 0.01), while the PaCO₂ in non ventilation group was significantly higher (T4: 46.57 ± 5.78 vs. 37.27 ± 6.10 mmHg, P < 0.01; T5: 48.77 ± 6.59 vs. 42.63 ± 6.03 mmHg, P < 0.01) and the pH value in non ventilation group was significantly lower (T4: 7.35 ± 0.029 vs 7.42 ± 0.047, P < 0.01; T5: 7.34 ± 0.033 vs 7.39 ± 0.044, P < 0.01). At T4, the HCO₃^- in non ventilation group was significantly higher (25.79 ± 2.36 vs. 23.98 ± 2.18 mmol l^- 1, P < 0.01).

CONCLUSIONS

During apnoea, the increase in gastric volume was milder in patients undergoing facemask oxygenation without ventilation than with positive pressure ventilation.

TRIAL REGISTRATION

ChiCTR2100054193, 10/12/2021, Title: "Effect of positive pressure and non-positive pressure ventilation on gastric volume during induction of general anesthesia in laparoscopic surgery: a randomized controlled trial". Website: https://www.chictr.ogr.cn .

Comparison of I-gel and LMA Protector in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Aims

Comparison of the use of I-gel and Laringeal Mask Airway (LMA) Protector in laparoscopic cholecystectomy regarding the time and ease of insertion for supraglottic airway devices (SAD) and gastric tube (GT), airway sealing capacity, and postoperative complications.

Patients and Methods

Sixty-four American Society of Anaesthesiologists (ASA) I-III patients undergoing laparoscopic cholecystectomy were randomly allocated into two groups. After anesthesia induction, LMA Protector was inserted in Group LPRO (LMA Protector) (n = 33) and I-gel was inserted in Group IGEL (I-gel) (n = 31) patients. Time of SAD insertion, number of attempts, time, and ease of GT insertion were recorded. The peak inspiratory pressure (PIP) and oropharyngeal leak pressure (OLP) were measured at the time of SAD insertion, 10 min after insertion, 10 min after pneumoperitoneum, and just before the termination of pneumoperitoneum. The presence of bloodstains on SAD, sore throat, hoarseness, nausea, and pain in swallowing was assessed postoperatively. A P value of < 0.05 was accepted as statistically significant.

Result

Two patients in Group LPRO needed endotracheal intubation and were excluded from the study. The SAD insertion time was shorter in Group IGEL than in Group LPRO (13 ± 7.4 s vs. 18.8 ± 9.8 s). The number of attempts and success rate on the first attempt were similar in both groups. GT insertion time was shorter in Group IGEL than Group LPRO (11 ± 7.7 s vs. 21 ± 11 s). The insertion of GT was easier in Group IGEL. The OLP levels decreased during the pneumoperitoneum in Group LPRO while they remained constant in Group IGEL.

Conclusion

We observed that I-gel offers more stable airway sealing and easier GT insertion advantages when compared with LMA Protector in laparoscopic cholecystectomy.