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El-Amrawy WZ, El-Attar AM. Classical TAP vs. I TAP Using the Same Dose of Local Anesthetic in Elective Cesarean Section: A Randomized Controlled Trial. Pain Ther 2024; 13:495-508. [PMID: 38300395 PMCID: PMC11111634 DOI: 10.1007/s40122-023-00564-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 11/10/2023] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION The effectiveness of postoperative pain control following a Cesarean section influences mother-child attachment, improves early healing, and undoubtedly hastens discharge. Transverse abdominis plane (TAP) and ilioinguinal iliohypogastric (ILIH) blocks have been used to minimize postoperative opioid intake, although their relative effectiveness is unknown. The study aims to determine which procedure was more effective at reducing the need for postoperative rescue analgesics after lower segment Cesarean section (LSCS). TAP block or I TAP (TAP block plus ilioinguinal iliohypogastric nerve block). Both procedures used the same amount of local anesthetic. METHODS A sealed envelope technique was used to randomly assign 210 patients who received LSCS into two equal groups to receive either ultrasound (US)-guided TAP block or US-guided ILIH nerve block with US-guided TAP block at the conclusion of the procedure. As per the study protocol, the charge nurse in the postoperative ward gave rescue analgesics to patients who complained of discomfort. At hours 0, 2, 4, 6, 8, 10, and 24 following surgeries, a blinded observer checked on the patient and noted the effectiveness of pain management, the quantity of rescue analgesics used, and patient satisfaction. RESULTS While there was a substantial decrease in pain score while resting at 2, 3, 4, 8, 12, 16, 20, and 24 postoperative hours in the ITAP group, there was not a significant change in visual analogue scale (VAS) score at the first postoperative hour. However, there was a large delay in the first request for analgesia in the ITAP group (13.15 ± 1.85) as opposed to the TAP group (10.06 ± 1.61) and there was a significant decline in nalbuphine use as well as a higher satisfaction score in the ITAP group. CONCLUSIONS Following LSCS, ITAP block offered better postoperative analgesia than TAP block in terms of quality.
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Affiliation(s)
- Wessam Zakaria El-Amrawy
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Ahmed Mohamed El-Attar
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Agarwal J, Babuwe-Ngobi J, Belani KG, Malhotra N. Peripheral nerve blocks for analgesia following cesarean delivery A narrative review. J Anaesthesiol Clin Pharmacol 2024; 40:192-198. [PMID: 38919417 PMCID: PMC11196051 DOI: 10.4103/joacp.joacp_204_22] [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] [Received: 06/01/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/27/2024] Open
Abstract
Spinal and epidural blocks are commonly employed for pain relief during and following cesarean section. Intrathecal morphine (ITM) has been the gold standard for the same for many years. In recent times, many peripheral nerve blocks (PNBs) have been tried for postoperative analgesia following cesarean delivery (PACD). This article has reviewed the common PNBs used for PACD. The role of PNBs along with ITM has been studied and the current best strategy for PACD has also been explored. Currently, Ilio-inguinal nerve and anterior transversus abdominis plane block in conjunction with intrathecal morphine have been found to be the most effective strategy, providing lower rest pain at 6 hours as compared to ITM alone. In patients not receiving intrathecal morphine, recommended PNBs are lateral transversus abdominis plane block, single shot local anesthetic wound infiltration, or continuous wound infiltration with catheter below rectus fascia. PNBs are recommended for PACD. They have an opioid-sparing effect and are devoid of adverse effects associated with central neuraxial blocks such as hypotension, bradycardia, and urine retention. However, caution must be observed with PNBs for possible local anesthetic toxicity due to the large volumes of drug required.
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Affiliation(s)
- Jyotsna Agarwal
- Department of Anaesthesia and Pain Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Joy Babuwe-Ngobi
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kumar G. Belani
- Medicine and Pediatrics, University of Minnesota Medical Center, Minneapolis, MN 55455, USA
| | - Naveen Malhotra
- Department of Cardiac Anaesthesia and Pain Management Centre, PGIMS, Rohtak, Haryana, India
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Jeffries SD, Harutyunyan R, Morse J, Hemmerling TM. Investigation into the clinical performance of rectus sheath block in reducing postoperative pain following surgical intervention: A systematic review and meta-analysis of randomised controlled trials. Indian J Anaesth 2024; 68:142-152. [PMID: 38435659 PMCID: PMC10903772 DOI: 10.4103/ija.ija_1099_23] [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] [Received: 11/12/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 03/05/2024] Open
Abstract
Background and Aims Rectus sheath block (RSB) is an effective postoperative pain control technique in abdominal surgical procedures. This systematic review evaluated the efficacy and outcome data of patients undergoing RSB compared to the standard of care in both laparoscopic and open surgical procedures. Methods This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO ID: CRD42022372596). The search was restricted to randomised controlled trials (RCTs) comparing RSB effectiveness on postoperative pain to any standard general anaesthesia technique (control). We systematically explored PubMed, Medline, Central, Scopus and Web of Science for RCTs from inception to September 2023. The primary outcome was the evaluation of pain scores at rest 0-2, 10-12 and 12-24 h postoperatively. The secondary outcome was the analysis of postoperative intravenous (IV) morphine equivalent consumption at 24-h. A risk-of-bias tool for randomised trials (ROB 2.0, Cochrane, Copenhagen, Denmark) assessment and Grades of Recommendation, Assessment, Development and Evaluation (GRADE, Cochrane, Copenhagen, Denmark) analysis was conducted to evaluate the quality of the RCTs. Results Twenty RCTs involving 708 participants who received RSB intervention and 713 who received alternative analgesic care were included. RSB pain scores were significantly lower than control at 0-2 h (P < 0.001) and 10-12 h (P < 0.001) postoperatively. No significant effect was observed at 24 h (P = 0.11). RSB performance compared to control in 24-h IV morphine equivalency in milligrams was significantly lower (P < 0.001). Conclusion RSB implementation was associated with reduced postoperative pain scores and decreased opioid consumption in IV morphine equivalency up to 24 h following surgical intervention.
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Affiliation(s)
- Sean D. Jeffries
- Department of Experimental Surgery, McGill University Health Center, Montréal, Canada
- Department of Anaesthesia, McGill University, Montréal, Canada
| | - Robert Harutyunyan
- Department of Experimental Surgery, McGill University Health Center, Montréal, Canada
| | - Joshua Morse
- Department of Experimental Surgery, McGill University Health Center, Montréal, Canada
| | - Thomas M. Hemmerling
- Department of Experimental Surgery, McGill University Health Center, Montréal, Canada
- Department of Anaesthesia, McGill University, Montréal, Canada
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Owada Y, Murata Y, Hamaguchi Y, Yamada K, Inomata S, Ogawa K, Ohara Y, Akashi Y, Enomoto T, Maruo K, Tanaka M, Oda T. Comparison of postoperative analgesic effects of thoracic epidural analgesia and rectus sheath block in laparoscopic abdominal surgery: A randomized controlled noninferiority trial. Asian J Endosc Surg 2023; 16:423-431. [PMID: 36958287 DOI: 10.1111/ases.13180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/18/2023] [Accepted: 03/04/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION In the Enhanced Recovery After Surgery program, abdominal wall blocks are strongly recommended as postoperative multimodal analgesia for laparoscopic abdominal surgery. The purpose of this study was to compare the efficacy of single-shot rectus sheath block (RSB) with that of thoracic epidural analgesia (TEA) as a method of multimodal analgesia in patients receiving conventional laparoscopic abdominal surgery. METHODS A noninferiority comparison was performed. Patients scheduled for laparoscopic gastric or colorectal surgery were enrolled in this study. Patients were divided randomly into two groups: TEA and RSB. The primary endpoint was the numerical rating scale (NRS) score upon coughing as of 24 hours after surgery. RESULTS In total, 80 patients were randomly assigned to receive TEA (n = 42) or RSB (n = 38). Three patients were excluded from the TEA group after randomization. The NRS score on coughing as of 24 hours after surgery was significantly lower in the TEA group than in the RSB group (least square mean: 3.59 vs 6.39; 95% confidence interval for the difference: 1.87 to 3.74, P < .001). The NRS scores upon coughing and at rest were significantly lower in the TEA group than in the RSB group as of 4, 24 and 48 hours after surgery. Patient satisfaction with postoperative analgesia was significantly higher in the TEA group. Postoperative adverse events were not significantly different between groups. CONCLUSION This is the first report of comparing RSB with TEA in laparoscopic surgery. TEA may be recommended as a multimodal analgesia protocol for laparoscopic gastric and colorectal surgery.
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Affiliation(s)
- Yohei Owada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuya Murata
- Department of Anesthesiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Yuto Hamaguchi
- Department of Anesthesiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kumiko Yamada
- Department of Anesthesiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Shinichi Inomata
- Department of Anesthesiology, Institution of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Koichi Ogawa
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yusuke Ohara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yosihimasa Akashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tsuyoshi Enomoto
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Makoto Tanaka
- Department of Anesthesiology, Institution of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tatsuya Oda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Ishikawa Y, Sakai DM, Im JS, Zhang S, Reed RA, Quandt JE, Baldo CF, Walters B, Barletta M. Antinociceptive effects of bupivacaine injected within the internal abdominis rectus sheath in standing healthy horses. Vet Anaesth Analg 2023; 50:294-301. [PMID: 37024406 DOI: 10.1016/j.vaa.2023.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE To evaluate a regional anesthetic technique for blocking the abdominal midline in horses. STUDY DESIGN Anatomical description and prospective, crossover, placebo-controlled, blinded study. ANIMALS Adult horses; two cadavers, six healthy animals. METHODS In stage 1, 0.5% methylene blue with 0.25% bupivacaine (0.5 mL kg-1) was injected using ultrasonography into the internal rectus abdominis sheath (RAS) of two cadavers with a one-point or two-point technique. The dye spread was described after the dissection of the abdomens. In stage 2, each horse was injected with 1 mL kg-1 of 0.9% NaCl (treatment PT) or 0.2% bupivacaine (treatment BT) using a two-point technique. The abdominal midline mechanical nociceptive threshold (MNT) was measured with a 1 mm blunted probe tip and results analyzed with mixed-effect anova. Signs of pelvic limb weakness were recorded. RESULTS The cadaver dissections showed staining of the ventral branches from the eleventh thoracic (T11) to the second lumbar (L2) nerve with the one-point technique and T9-L2 with the two-point technique. Baseline MNTs were, mean ± standard deviation, 12.6 ± 1.6 N and 12.4 ± 2.4 N in treatments PT and BT, respectively. MNT increased to 18.9 ± 5.8 N (p = 0.010) at 30 minutes, and MNT was between 9.4 ± 2.0 and 15.3 ± 3.4 N from 1 to 8 hours (p > 0.521) in treatment PT. MNTs in treatment BT were 21.1 ± 5.9 to 25.0 ± 0.1 N from 30 minutes to 8 hours (p < 0.001). MNTs after the RAS injections were higher in treatment BT than PT (p = 0.007). No pelvic limb weakness was observed. CONCLUSIONS AND CLINICAL RELEVANCE Antinociception of at least 8 hours without pelvic limb weakness was observed in the abdominal midline in standing horses after the RAS block. Further investigations are necessary to evaluate suitability for ventral celiotomies.
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Affiliation(s)
- Yushun Ishikawa
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Daniel M Sakai
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.
| | - Jessica Sy Im
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Shufan Zhang
- Institute of Bioinformatics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Rachel A Reed
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Jane E Quandt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Caroline F Baldo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, MN, USA
| | - Brian Walters
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, MN, USA
| | - Michele Barletta
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
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Allen BFS, McEvoy MD. Regional Anesthesia for Thoracic and Abdominal Surgery: Tips and Tricks for the Surgeon. Am Surg 2023; 89:183-191. [PMID: 35798719 DOI: 10.1177/00031348221109499] [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: 01/17/2023]
Abstract
The use of ultrasound-guided regional anesthesia (UGRA) has flourished over the past two decades with the description of many novel techniques and the incorporation of UGRA into patient care pathways for many types of surgery, including thoracic and abdominal surgery. Numerous facial plane blocks have been developed for analgesia of the chest and abdomen. Though analgesic efficacy varies based on the specific technique, it is important to be aware of the regional anesthesia techniques in common usage, their analgesic distributions, side effect profiles, and efficacy. In this review, we describe fascial plane blocks developed since 2010 as well as older regional anesthesia techniques and provide context for how and why they might be incorporated into patient care pathways. We will provide salient details on block coverage and briefly discuss evidence and relevant controversies around their use.
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Affiliation(s)
- Brian F S Allen
- Department of Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew D McEvoy
- Department of Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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7
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Kwon HJ, Kim YJ, Kim Y, Kim S, Cho H, Lee JH, Kim DH, Jeong SM. Complications and Technical Consideration of Ultrasound-Guided Rectus Sheath Blocks: A Retrospective Analysis of 4033 Patients. Anesth Analg 2023; 136:365-372. [PMID: 36638514 DOI: 10.1213/ane.0000000000006282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although the ultrasound-guided rectus sheath block (RSB) is usually regarded as an easy and safe procedure in clinical settings, there is currently no report on complications incidence. Therefore, the present study investigated complications in a large cohort and described the technical considerations to minimize complications of real-time ultrasound-guided RSBs. METHODS This was a retrospective cohort study of patients who underwent real-time ultrasound-guided RSBs for perioperative pain control in laparoscopic surgery with an umbilical port between February 1, 2017, and February 28, 2021, at the Asan Medical Center in South Korea. All RSBs were performed bilaterally using a 23-gauge Quincke needle, and a bilateral 2-block placement was regarded as 1 RSB. Patient data, including demographics, preoperative laboratory data, preoperative antiplatelet or anticoagulant medication with the duration of discontinuation, and type of surgery, were collected to show the study population characteristics and explore potential factors associated with adverse events such as hematoma. Ultrasound images of patients and adverse events of RSBs, including extrarectus sheath injections, vascular injuries, bowel injury, or local anesthetic systemic toxicity, were also analyzed accordingly. RESULTS A total of 4033 procedures were analyzed. The mean body mass index of the patients was 24.1 (21.8-26.5) kg/m2. The preoperative laboratory data were within normal range in 4028 (99.9%) patients. Preoperative antiplatelets or anticoagulants were administered in 17.3% of the patients. Overall, 96 complications (2.4%) were observed. Among them, extrarectus sheath injection occurred in 88 cases (2.2%), which included preperitoneal injection (0.9%) and intraperitoneal injection (1.3%). Vascular injuries constituted 8 cases (0.2%) and all vascular injuries resulted in hematoma: 7 cases of inferior epigastric artery injury with rectus sheath hematoma and 1 of inferior mesenteric artery injury with retroperitoneal hematoma. Bowel injury or local anesthetic systemic toxicity was not reported. CONCLUSIONS In this study of RSBs performed on 4033 patients using a 23-gauge Quincke needle in patients with low body mass index, there were 8 cases (0.2%) of vascular injury, all of which accompanied hematoma.
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Affiliation(s)
- Hyun-Jung Kwon
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeon Ju Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Youngmu Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seonjin Kim
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Hakmoo Cho
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Jong-Hyuk Lee
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Doo-Hwan Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Moon Jeong
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Transversus abdominis plane (TAP) block for pain management of rectus sheath hematoma in the emergency department (ED). Am J Emerg Med 2023; 63:183.e1-183.e3. [PMID: 36369046 DOI: 10.1016/j.ajem.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022] Open
Abstract
Peripheral nerve blocks for pain management have historically been discussed in anesthesiology literature but, until recently, have not been considered in emergency medicine contexts. Transversus abdominis plane (TAP) blocks, in particular, have recently been explored in the emergency department for pain control in acute appendicitis but are potentially helpful for managing abdominal pain of other etiologies. One such pathology is rectus sheath hematomas, where conservative management is often necessary as curative treatments often pose more significant risks than are necessary. We report the case of a 57-year-old female presenting to the emergency department with severe abdominal pain following vigorous exercise. She was found to have a large rectus sheath hematoma on computed tomography. An ultrasound-guided transversus abdominis plane block was performed in the emergency department, and the patient had complete resolution of her pain.
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9
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Fascial plane blocks: moving from the expansionist to the reductionist era. Can J Anaesth 2022; 69:1185-1190. [PMID: 35999333 DOI: 10.1007/s12630-022-02309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/17/2022] [Accepted: 07/13/2022] [Indexed: 01/12/2023] Open
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10
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Garbin M, Benito J, Ruel HLM, Watanabe R, Monteiro BP, Cagnardi P, Steagall PV. Pharmacokinetics of Bupivacaine Following Administration by an Ultrasound-Guided Transversus Abdominis Plane Block in Cats Undergoing Ovariohysterectomy. Pharmaceutics 2022; 14:pharmaceutics14081548. [PMID: 35893804 PMCID: PMC9331386 DOI: 10.3390/pharmaceutics14081548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 02/06/2023] Open
Abstract
Bupivacaine is commonly used for peripheral nerve block in veterinary medicine. This study described the pharmacokinetics of two doses of bupivacaine following administration by an ultrasound-guided transversus abdominis plane (TAP) block in cats undergoing ovariohysterectomy. Twelve healthy female adult cats were included in a randomized, prospective, blinded clinical trial. Anaesthetic protocol included acepromazine–buprenorphine–propofol–isoflurane–meloxicam. Each cat received 1 mL/kg of bupivacaine 0.2% or 0.25% (BUPI-2 and BUPI-2.5, respectively) via bilateral two-point TAP block before surgery (n = 6/group). Plasma concentrations of bupivacaine were detected using liquid chromatography-mass spectrometry. A one-compartment model and non-compartmental analysis described the pharmacokinetic parameters. Bupivacaine was detected up to 480 min (335 ± 76 in BUPI-2 and 485 ± 198 ng/mL in BUPI-2.5). For BUPI-2 and BUPI-2.5, maximum plasma concentrations were 1166 ± 511 and 1810 ± 536 ng/mL at 33 ± 14 and 47 ± 22 min, clearance was 5.3 ± 1.8 and 4.9 ± 1.5 mL/min/kg, and elimination half-life were 253 ± 55 and 217 ± 52 min, respectively. The two doses of bupivacaine via TAP block produced concentrations below toxic levels in cats. A dose of 2.5 mg/kg bupivacaine was safe to be administered using this block in healthy cats.
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Affiliation(s)
- Marta Garbin
- Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada; (M.G.); (J.B.); (H.L.M.R.); (R.W.); or (B.P.M.)
| | - Javier Benito
- Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada; (M.G.); (J.B.); (H.L.M.R.); (R.W.); or (B.P.M.)
| | - Hélène L. M. Ruel
- Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada; (M.G.); (J.B.); (H.L.M.R.); (R.W.); or (B.P.M.)
| | - Ryota Watanabe
- Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada; (M.G.); (J.B.); (H.L.M.R.); (R.W.); or (B.P.M.)
| | - Beatriz P. Monteiro
- Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada; (M.G.); (J.B.); (H.L.M.R.); (R.W.); or (B.P.M.)
| | - Petra Cagnardi
- Department of Veterinary Medicine and Animal Sciences, University of Milan, 26900 Lodi, Italy;
| | - Paulo V. Steagall
- Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada; (M.G.); (J.B.); (H.L.M.R.); (R.W.); or (B.P.M.)
- Department of Veterinary Clinical Sciences and Centre Animal Health and Welfare, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
- Correspondence:
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11
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Toscano A, Capuano P, Attisani M, Rinaldi M, Brazzi L. Transversus thoracic plane block and rectus sheath block for left ventricular assist device implantation via full median sternotomy: A case report. J Card Surg 2022; 37:2115-2119. [PMID: 35254689 DOI: 10.1111/jocs.16391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/21/2022] [Accepted: 02/17/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Traditionally, pain management after left ventricular assist device (LVAD) implantation via median sternotomy have been based on intravenous opioids but, in the era of enhanced recovery after surgery, a multimodal opioid-sparing analgesia could represent a valid alternative reducing opioids related side effects. CASE REPORT We described the successfully use of an opioid-sparing regimen for pain management after LVAD implantation via median sternotomy based on two ultrasound-guided fascial plane wall blocks. Bilateral ultrasound-guided transversus thoracic plane block was performed to manage sternotomy pain; additionally, unilateral left ultrasound-guided rectus sheath block was performed to provide somatic pain relief for left abdominal wall structures superficial to the peritoneum within which the LVAD driveline was inserted. The patient was extubated on Day 1 and good quality analgesia (numerical rating scale <3) was obtained, without using nonsteroidal antiinflammatory drugs or opioids. The patient was discharged from Intensive Care Unit on Day 3 and during hospitalization (lasted 24 days) there was no need for rescue analgesia administration.
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Affiliation(s)
- Antonio Toscano
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Paolo Capuano
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Matteo Attisani
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Mauro Rinaldi
- Department of Surgical Sciences, University of Turin, Turin, Italy.,Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Luca Brazzi
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza' Hospital, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
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Ienello L, Kennedy M, Wendt-Hornickle E, Baldo C, Moshnikova V, Guedes A. Ultrasound-guided rectus sheath block injections in miniature swine cadavers: technique description and distribution of two injectate volumes. Vet Anaesth Analg 2022; 49:210-218. [DOI: 10.1016/j.vaa.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
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13
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Rani D, Aggarwal S, Gupta A, Mudgal P. Ultrasound guided rectus sheath and transverse abdominis blocks for robotic urological surgeries – A case series. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_10_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mohamed RHB, Al Jubran H, Alsaeed Z, Al-Sahwi S, Alhouri S, Al Turaik W. Ultrasound-Guided Transversus Abdominis Plane Block in laparoscopic surgeries: A scoping review. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.2001975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Radwa Hamdi Bakr Mohamed
- Vice Deanship for Quality and Development, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hawra Al Jubran
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zainab Alsaeed
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sukainah Al-Sahwi
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shahad Alhouri
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Walaa Al Turaik
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Toscano A, Cuccomarino S, Capuano P, Bonomo LD, Forcella KMR, Aprà F, Jannaci A, Brazzi L. Effectiveness of Subcostal Transversus Abdominis Plane Block in Subcutaneous Onlay Laparoscopic Approach (SCOLA) Surgery: A Retrospective Observational Study. Surg Laparosc Endosc Percutan Tech 2021; 31:760-764. [PMID: 34369482 DOI: 10.1097/sle.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative analgesia in SCOLA (subcutaneous onlay laparoscopic approach) surgery is traditionally based on intravenous opioids. The aim of this retrospective observational study was to evaluate the efficacy of bilateral subcostal transversus abdominis plane (SCTAP) block on postoperative pain relief in the first 48 postoperative hours following SCOLA. MATERIALS AND METHODS From August 2017 to December 2019, 163 patients were eligible for the analysis. Postoperative analgesia was managed either with an intravenous tramadol continuous infusion (opioid group) or a multimodal opioid-sparing strategy based on bilateral SCTAP block (SCTAP group), according to the anesthesiologist's postoperative plan. After data collection, 103 patients were assigned post hoc to the SCTAP group and 60 patients to the opioid group. The primary outcome was the evaluation of postoperative pain, considering both the Numeric Rating Scale score and the percentage of patients with uncontrolled pain at 6, 12, 24, or 48 hours. Secondary outcomes were differences in the administration of ketorolac rescue analgesia and incidence of mild adverse effects. RESULTS There were no significant differences in median Numeric Rating Scale at 6, 12, 24, and 48 hours and ketorolac rescue dose consumption in both groups. Five patients (4.85% of a total of 103 patients) referred postoperative nausea and vomiting in the SCTAP group versus 10 patients (16.67% of a total of 60 patients) in the opioid group (P=0.02). CONCLUSION Analgesia with SCTAP block seems to represent a feasible and efficient strategy for pain management in patients undergoing SCOLA surgery, allowing good quality analgesia, low opioids requirements, and reduced incidence of postoperative nausea and vomiting.
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Affiliation(s)
| | | | - Paolo Capuano
- Surgical Sciences, "Città della Salute e della Scienza" Hospital, Turin
| | - Luca D Bonomo
- Surgical Sciences, "Città della Salute e della Scienza" Hospital, Turin
| | | | - Fabrizio Aprà
- General Surgery Unit, Chivasso Hospital, Chivasso, Italy
| | | | - Luca Brazzi
- Departments of Anesthesia, Critical Care, and Emergency
- Surgical Sciences, "Città della Salute e della Scienza" Hospital, Turin
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Teshome D, Hunie M, Essa K, Girma S, Fenta E. Rectus sheath block and emergency midline laparotomy at a hospital in Ethiopia: A prospective observational study. Ann Med Surg (Lond) 2021; 68:102572. [PMID: 34336198 PMCID: PMC8318980 DOI: 10.1016/j.amsu.2021.102572] [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] [Received: 05/23/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Midline laparotomy is associated with severe postoperative pain. Literature showed controversial results regarding the efficacy of the rectus sheath block. METHODS This is a prospective cohort study that recruits 30 patients in the rectus sheath block (RSB) group and 30 patients in the multimodal analgesia (MMA) group who underwent emergency midline laparotomy. The RSB was performed by an experienced anesthetist using a land-mark technique. Independent t-test and Mann-Whitney-U test were used for numeric data while Chi-Square or Fisher exact test was used for categorical variables. P-values < 0.05 were considered as statistically significant. RESULTS The numeric rating scale score at the recovery was significantly reduced in an RSB group with a p-value of 0.039. Postoperative numeric rating scale scores at 3rd, 6th, 12th, and 24th hours were statistically significantly lower in the RSB group. Postoperative tramadol consumption in 24 h was significantly lower with a p-value of 0.0001 for the rectus sheath group. CONCLUSIONS For midline laparotomy, adding a bilateral rectus sheath block at the end of the operation might be an effective postoperative analgesia option.
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Affiliation(s)
- Diriba Teshome
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Metages Hunie
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Keder Essa
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sossina Girma
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Efrem Fenta
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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17
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Hamid HKS, Ahmed AY, Alhamo MA, Davis GN. Efficacy and Safety Profile of Rectus Sheath Block in Adult Laparoscopic Surgery: A Meta-analysis. J Surg Res 2021; 261:10-17. [PMID: 33387729 DOI: 10.1016/j.jss.2020.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rectus sheath block (RSB) has been increasingly used for pain management after laparoscopic procedures but with a conflicting data on its analgesic efficacy. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of RSB in adults undergoing laparoscopic surgery. METHODS A systematic literature search of the PubMed, Embase, CINAHL, and Cochrane Library databases was conducted from inception through October 1, 2020, to identify trials comparing RSB with a control group in laparoscopic surgery. The primary outcome was rest pain scores at 0-2 h postoperatively. Secondary outcomes included pain scores at rest at 10-12 and 24 h postoperatively, pain scores on movement at 0-2, 10-12, and 24 h postoperatively, 24- and 48-h opioid consumption, opioid-related side effects, and RSB-associated adverse events. RESULTS Nine trials with 698 patients were included. RSB was associated with significantly lower rest pain scores at 0-2 h postoperatively (standardized mean difference -1.83, 95% confidence interval [-2.70, -0.96], P < 0.001, I2 = 95%) than control. Furthermore, RSB significantly reduced pain scores at rest at 10-12 h postoperatively and on movement at 0-2 h postoperatively, 24-h opioid consumption, and opioid-related side effects. Other secondary outcomes were similar between groups. Preoperative RSB provided better pain control compared with postoperative block administration. None of the studies reported local or systemic complications related to RSB. CONCLUSIONS In the setting of laparoscopic surgery, RSB improves pain control for up to 12 h postoperatively and reduces opioid consumption, without major reported adverse events.
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Affiliation(s)
- Hytham K S Hamid
- Department of Surgery, Soba University Hospital, Khartoum, Sudan.
| | - Amjed Y Ahmed
- Department of Surgery, Soba University Hospital, Khartoum, Sudan
| | - Manhl A Alhamo
- Department of Nursing, Alexandria University, Alexandria, Egypt
| | - George N Davis
- Department of Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
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Danar Sumantri S. Low-cost techniques for bilateral intermittent transversus abdominis plane block using intravenous cannula following cesarean section. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_179_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Management of pain after Cesarean delivery without intrathecal morphine: networking for the best answer. Can J Anaesth 2020; 67:1704-1709. [PMID: 33021726 DOI: 10.1007/s12630-020-01819-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/21/2020] [Indexed: 10/23/2022] Open
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