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Lohmöller K, Carstensen V, Pogatzki-Zahn EM, Freys SM, Weibel S, Schnabel A. Regional anaesthesia for postoperative pain management following laparoscopic, visceral, non-oncological surgery a systematic review and meta-analysis. Surg Endosc 2024; 38:1844-1866. [PMID: 38307961 DOI: 10.1007/s00464-023-10667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Postoperative pain management following laparoscopic, non-oncological visceral surgery in adults is challenging. Regional anaesthesia could be a promising component in multimodal pain management. METHODS We performed a systematic review and meta-analysis with GRADE assessment. Primary outcomes were postoperative acute pain intensity at rest/during movement after 24 h, the number of patients with block-related adverse events and the number of patients with postoperative paralytic ileus. RESULTS 82 trials were included. Peripheral regional anaesthesia combined with general anaesthesia versus general anaesthesia may result in a slight reduction of pain intensity at rest at 24 h (mean difference (MD) - 0.72 points; 95% confidence interval (CI) - 0.91 to - 0.54; I2 = 97%; low-certainty evidence), which was not clinically relevant. The evidence is very uncertain regarding the effect on pain intensity during activity at 24 h (MD -0.8 points; 95%CI - 1.17 to - 0.42; I2 = 99%; very low-certainty evidence) and on the incidence of block-related adverse events. In contrast, neuraxial regional analgesia combined with general anaesthesia (versus general anaesthesia) may reduce postoperative pain intensity at rest in a clinical relevant matter (MD - 1.19 points; 95%CI - 1.99 to - 0.39; I2 = 97%; low-certainty evidence), but the effect is uncertain during activity (MD - 1.13 points; 95%CI - 2.31 to 0.06; I2 = 95%; very low-certainty evidence). There is uncertain evidence, that neuraxial regional analgesia combined with general anaesthesia (versus general anaesthesia) increases the risk for block-related adverse events (relative risk (RR) 5.11; 95%CI 1.13 to 23.03; I2 = 0%; very low-certainty evidence). CONCLUSION This meta-analysis confirms that regional anaesthesia might be an important part of multimodal postoperative analgesia in laparoscopic visceral surgery, e.g. in patients at risk for severe postoperative pain, and with large differences between surgical procedures and settings. Further research is required to evaluate the use of adjuvants and the additional benefit of regional anaesthesia in ERAS programmes. PROTOCOL REGISTRATION PROSPERO CRD42021258281.
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Affiliation(s)
- Katharina Lohmöller
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer Campus 1 A, 48149, Münster, Germany
| | - Vivian Carstensen
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer Campus 1 A, 48149, Münster, Germany
| | - Esther M Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer Campus 1 A, 48149, Münster, Germany
| | - Stephan M Freys
- Department of Surgery, DIAKO Diakonie Hospital, Bremen, Germany
| | - Stephanie Weibel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Schnabel
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer Campus 1 A, 48149, Münster, Germany.
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Mongelli F, Marengo M, Bertoni MV, Volontè F, Ledingham NS, Garofalo F. Laparoscopic-Assisted Transversus Abdominis Plane (TAP) Block Versus Port-Site Infiltration with Local Anesthetics in Bariatric Surgery: a Double-Blind Randomized Controlled Trial. Obes Surg 2023; 33:3383-3390. [PMID: 37740830 DOI: 10.1007/s11695-023-06825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/21/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The transversus abdominis plane (TAP) block has shown great potential usefulness in the management of postoperative pain; however, there is lacking evidence regarding its use in bariatric surgery. This randomized double-blind trial was aimed at comparing the effectiveness of the TAP block and port-site infiltration (PSI) in patients undergoing bariatric surgery. METHODS We included patients ≥ 18 years old undergoing bariatric surgery. From July 2020 to July 2021, all eligible patients were randomized to receive either laparoscopic-assisted TAP block or PSI. Demographic and clinical data were collected and analyzed. RESULTS During the study period, we included 113 patients. Fifty-one were allocated to the TAP block group and 62 to the PSI group. The mean age was 47.9 ± 11.2 years, 88 (77.9%) patients were female, and mean BMI was 40.5 ± 5.9 kg/m2. Operative time was 110 ± 42 min vs. 114 ± 41 min in the TAP block and PSI groups (p = 0.658). At 24 h after surgery, pain on the VAS was 2.5 ± 2.6 vs. 2.3 ± 2.1 (p = 0.661). No significant difference between the groups was noted at 3, 6, 12, and 18 h. Also, opioid and antiemetic consumption, the length of stay (3.4 ± 1.5 days vs. 3.2 ± 1.1 days, p = 0.392), and satisfaction score (154 ± 10 pts vs. 154 ± 16 pts, p = 0.828) were similar in the two groups. CONCLUSIONS Patients undergoing bariatric surgery and receiving either the TAP block or the PSI had similar postoperative pain, nausea, length of stay, and satisfaction. As PSI is technically easier and more reproducible, it might be the first choice for postoperative multimodal analgesia in bariatric surgery.
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Affiliation(s)
- Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6500, Lugano, Switzerland.
| | - Michele Marengo
- Department of Surgery, Locarno Regional Hospital, EOC, 6600, Locarno, Switzerland
| | | | | | | | - Fabio Garofalo
- Department of Surgery, Lugano Regional Hospital, EOC, 6900, Lugano, Switzerland
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De Cassai A, Paganini G, Pettenuzzo T, Zarantonello F, Boscolo A, Tulgar S, Carron M, Munari M, Navalesi P. Single-Shot Regional Anesthesia for Bariatric Surgery: a Systematic Review and Network Meta-Analysis. Obes Surg 2023; 33:2687-2694. [PMID: 37498489 DOI: 10.1007/s11695-023-06737-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Laparoscopic bariatric surgeries can cause intense postoperative pain. Opioid medication can alleviate the pain but can have harmful side effects especially in patients with obstructive sleep apnea. To promote early recovery, enhanced recovery after surgery guideline advises minimizing opioid use and opting for alternative analgesics. This paper aims to investigate the effect of regional anesthesia techniques through a systematic review and network meta-analysis. Primary outcome is postoperative morphine equivalent consumption at 24 h. METHODS Search was conducted in the following databases: PubMed, CENTRAL, Scopus, and EMBASE, from the inception until 10 January 2023. The eligibility criteria were determined by PICOS, including postoperative opioid consumption, pain scores, time to ambulate, use of additional analgesics, and adverse events. The quality assessment was performed using the Risk of Bias 2 Tool, and the certainty of evidence was assessed using the GRADE approach. Funnel plots were used to evaluate publication bias. RESULTS We included 22 studies in quantitative synthesis. A review of 12 studies found that all techniques had a lower mean consumption of opioids compared to placebo or no intervention, with TAP block having the greatest reduction. The quality of evidence for postoperative pain, PONV, time to deambulate, and use of rescue analgesics, was rated as moderate, with TAP block being the most effective intervention. There was no publication bias in any outcome. CONCLUSIONS TAP block is superior to other regional anesthesia techniques in reducing opioid consumption, pain, PONV, and use of rescue analgesics in bariatric surgery. However, further research is needed.
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Affiliation(s)
- Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy.
| | - Greta Paganini
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Tommaso Pettenuzzo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | | | - Annalisa Boscolo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Samsun Training and Research Hospital, Samsun University, Samsun, Turkey
| | - Michele Carron
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Marina Munari
- UOC Anesthesia and Intensive Care Unit Sant'Antonio, University Hospital of Padua, Padua, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
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Ibrahim M, Elnabtity AM, Hegab A, Alnujaidi OA, El Sanea O. Combined opioid free and loco-regional anaesthesia enhances the quality of recovery in sleeve gastrectomy done under ERAS protocol: a randomized controlled trial. BMC Anesthesiol 2022; 22:29. [PMID: 35062872 PMCID: PMC8781357 DOI: 10.1186/s12871-021-01561-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/28/2021] [Indexed: 02/06/2023] Open
Abstract
Background It is debatable whether opioid-free anaesthesia (OFA) is better suited than multimodal analgesia (MMA) to achieve the goals of enhanced recovery after surgery (ERAS) in patients undergoing laparoscopic sleeve gastrectomy. Methods In all patients, anaesthesia was conducted with an i.v. induction with propofol (2 mg. kg-1), myorelaxation with cisatracurium (0.15 mg.kg-1), in addition to an ultrasound-guided bilateral oblique subcostal transverse abdominis plane block. In addition, patients in the OFA group (n = 51) received i.v. dexmedetomidine 0.1 μg.kg-1 and ketamine (0.5 mg. kg-1) at induction, then dexmedetomidine 0.5 μg. kg-1.h-1, ketamine 0.5 mg.kg-1.h-1, and lidocaine 1 mg. kg-1.h-1 for maintenance, while patients in the MMA group (n = 52) had only i.v. fentanyl (1 μg. kg-1) at induction. The primary outcome was the quality of recovery assessed by QoR-40, at the 6th and the 24th postoperative hour. Secondary outcomes were postoperative opioid consumption, time to ambulate, time to tolerate oral fluid, and time to readiness for discharge. Results At the 6th hour, the QoR-40 was higher in the OFA than in the MMA group (respective median [IQR] values: 180 [173–195] vs. 185 [173–191], p < 0.0001), but no longer difference was found at the 24th hour (median values = 191 in both groups). OFA also significantly reduced postoperative pain and morphine consumption (20 mg [1–21] vs. 10 mg [1–11], p = 0.005), as well as time to oral fluid tolerance (238 [151–346] vs. 175 min [98–275], p = 0.022), and readiness for discharge (505 [439–626] vs. 444 min [356–529], p = 0.001), but did not influence time to ambulate. Conclusion While regional anaesthesia achieved most of the intraoperative analgesia, avoiding intraoperative opioids with the help of this OFA protocol was able to improve several sensible parameters of postoperative functional recovery, thus improving our knowledge on the OFA effects. Clinical trial number Registration number NCT04285255.
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Transversus Abdominis Plane Block Versus Intraperitoneal Local Anesthetics in Bariatric Surgery: A Systematic Review and Network Meta-analysis. Obes Surg 2021; 31:4305-4315. [PMID: 34282569 DOI: 10.1007/s11695-021-05564-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transversus abdominis plane (TAP) block and intraperitoneal local anesthetics (IPLA) are widely investigated techniques that potentially improve analgesia after bariatric surgery. The analgesic efficacy of TAP block has been shown in previous studies, but the performance of TAP block can be difficult in patients with obesity. We performed a systematic review and meta-analysis to compare the analgesic efficacy of TAP block and IPLA. An alternative technique is useful in clinical setting when TAP block is not feasible. METHODS We searched PubMed, Embase, and CENTRAL from inception until August 2020 for randomized controlled trials comparing both techniques. The primary outcome was cumulative morphine consumption at 24 h. Secondary pain-related outcomes included pain score at rest and on movement at 2, 6, 12, and 24 h; postoperative nausea and vomiting; and length of hospital stay. RESULTS We included 23 studies with a total of 2,178 patients. TAP block is superior to control in reducing opioid consumption at 24 h, improving pain scores at all the time points and postoperative nausea and vomiting. The cumulative opioid consumption at 24 h for IPLA is less than control, while the indirect comparison between IPLA with PSI and control showed a significant reduction in pain scores at rest, at 2 h, and on movement at 12 h, and 24 h postoperatively. CONCLUSIONS Transversus abdominis plane block is effective for reducing pain intensity and has superior opioid-sparing effect compared to control. Current evidence is insufficient to show an equivalent analgesic benefit of IPLA to TAP block.
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Saravanan R, Venkatraman R, Karthika U. Comparison of Ultrasound-Guided Modified BRILMA Block with Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy - A Randomized Controlled Trial. Local Reg Anesth 2021; 14:109-116. [PMID: 34239324 PMCID: PMC8259940 DOI: 10.2147/lra.s316320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims Subcostal Transversus Abdominis Plane (TAP) block is the standard practice for postoperative analgesia following laparoscopic cholecystectomy. This study aimed to compare the efficacy of modified BRILMA Block (blocking the BRanches of Intercostal nerves at the Level of Mid-Axillary line) with Subcostal TAP block for pain relief following laparoscopic cholecystectomy. Methods Sixty cases scheduled for laparoscopic cholecystectomy were randomly divided into two groups: modified BRILMA block (Group B) and Subcostal TAP block (Group T). General anesthesia was standardized for both groups. Blocks were performed with 20 mL of 0.2% Ropivacaine under ultrasound guidance after induction of anesthesia. Patients were administered morphine through patient controlled analgesia (PCA) pump with a bolus dose of 1 mg, 10 min lockout interval, and a basal infusion rate of 0.1 mg/h. The pain was assessed by the Visual Analog Scale (VAS) scores of one to ten. The total morphine consumption, time to first request for rescue analgesia, and VAS scores at rest and with movement, and complications, if any, were recorded. Results The morphine consumption in Group B was 5.67 ± 1.98 mg and in Group T was 5.17 ± 1.85 mg, which was found to be statistically insignificant (p-value = 0.317). The time to first request for rescue analgesia was 759.33 ± 80.29 min in Group B which was comparable to 854 ± 93.01 min in Group T and statistically insignificant (p-value = 0.295). The average VAS scores at rest as well as on movement were comparable in both the groups during the entire 24 h postoperative period. No complications were encountered in our study. Conclusion Ultrasound-guided modified BRILMA block is equally efficacious as subcostal TAP block in providing postoperative analgesia with similar morphine consumption and no significant difference in VAS scores at rest and movement following laparoscopic cholecystectomy. Trial Registration Number CTRI/2020/02/023457.
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Affiliation(s)
- Ravi Saravanan
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, 603203, India
| | - Rajagopalan Venkatraman
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, 603203, India
| | - Urkavalan Karthika
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, 603203, India
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Freitag FAV, Amora DDS, Muehlbauer E, Dornbusch PT, Machado M, Montiani-Ferreira F, Prisco Farias EL, Valverde A, Duque Moreno JC. Ultrasound-guided modified subcostal transversus abdominis plane block and influence of recumbency position on dye spread in equine cadavers. Vet Anaesth Analg 2021; 48:596-602. [PMID: 33903072 DOI: 10.1016/j.vaa.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/28/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe and evaluate an ultrasound-guided modified subcostal approach for the transversus abdominis plane (TAP) block in horse cadavers in lateral or dorsal recumbency. STUDY DESIGN Prospective, experimental cadaveric study. ANIMALS Study of one preserved foal and eight fresh adult horse cadavers. METHODS The lateral and ventral abdominal wall of a preserved cadaver was dissected to identify the muscles and nerves. A unilateral standard TAP block technique was performed (60 mL of methylene blue dye-bupivacaine) on a fresh cadaver in right lateral recumbency. A modified subcostal technique was performed on the opposite side using a linear ultrasound transducer and in-plane approach. Injection points (two 30 mL dye) were at the level of the TAP (between the rectus abdominis and transversus abdominis muscles and ventral to the cutaneous trunci muscle) perpendicular to: 1) the mid-point between the xiphoid cartilage and umbilical scar; and 2) at a point between the caudal and middle thirds of the abdomen measured from the first injection point to the umbilical scar. The modified subcostal approach was performed in seven additional cadavers in both hemiabdomens, with three cadavers in lateral and four cadavers in dorsal recumbency. Ultrasound guidance was used with all injections. RESULTS The standard approach stained the sixteenth to eighteenth thoracic nerves (T16-T18). The modified subcostal approach performed in lateral recumbency provided greater spread (T9-T17) than dorsal recumbency (T12-T18) (p = 0.016). CONCLUSIONS AND CLINICAL RELEVANCE The modified subcostal TAP approach resulted in extensive staining exceeding the standard approach. The nerves stained are consistent with production of ventral abdominal wall anesthesia in horses. Clinical studies are needed to verify these findings.
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Affiliation(s)
- Flavio A V Freitag
- Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil; Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Dorli da S Amora
- Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil
| | - Eloisa Muehlbauer
- Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil
| | - Peterson T Dornbusch
- Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil
| | - Marcello Machado
- Anatomy Department, Biological Science Sector, Federal University of Paraná, Curitiba, PR, Brazil
| | | | - Edison L Prisco Farias
- Anatomy Department, Biological Science Sector, Federal University of Paraná, Curitiba, PR, Brazil
| | - Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Boselli E, Hopkins P, Lamperti M, Estèbe JP, Fuzier R, Biasucci DG, Disma N, Pittiruti M, Traškaitė V, Macas A, Breschan C, Vailati D, Subert M. European Society of Anaesthesiology and Intensive Care Guidelines on peri-operative use of ultrasound for regional anaesthesia (PERSEUS regional anesthesia): Peripheral nerves blocks and neuraxial anaesthesia. Eur J Anaesthesiol 2021; 38:219-250. [PMID: 33186303 DOI: 10.1097/eja.0000000000001383] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nowadays, ultrasound-guidance is commonly used in regional anaesthesia (USGRA) and to locate the spinal anatomy in neuraxial analgesia. The aim of this second guideline on the PERi-operative uSE of UltraSound (PERSEUS-RA) is to provide evidence as to which areas of regional anaesthesia the use of ultrasound guidance should be considered a gold standard or beneficial to the patient. The PERSEUS Taskforce members were asked to define relevant outcomes and rank the relative importance of outcomes following the GRADE process. Whenever the literature was not able to provide enough evidence, we decided to use the RAND method with a modified Delphi process. Whenever compared with alternative techniques, the use of USGRA is considered well tolerated and effective for some nerve blocks but there are certain areas, such as truncal blocks, where a lack of robust data precludes useful comparison. The new frontiers for further research are represented by the application of USG during epidural analgesia or spinal anaesthesia as, in these cases, the evidence for the value of the use of ultrasound is limited to the preprocedure identification of the anatomy, providing the operator with a better idea of the depth and angle of the epidural or spinal space. USGRA can be considered an essential part of the curriculum of the anaesthesiologist with a defined training and certification path. Our recommendations will require considerable changes to some training programmes, and it will be necessary for these to be phased in before compliance becomes mandatory.
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Affiliation(s)
- Emmanuel Boselli
- From the Department of Anaesthesiology, Pierre Oudot Hospital, Bourgoin-Jallieu, University Claude Bernard Lyon I, University of Lyon, France (EB), Leeds Institute of Medical Research at St James's School of Medicine, University of Leeds, Leeds, UK (PH), Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (ML), Department of Anaesthesiology, Intensive Care and Pain Medicine, University hospital of Rennes, Rennes, France (JPE), Department of Anaesthesiology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France (RF), Intensive Care Unit, Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy (DGB), Department of Anaesthesiology, IRCCS Istituto Giannina Gaslini, Genova, Italy (ND), Department of Surgery, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy (MP), Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania (VT, AM), Department of Anaesthesia, Klinikum Klagenfurt, Austria (CB), Anaesthesia and Intensive Care Unit, Melegnano Hospital (DV) and Department of Surgical and Intensive Care Unit, Sesto San Giovanni Civic Hospital, Milan, Italy (MS)
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Transversus Abdominis Plane Block Appears to Be Effective and Safe as a Part of Multimodal Analgesia in Bariatric Surgery: a Meta-analysis and Systematic Review of Randomized Controlled Trials. Obes Surg 2020; 31:531-543. [PMID: 33083978 PMCID: PMC7847866 DOI: 10.1007/s11695-020-04973-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022]
Abstract
Purpose Pain after bariatric surgery can prolong recovery. This patient group is highly susceptible to opioid-related side effects. Enhanced Recovery After Surgery guidelines strongly recommend the administration of multimodal medications to reduce narcotic consumption. However, the role of ultrasound-guided transversus abdominis plane (USG-TAP) block in multimodal analgesia of weight loss surgeries remains controversial. Materials and Methods A systematic search was performed in four databases for studies published up to September 2019. We considered randomized controlled trials that assessed the efficacy of perioperative USG-TAP block as a part of multimodal analgesia in patients with laparoscopic bariatric surgery. Results Eight studies (525 patients) were included in the meta-analysis. Pooled analysis showed lower pain scores with USG-TAP block at every evaluated time point and lower opioid requirement in the USG-TAP block group (weighted mean difference (WMD) = − 7.59 mg; 95% CI − 9.86, − 5.39; p < 0.001). Time to ambulate was shorter with USG-TAP block (WMD = − 2.22 h; 95% CI − 3.89, − 0.56; p = 0.009). This intervention also seemed to be safe: only three non-severe complications with USG-TAP block were reported in the included studies. Conclusion Our results may support the incorporation of USG-TAP block into multimodal analgesia regimens of ERAS protocols for bariatric surgery. Electronic supplementary material The online version of this article (10.1007/s11695-020-04973-8) contains supplementary material, which is available to authorized users.
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Transversus abdominis plane block using a short-acting local anesthetic reduces pain and opioid consumption after laparoscopic bariatric surgery: a meta-analysis. Surg Obes Relat Dis 2020; 16:1349-1357. [DOI: 10.1016/j.soard.2020.04.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/19/2020] [Accepted: 04/16/2020] [Indexed: 11/21/2022]
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Aamir MA, Sahebally SM, Heneghan H. Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery-a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Obes Surg 2020; 31:133-142. [PMID: 32779074 DOI: 10.1007/s11695-020-04898-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Effective postoperative analgesia is paramount in patients undergoing bariatric surgery, given their increased predisposition to narcotic-induced respiratory depression. Transversus abdominis plane (TAP) block has shown promise in the enhanced recovery pathway for several abdominal procedures. We performed a systematic review and meta-analysis to compare the effectiveness of TAP block in laparoscopic bariatric surgery. MATERIALS AND METHODS PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until June 2020. All randomized trials that compared TAP blocks versus none in laparoscopic bariatric procedures were included. The primary outcome was narcotic consumption at 24 h postoperatively, whilst secondary outcomes included postoperative pain scores at 24 h, time to ambulation, postoperative nausea and vomiting (PONV) and complication rates. Random effects models were used to calculate pooled effect size estimates. RESULTS Seven randomized controlled trials were included, capturing 617 patients. There was high statistical heterogeneity across studies. On random effects analysis, there were no significant differences in narcotic consumption (MD -12.63 mg, 95% CI = -31.67 to 6.41, p = 0.19), pain scores (MD -0.71, 95% CI = -1.93 to 0.50, p = 0.25) or complications (RD = -0.00, 95% CI = -0.03 to 0.03, p = 0.87) between TAP and no TAP groups. However, TAP was associated with significantly less time to ambulation (MD -2.22 h, 95% CI = -3.89 to -0.56, p = 0.009) and PONV (OR = 0.13, 95% CI = 0.05 to 0.35, p < 0.0001). CONCLUSIONS TAP in laparoscopic bariatric surgery is associated with significantly less PONV and time to ambulation, but similar complication rates, narcotic usage and postoperative pain at 24 h compared to no TAP.
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Affiliation(s)
| | - Shaheel Mohammad Sahebally
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland. .,Department of Surgery, St Vincent's University Hospital, Dublin, Ireland.
| | - Helen Heneghan
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland.,Section of Surgery, School of Medicine, University College Dublin, Dublin, Ireland
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Grape S, Kirkham KR, Albrecht E. The Analgesic Efficacy of Transversus Abdominis Plane Block After Bariatric Surgery: a Systematic Review and Meta-analysis with Trial Sequential Analysis. Obes Surg 2020; 30:4061-4070. [DOI: 10.1007/s11695-020-04768-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Transversus Abdominis Plane Block versus Wound Infiltration with Conventional Local Anesthetics in Adult Patients Underwent Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8914953. [PMID: 32280705 PMCID: PMC7125448 DOI: 10.1155/2020/8914953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/16/2020] [Accepted: 03/07/2020] [Indexed: 11/18/2022]
Abstract
Background How to effectively control the postoperative pain of patients is extremely important to clinicians. Transversus abdominis plane (TAP) block is a novel analgesic method reported to greatly decrease postoperative pain. However, in many areas, there still exists a phenomenon of surgeons using wound infiltration (WI) with conventional local anesthetics (not liposome anesthetics) as the main means to decrease postoperative pain because of traditional wisdom or convenience. Here, we compared the analgesic effectiveness of the two different methods to determine which method is more suitable for adult patients. Materials and methods. A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TAP block and WI without liposome anesthetics in adult patients were performed. Frequently used databases were extensively searched. The main outcomes were postoperative pain scores in different situations (at rest or during movement) and the time until the first use of rescue analgesics. The secondary outcomes were postoperative nausea and vomiting (PONV) incidence and patient satisfaction scores. Results Fifteen studies with 983 participants met the inclusion criteria and were included in the present study. The heterogeneity in the final analysis regarding the pain score was low to moderate. The major results of the sensitivity analysis were stable. WI had the same analgesic effect as TAP block only at the one-hour postoperative time point (mean difference = -0.32, 95% confidence interval (-0.87, 0.24), P = 0.26) and was associated with a shorter time until the first rescue analgesic and poorer patient satisfaction. Conclusion TAP block results in a more effective and steady analgesic effect than WI with conventional local anesthetics in adult patients from the early postoperative period and obtains higher patient satisfaction.
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Kamhawy G, El-Taher E, Abdelrahman M. A comparison of oblique subcostal transversus abdominis plane block versus thoracic paravertebral block for postoperative analgesia after open cholecystectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Evidence-Based Management of Postoperative Pain in Adults Undergoing Laparoscopic Sleeve Gastrectomy. World J Surg 2019; 43:1571-1580. [DOI: 10.1007/s00268-019-04934-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kargar R, Minas V, Gorgin-Karaji A, Shadjoo K, Padmehr R, Mohazzab A, Enzevaei A, Samimi-Sadeh S, Kamali K, Khazali S. Transversus abdominis plane block under laparoscopic guide versus port-site local anaesthetic infiltration in laparoscopic excision of endometriosis: a double-blind randomised placebo-controlled trial. BJOG 2018; 126:647-654. [DOI: 10.1111/1471-0528.15502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- R Kargar
- Reproductive Biotechnology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
- Avicenna Center for Endometriosis and Minimally Invasive Gynaecology; ACECR; Tehran Iran
| | - V Minas
- Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG); Ashford and St. Peter's Hospitals NHS Foundation Trust; Chertsey UK
| | - A Gorgin-Karaji
- Reproductive Biotechnology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
- Avicenna Center for Endometriosis and Minimally Invasive Gynaecology; ACECR; Tehran Iran
| | - K Shadjoo
- Reproductive Biotechnology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
- Avicenna Center for Endometriosis and Minimally Invasive Gynaecology; ACECR; Tehran Iran
| | - R Padmehr
- Reproductive Biotechnology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
- Avicenna Center for Endometriosis and Minimally Invasive Gynaecology; ACECR; Tehran Iran
| | - A Mohazzab
- Reproductive Biotechnology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
- Avicenna Center for Endometriosis and Minimally Invasive Gynaecology; ACECR; Tehran Iran
| | - A Enzevaei
- Reproductive Biotechnology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
- Avicenna Center for Endometriosis and Minimally Invasive Gynaecology; ACECR; Tehran Iran
| | - S Samimi-Sadeh
- Department of Anaesthesiology; Mohebe Yas Hospital, School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - K Kamali
- Department of Public Health; School of Public Health; Zanjan University of Medical Sciences; Zanjan Iran
| | - S Khazali
- Reproductive Biotechnology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
- Avicenna Center for Endometriosis and Minimally Invasive Gynaecology; ACECR; Tehran Iran
- Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG); Ashford and St. Peter's Hospitals NHS Foundation Trust; Chertsey UK
- Royal Holloway - University of London; London UK
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Mittal T, Dey A, Siddhartha R, Nali A, Sharma B, Malik V. Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic gastric sleeve resection: a randomized single blinded case control study. Surg Endosc 2018; 32:4985-4989. [PMID: 29869078 DOI: 10.1007/s00464-018-6261-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain following bariatric surgery can be quite troublesome and prolongs recovery. Transversus abdominis plane (TAP) block is a new regional anesthetic technique to reduce postoperative pain and is an important part of current analgesic regimen for many abdominal surgeries. The primary objective of our study was to assess the efficacy of the TAP block in controlling postoperative pain in laparoscopic sleeve gastrectomy. Secondary outcomes assessed in this study were postoperative nausea and vomiting (PONV), time to ambulate, readiness for discharge, and whether it leads to improved patient satisfaction. METHODS This is a prospective single blind randomized controlled study. A total of 60 patients were included in the study. Patients were allocated in two groups, using a computer generated randomization sequence using http://www.randomization.com . Test group included 30 patients who received Ultrasound-guided transversus abdominis plane (USG-TAP) block along with systemic analgesia and the Control group included 30 patients who received only systemic analgesia. Postoperatively patients were evaluated for pain and satisfaction using VAS scores and 'Capuzzo' satisfaction score, respectively. RESULTS Sixty patients were enrolled in the study after fulfilling the eligibility criteria. No patient was lost to follow-up. The difference of VAS scores between test (TAP) and control (Non-TAP) was statistically significant both at rest and on movement. The patient satisfaction score in TAP group was higher than the control group (p value < 0.001). The patients who received TAP block showed earlier readiness for discharge, early ambulation, early resumption of bowel activity, and decreased incidence of PONV as compared to the non-TAP group. CONCLUSION USG-guided TAP block is a feasible, minimally invasive technique and can be a part of an effective multimodal analgesia in morbidly obese patients undergoing bariatric surgery. Limitations of this study would be the small sample size and the study being Single-blinded.
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Affiliation(s)
- Tarun Mittal
- Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, New Delhi, India. .,Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, Room No. 1316, Old Building, New Delhi, India.
| | - Ashish Dey
- Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Rahul Siddhartha
- Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Abhilash Nali
- Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Bimla Sharma
- Department of Anaesthesiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vinod Malik
- Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis. J Anesth 2017; 31:432-452. [DOI: 10.1007/s00540-017-2323-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/07/2017] [Indexed: 01/12/2023]
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Saxena R, Joshi S, Srivastava K, Tiwari S, Sharma N, Valecha UK. Comparative study of ultrasound-guided abdominal field blocks versus port infiltration in laparoscopic cholecystectomies for post-operative pain relief. Indian J Anaesth 2016; 60:578-83. [PMID: 27601741 PMCID: PMC4989809 DOI: 10.4103/0019-5049.187790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Aims: Post-operative pain is a major concern for day care surgeries like laparoscopic cholecystectomy. This study aimed to compare the efficacy of ultrasound guided abdominal field blocks (USAFB) with port site infiltrations for post-operative analgesia in terms of quality of pain relief, opioid consumption and patient satisfaction for day care surgeries Methods: Eighty patients presenting for laparoscopic cholecystectomy were randomly allocated to two groups either to receive port-site infiltration of local anaesthetic (n = 40, Group A) or USAFB (n = 40, Group B group). Numeric rating scores (NRS) were measured postoperatively to primarily assess the pain severity and opioid requirements. Data were analysed using Chi-Square test/Fisher's exact test for categorical data and Mann–Whitney test/unpaired t-test for quantitative data. Results: The study group (Group B) had significantly reduced NRS and opioid consumption over 24 h. The overall fentanyl consumption in patients receiving port infiltrations was approximately twice (200 100 μg) as compared to patients in USAFB group (120 74 μg) (P < 0.0001). Maximum fentanyl consumption was 400 μg (Group A) and 262 μg (Group B) over 24 h and the minimum requirement was 50 μg and zero, respectively. Conclusion: Superior post-operative analgesia was observed with USAFB which may help in minimising opioid-related adverse effects and facilitating faster recovery.
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Affiliation(s)
- Ruchi Saxena
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Saurabh Joshi
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Kuldeep Srivastava
- Department of Community Medicine, TSM Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Shashank Tiwari
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Nitin Sharma
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Umesh K Valecha
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
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