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Haley AL, Kennedy MJ, Hickey C, Gordon-Evans WJ, Wendt-Hornickle E, Tearney CC, Walters B, Ienello L, Guedes AG. Evaluation of preoperative rectus sheath block with bupivacaine for analgesia in cats undergoing ovariohysterectomy: a cadaveric and randomized clinical study. Vet Anaesth Analg 2024:S1467-2987(24)00134-X. [PMID: 39209569 DOI: 10.1016/j.vaa.2024.07.010] [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: 01/17/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Phase 1: to determine the feasibility of desensitizing ventral branches of spinal nerves within the rectus sheath using an ultrasound-guided rectus sheath block (USRSB). Phase 2: to determine the effect of preoperative USRSB on intraoperative responses to surgical stimulation and postoperative pain. STUDY DESIGN Cadaveric study and prospective, randomized, blinded, parallel-arm clinical trial. ANIMALS A group of five cat cadavers and 37 shelter-owned cats undergoing ovariohysterectomy. METHODS Phase 1: anatomical dissection was performed on one uninjected cadaver. Abdominal walls were dissected in four cadavers (eight hemiabdomens) following bilateral USRSB using 1:1 new methylene blue and 0.5% bupivacaine (0.8 mL kg-1 total). Phase 2: preoperative bilateral USRSB was performed with 0.8 mL kg-1 of 0.25% bupivacaine (RSB) or equivalent volume of 0.9% saline (CONTROL). Intraoperative systolic arterial blood pressure (SAP), heart rate (HR), respiratory rate (fR) and vaporizer setting (vap%) were recorded before skin incision, during celiotomy and abdominal wall closure. In recovery, cats were administered robenacoxib (2 mg kg-1; CONTROL) or 0.9% saline (0.1 mL kg-1; RSB) subcutaneously. Postoperative pain was evaluated for 6 hours using the Glasgow Composite Measure Pain Scale. RESULTS Phase 1: spinal nerves T9-L3 were identified within the rectus sheath, and stained in 0%, 40%, 63%, 75%, 100%, 88%, 50% and 13% of hemiabdomens, respectively. Phase 2: 37 cats were included (RSB, n = 17; CONTROL, n = 20). Intraoperatively, SAP, HR and fR were not significantly different between groups. Vap% was significantly lower in RSB during celiotomy (p = 0.036) and closure (p = 0.044). Postoperatively, RSB cats were 5.3 times (95% CI 1.8-8.3) more likely to require rescue analgesia than CONTROL cats. CONCLUSIONS AND CLINICAL RELEVANCE During surgery, USRSB with bupivacaine offered minor benefits and provided markedly less postoperative analgesia than robenacoxib, indicating that relying on USRSB provides insufficient postoperative analgesia for ovariohysterectomy in cats.
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Affiliation(s)
- Adrienne L Haley
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA.
| | - Martin J Kennedy
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Colleen Hickey
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Wanda J Gordon-Evans
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Erin Wendt-Hornickle
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Caitlin C Tearney
- 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
| | - Lauren Ienello
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Alonso Gp Guedes
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
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Polo-Paredes G, Soler M, Gil F, Laredo FG, Agut A, Carrillo-Flores S, Belda E. Description and Evaluation of Dye and Contrast Media Distribution of Ultrasound-Guided Rectus Sheath Block in Cat Cadavers. Animals (Basel) 2024; 14:1743. [PMID: 38929362 PMCID: PMC11200878 DOI: 10.3390/ani14121743] [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: 05/12/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
The rectus sheath block is an ultrasound-guided anaesthetic technique which aims to provide analgesia to the abdominal midline. This study aimed to assess the distribution of 0.4 mL kg-1 of a mixture of methylene blue and iopromide injected into each hemiabdomen in the internal rectus sheath in cat cadavers. We hypothesise that this technique would be feasible and would cover the rami ventrales of the last thoracic and the first lumbar spinal nerves. The study was divided into two phases. Phase 1 aimed to study the anatomical structures of the ventral abdominal wall (four cats were dissected). Phase 2 (ten cadavers) consisted of an ultrasound-guided injection of the mixture mentioned above and the assessment of its distribution by computed tomography and anatomical dissection. The results showed the staining of the cranioventral abdominal wall with a craniocaudal spread of four (three to eight) vertebral bodies. Methylene blue stained three (one to four) rami ventrales, affecting T10 (60%), T11 (100%), T12 (90%), T13 (50%) and L1 (5%). Based on these results, it could be stated that this technique could supply anaesthesia to the midline of the abdominal midline cranial to the umbilicus in clinical patients, but it may not be able to provide anaesthesia to the middle and caudal midline abdominal region.
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Affiliation(s)
- Gonzalo Polo-Paredes
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
- Escuela Internacional de Doctorado de la Universidad de Murcia, Programa en Ciencias Veterinarias, Universidad de Murcia, 30100 Murcia, Spain
| | - Marta Soler
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
| | - Francisco Gil
- Departamento de Anatomía y Anatomía Patológica Comparada, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain;
| | - Francisco G. Laredo
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
| | - Amalia Agut
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
| | | | - Eliseo Belda
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
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Hughe AJ, Mankarious MM, Deutsch MJ, Scow JS. Awake Colostomy Under Regional Anesthesia in Frail Patients. Am Surg 2023; 89:6264-6266. [PMID: 36164724 DOI: 10.1177/00031348221129507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexa J Hughe
- College of Medicine, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Marc M Mankarious
- Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Jeffrey S Scow
- Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
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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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Fu H, Fu Y, Xu X, Gao Y. Ultrasound-Guided Rectus Sheath Block Combined with Butorphanol for Single-Incision Laparoscopic Cholecystectomy: What is the Optimal Dose of Ropivacaine? J Pain Res 2020; 13:2609-2615. [PMID: 33116803 PMCID: PMC7571579 DOI: 10.2147/jpr.s265418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose In recent years, ultrasound-guided rectus sheath block (RSB) has been widely used in postoperative analgesia of abdominal operation. However, there is no uniform standard for the optimal dose of local anesthetics (LA) under ultrasound-guided rectus sheath block. This study aimed to determine the dose of ropivacaine combined with butorphanol that is effective in 50% (ED50) and 95% (ED95) of subjects for successful pain-free ultrasound-guided RSB in single-incision laparoscopic cholecystectomy (SILC). Patients and Methods Twenty-four patients scheduled to undergo single-incision laparoscopic cholecystectomy received an ultrasound-guided RSB. The initial dose of ropivacaine injected was 1.7 mg/kg, which was subsequently increased or decreased by 0.2 mg/kg, depending on whether the previous patient was free from pain (numeric rating scale (NRS) score of incisional pain at rest within 12 h after operation ≤ 3). All patients were treated with butorphanol 0.02 mg/kg as preemptive analgesia. The ED50 and ED95 were calculated using a probit regression model. Results The ED50 and ED95 of ropivacaine combined with butorphanol in ultrasound-guided rectus sheath block for analgesia in SILC, which were calculated by the probit regression model, were 0.719 mg/kg (95% confidence interval (CI), 0.553 mg/kg−0.873 mg/kg) and 0.967 mg/kg (95% CI, 0.835 mg/kg−1.91 mg/kg), respectively. Conclusion As part of a multimodal analgesia strategy, a dose of 0.719 mg/kg ropivacaine provided successful RSB under ultrasound guidance in 50% of the patients who underwent SILC. A dose of 0.967 mg/kg would be successful in 95% of patients.
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Affiliation(s)
- Huimin Fu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Yu Fu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Xingguo Xu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Yongtao Gao
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
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Fu H, Zhong C, Fu Y, Gao Y, Xu X. Perioperative Analgesic Effects of Preemptive Ultrasound-Guided Rectus Sheath Block Combined with Butorphanol or Sufentanil for Single-Incision Laparoscopic Cholecystectomy: A Prospective, Randomized, Clinical Trial. J Pain Res 2020; 13:1193-1200. [PMID: 32547182 PMCID: PMC7259462 DOI: 10.2147/jpr.s252952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023] Open
Abstract
Purpose Pain after single-incision laparoscopic cholecystectomy (SILC), especially visceral pain, often troubles patients and doctors. Whether preemptive butorphanol can relieve visceral pain in patients undergoing SILC remains unknown. The goal of this study was to assess the efficacy of ultrasound-guided bilateral rectus sheath block (RSB) and butorphanol for perioperative analgesia in patients undergoing SILC. Patients and Methods Fifty-eight patients who met the criteria were randomly divided into two groups, both of which were given preemptive RSB. Patients were given either butorphanol 0.02mg/kg (group B, n=29) or sufentanil 0.1 µg/kg (group S, n=29) as preemptive analgesia. The primary outcome was the cumulative frequency of rescue analgesic request within 24 hours after operation. Secondary outcomes were numeric rating scale (NRS) scores (from 0 to 10) of incisional pain and visceral pain, the length of hospital stay and the incidence of postoperative adverse events. Results The frequency of postoperative rescue analgesic request of group S was significantly higher than that of group B (P=0.021). The NRS scores for visceral pain were lower in group B at 2, 6 and 12 hours after surgery than in group S (both P<0.001). The occurrence of postoperative nausea and vomiting (PONV) was significantly higher in group S. There were no significant differences between two groups for other outcomes. Conclusion Butorphanol can provide sufficient visceral pain treatment after SILC than the dose of sufentanil in equal analgesic effect.
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Affiliation(s)
- Huimin Fu
- Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Chaochao Zhong
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Yu Fu
- Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Yongtao Gao
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Xingguo Xu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People's Republic of China
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St James M, Ferreira TH, Schroeder CA, Hershberger-Braker KL, Schroeder KM. Ultrasound-guided rectus sheath block: an anatomic study in dog cadavers. Vet Anaesth Analg 2019; 47:95-102. [PMID: 31786077 DOI: 10.1016/j.vaa.2019.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe the ultrasound-guided rectus sheath block technique and the anatomical spread of two volumes of methylene blue injection in dog cadavers. STUDY DESIGN Blinded, prospective, experimental cadaveric study. ANIMALS A total of eight dog cadavers weighing 8.9 ± 1.6 kg. METHODS Ultrasound-guided rectus sheath injections were performed bilaterally 1 cm cranial to the umbilicus using 0.25 mL kg-1 (low volume; LV) and 0.50 mL kg-1 (high volume; HV) of 0.5% methylene blue dye. A total of 16 hemiabdomens were injected. The ultrasound image quality of the muscular and fascial plane landmarks and needle visualization were scored using a standardized scale. Cadavers were dissected to determine the distribution of the dye and to assess staining of ventral branches of the spinal nerves. RESULTS Fewer ventral spinal nerve branches were stained in the LV group than in the HV group, at 2.00 ± 0 and 2.90 ± 0.83, respectively (p < 0.01). Ventral branches of thoracic (T) and lumbar (L) spinal nerves (T10, T11, T12, T13 and L1) were stained 25%, 100%, 75%, 25% and 0% of the time in LV group and 12.5%, 87.5%, 100.0%, 75.0% and 13.0% in HV group. A lesser extent of cranial-caudal dye distribution was observed in the LV group than in the HV group (7.1 ± 1.8 cm and 9.2 ± 1.8 cm, respectively; p = 0.03). There was no significant difference in medial-lateral spread of dye, number of test doses or ultrasound image quality scores between groups. CONCLUSIONS AND CLINICAL RELEVANCE The results of this study suggest that, on an anatomical basis, this easily performed block has the potential to provide effective abdominal wall analgesia for the ventral midline. This study supports the potential of the rectus sheath block for abdominal procedures, and further investigations on its clinical efficacy are warranted.
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Affiliation(s)
- Mariko St James
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Tatiana H Ferreira
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
| | - Carrie A Schroeder
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Hershberger-Braker
- Department of Pathobiological Sciences, Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristopher M Schroeder
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Nair A, Amula VE, Naik V, Kodisharapu PK, Poornachand A, Shyam Prasad MS, Saifuddin MS, Rayani BK. Comparison of Postoperative Analgesia in Patients Undergoing Ileostomy Closure with and Without Dual Transversus Abdominis Plane (TAP) Block: A Randomized Controlled Trial. Rambam Maimonides Med J 2019; 10:RMMJ.10356. [PMID: 30304665 PMCID: PMC6363374 DOI: 10.5041/rmmj.10356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND AIMS Multimodal analgesia comprising opioid, paracetamol, and non-steroidal anti-inflammatory drugs is used for managing postoperative surgical pain after ileostomy closure (IC). We investigated the efficacy of unilateral dual transversus abdominis plane (TAP) block to reduce morphine consumption in the first 24 hours along with a reduction in visual analogue score for pain and in postoperative nausea/vomiting. METHODS This was a single-center, investigator-initiated, prospective, parallel-group, placebo-controlled randomized study involving patients undergoing IC under general anesthesia. We recruited 55 patients in two groups: 28 in a TAP group and 27 in a placebo group. The TAP group patients received 30 mL of 0.375% bupivacaine: 15 mL by a posterior TAP approach and 15 mL by a subcostal approach using ultrasonography. Patients in the placebo group received 30 mL normal saline (placebo) using the same approaches. Blocks were administered at the end of surgery before extubation. To monitor for the primary outcome-24-hour morphine consumption for both groups-patients were transferred to a high-dependency unit. The secondary outcome was to compare postoperative nausea/vomiting in both groups. RESULTS The demographic data, gender distribution, ASA physical status, duration of surgery, and time of first morphine dose was comparable in both groups. The 24-hour morphine consumption was 3.29±2.78 mg and 9.23±2.94 mg for the TAP and placebo groups, respectively, which was statistically significant (P=0.001). CONCLUSION Dual TAP block reduces opioid consumption in the first 24 hours after an IC and can facilitate early recovery with less adverse effects seen than with opioids and NSAIDs.
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Affiliation(s)
- Abhijit Nair
- To whom correspondence should be addressed. E-mail:
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Hosalli V, Ayyanagouda B, Hiremath P, Ambi U, Hulkund SY. Comparative efficacy of postoperative analgesia between ultrasound-guided dual transversus abdominis plane and Ilioinguinal/Iliohypogastric nerve blocks for open inguinal hernia repair: An open label prospective randomised comparative clinical trial. Indian J Anaesth 2019; 63:450-455. [PMID: 31263296 PMCID: PMC6573039 DOI: 10.4103/ija.ija_153_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Aims: Transversus abdominis plane (TAP) and Ilioinguinal/Iliohypogastric (IL/IH) nerve blocks have been advocated in reducing postoperative pain and additional analgesic requirement following lower abdominal surgeries with varied effect. The aim of this study was to determine post-operative analgesic efficacy by comparing dual TAP [combining TAP and IL/IH nerve blocks] and IL/IH nerve block alone for open inguinal hernia repair. Methods: Two hundred patients undergoing elective primary unilateral open inguinal hernia repair with a mesh were included in to this trial. Ultrasound-guided dual TAP (D-TAP Group) or IL/IH (IL/IH Group) nerve block were administered to patients following subarachnoid block according to their group allocation, with 0.5% ropivacaine. Post operatively patients were monitored for visual analogue scale (VAS) scores at rest (at 4, 12, 24 and 48h) and during movement (at 24, 48 h, 3 and 6 months). Pain scores at 3 and 6 months were assessed by telephonic interview, using the DN4 questionnaire for neuropathic pain. The statistics was obtained using Chi-square test for proportions in qualitative data and student's unpaired t test for quantitative data. P value <0.05 was considered significant. Results: The pain scores at rest (VAS-R) were significantly lower at 12 hours and 24 hours (P < 0.001) in D-TAP group, while pain scores at movement were significantly lower (P < 0.001) in D-TAP group at 24 and 48 hours compared to IL/IH group. The mean time required for first rescue analgesic was longer in D-TAP group (5.590 ± 2.386 hr) in comparison to IL/IH group (3.1053 ± 1.1822h). Conclusion: Ultrasound-guided dual TAP block provides more effective post-operative analgesia in open inguinal hernia repair.
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Affiliation(s)
- Vinod Hosalli
- Department of Anaesthesiology, S N Medical College and HSK Hospital, Navanagar, Bagalkot, Karnataka, India
| | - Basavaraja Ayyanagouda
- Department of Anaesthesiology, S N Medical College and HSK Hospital, Navanagar, Bagalkot, Karnataka, India
| | - Preetika Hiremath
- Department of Anaesthesiology, S N Medical College and HSK Hospital, Navanagar, Bagalkot, Karnataka, India
| | - Uday Ambi
- Department of Anaesthesiology, S N Medical College and HSK Hospital, Navanagar, Bagalkot, Karnataka, India
| | - S Y Hulkund
- Department of Anaesthesiology, S N Medical College and HSK Hospital, Navanagar, Bagalkot, Karnataka, India
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Kartalov A, Jankulovski N, Kuzmanovska B, Zdravkovska M, Shosholcheva M, Tolevska M, Naumovski F, Srceva M, Petrusheva AP, Selmani R, Sivevski A. The Effect of Rectus Sheath Block as a Supplement of General Anesthesia on Postoperative Analgesia in Adult Patient Undergoing Umbilical Hernia Repair. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2017; 38:135-142. [PMID: 29668467 DOI: 10.2478/prilozi-2018-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Ultrasound guided rectus sheath block can block the ventral rami of the 7th to 12th thoracolumbar nerves by injection of local anesthetic into the space between the rectus muscle and posterior rectus sheath. The aim of this randomized double-blind study was to evaluate the analgesic effect of the bilateral ultrasound guided rectus sheath block as supplement of general anesthesia on patents undergoing elective umbilical hernia repair. METHODS After the hospital ethics committee approval, 60 (ASA I-II) adult patients scheduled for umbilical hernia repair were included in this study. The group I (n=30) patents received only general anesthesia. In the group II (n = 30) patents after induction of general anesthesia received a bilateral ultrasound guided rectus sheath block with 40 ml of 0.25% bupivacaine. In this study we assessed demographic and clinical characteristics, pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after operation and total analgesic consumption of morphine dose over 24-hours. RESULTS There were statistically significant differences in VAS scores between the groups I and II at all postoperative time points - 2hr, 4 hr, 6 hr, 12 hr and 24 hr. (P < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in the group II (mean = 3.73 ± 1. 41) than the group I (mean = 8.76 ± 2.41). This difference was statistically significant (p = 0.00076). CONCLUSION The ultrasound guided rectus sheath block used for umbilical hernia repair could reduce postoperative pain scores and the amount of morphine consumption in 24 hours postoperative period.
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MESH Headings
- Adolescent
- Adult
- Aged
- Analgesics, Opioid/administration & dosage
- Anesthesia, General/adverse effects
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/adverse effects
- Bupivacaine/administration & dosage
- Bupivacaine/adverse effects
- Double-Blind Method
- Female
- Hernia, Umbilical/surgery
- Herniorrhaphy/adverse effects
- Humans
- Male
- Middle Aged
- Morphine/administration & dosage
- Nerve Block/adverse effects
- Nerve Block/methods
- Pain Measurement
- Pain, Postoperative/diagnosis
- Pain, Postoperative/etiology
- Pain, Postoperative/physiopathology
- Pain, Postoperative/prevention & control
- Rectus Abdominis/innervation
- Republic of North Macedonia
- Time Factors
- Treatment Outcome
- Ultrasonography, Interventional
- Young Adult
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Affiliation(s)
- Andrijan Kartalov
- Clinic for Anesthesiology, Reanimatology and Intensive Care Unit - KARIL, Skopje, Republic of Macedonia
| | | | - Biljana Kuzmanovska
- Clinic for Anesthesiology, Reanimatology and Intensive Care Unit - KARIL, Skopje, Republic of Macedonia
| | - Milka Zdravkovska
- Faculty of Medical Sciences, "Goce Delchev University", Shtip, Republic of Macedonia
| | - Mirjana Shosholcheva
- Clinic for Anesthesiology, Reanimatology and Intensive Care Unit - KARIL, Skopje, Republic of Macedonia
| | - Marija Tolevska
- Clinic for Anesthesiology, Reanimatology and Intensive Care Unit - KARIL, Skopje, Republic of Macedonia
| | - Filip Naumovski
- Clinic for Anesthesiology, Reanimatology and Intensive Care Unit - KARIL, Skopje, Republic of Macedonia
| | - Marija Srceva
- Clinic for Anesthesiology, Reanimatology and Intensive Care Unit - KARIL, Skopje, Republic of Macedonia
| | | | - Rexhep Selmani
- Clinic for Abdominal surgery, Skopje, Republic of Macedonia
| | - Atanas Sivevski
- University Clinic for Genecology and Obstetric, Skopje, Republic of Macedonia
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Zoff A, Laborda-Vidal P, Mortier J, Amengual M, Rioja E. Comparison of the spread of two different volumes of contrast medium when performing ultrasound-guided transversus abdominis plane injection in dog cadavers. J Small Anim Pract 2017; 58:269-275. [PMID: 28199008 DOI: 10.1111/jsap.12639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/19/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare, via CT imaging, the spread of different volumes of diluted iodinated contrast medium in the transversus abdominis muscle plane of dog cadavers. METHODS Prospective, randomised study. An electro stimulation or a SonoTAP needle was inserted in plane with the ultrasound beam in the fascia between the internal oblique and transversus abdominis muscles. A test dose of 1 ml of diluted contrast (30 mg/mL iohexol) was injected to confirm positioning, followed by 0 · 5 mL/kg (n=14) or 1 mL/kg (n=12) and the distribution of the fluid compared. RESULTS Contrast medium was identified exclusively in the transversus abdominis plane in 19 of 26 dogs. In one dog, the contrast lay between the external and internal oblique muscles and partially in three dogs. Intraperitoneal contrast was detected in 6 of 26 dogs (23%). No significant differences were found in the dorso-ventral or cranio-caudal spread or area of distribution but a significant difference was found in the transverse spread. There was an association between poor ultrasound visualisation of the tip of the needle and intraperitoneal injection. CLINICAL SIGNIFICANCE Injection of 1 mL/kg of diluted contrast did not result in wider cranio-caudal spread in the transversus abdominis muscle plane of dog cadavers when compared with 0 · 5 mL/kg. Intraperitoneal injection is a risk and might be reduced with good needle visualisation.
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Affiliation(s)
- A Zoff
- School of Veterinary Science, University of Liverpool, CH64 7TE, Neston, UK
| | - P Laborda-Vidal
- Prof. Agregado F. Veterinaria y Ciencias Experimentales, Universidad Católica de Valencia "San Vicente Mártir", Valencia, 46001, Spain
| | - J Mortier
- School of Veterinary Science, University of Liverpool, CH64 7TE, Neston, UK
| | - M Amengual
- Lumbry Park Veterinary Specialists, GU34 3HF, Alton, UK
| | - E Rioja
- School of Veterinary Science, University of Liverpool, CH64 7TE, Neston, UK
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Steffel L, Kim TE, Howard SK, Ly DP, Kou A, King R, Mariano ER. Comparative Effectiveness of Two Ultrasound-Guided Regional Block Techniques for Surgical Anesthesia in Open Unilateral Inguinal Hernia Repair. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:177-182. [PMID: 26614794 DOI: 10.7863/ultra.15.02057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/16/2015] [Indexed: 06/05/2023]
Abstract
Transversus abdominis plane (TAP) and ilioinguinal/iliohypogastric (II/IH) nerve blocks have been described as analgesic adjuncts for inguinal hernia repair, but the efficacy of these techniques in providing intraoperative anesthesia, either individually or together, is not known. We designed this retrospective cohort study to test the hypothesis that combining TAP and II/IH nerve blocks ("double TAP" technique) results in greater accordance between the preoperative anesthetic plan and actual anesthetic technique provided when compared to TAP alone. Based on this study, double TAP may be preferred for patients undergoing open inguinal hernia repair who wish to avoid general anesthesia.
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Affiliation(s)
- Lauren Steffel
- Department of Anesthesiology, Perioperative and Pain Medicine (L.S., T.E.K., S.K.H., A.K., E.R.M.) and Division of General Surgery (D.P.L.), Stanford University School of Medicine, Stanford, California USA; and Anesthesiology and Perioperative Care Service (T.E.K., S.K.H., R.K., E.R.M.) and Surgical Service (D.P.L.), VA Palo Alto Health Care System, Palo Alto, California USA
| | - T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine (L.S., T.E.K., S.K.H., A.K., E.R.M.) and Division of General Surgery (D.P.L.), Stanford University School of Medicine, Stanford, California USA; and Anesthesiology and Perioperative Care Service (T.E.K., S.K.H., R.K., E.R.M.) and Surgical Service (D.P.L.), VA Palo Alto Health Care System, Palo Alto, California USA
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine (L.S., T.E.K., S.K.H., A.K., E.R.M.) and Division of General Surgery (D.P.L.), Stanford University School of Medicine, Stanford, California USA; and Anesthesiology and Perioperative Care Service (T.E.K., S.K.H., R.K., E.R.M.) and Surgical Service (D.P.L.), VA Palo Alto Health Care System, Palo Alto, California USA
| | - Daphne P Ly
- Department of Anesthesiology, Perioperative and Pain Medicine (L.S., T.E.K., S.K.H., A.K., E.R.M.) and Division of General Surgery (D.P.L.), Stanford University School of Medicine, Stanford, California USA; and Anesthesiology and Perioperative Care Service (T.E.K., S.K.H., R.K., E.R.M.) and Surgical Service (D.P.L.), VA Palo Alto Health Care System, Palo Alto, California USA
| | - Alex Kou
- Department of Anesthesiology, Perioperative and Pain Medicine (L.S., T.E.K., S.K.H., A.K., E.R.M.) and Division of General Surgery (D.P.L.), Stanford University School of Medicine, Stanford, California USA; and Anesthesiology and Perioperative Care Service (T.E.K., S.K.H., R.K., E.R.M.) and Surgical Service (D.P.L.), VA Palo Alto Health Care System, Palo Alto, California USA
| | - Robert King
- Department of Anesthesiology, Perioperative and Pain Medicine (L.S., T.E.K., S.K.H., A.K., E.R.M.) and Division of General Surgery (D.P.L.), Stanford University School of Medicine, Stanford, California USA; and Anesthesiology and Perioperative Care Service (T.E.K., S.K.H., R.K., E.R.M.) and Surgical Service (D.P.L.), VA Palo Alto Health Care System, Palo Alto, California USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine (L.S., T.E.K., S.K.H., A.K., E.R.M.) and Division of General Surgery (D.P.L.), Stanford University School of Medicine, Stanford, California USA; and Anesthesiology and Perioperative Care Service (T.E.K., S.K.H., R.K., E.R.M.) and Surgical Service (D.P.L.), VA Palo Alto Health Care System, Palo Alto, California USA.
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Elbahrawy K, El-Deeb A. Rectus sheath block for postoperative analgesia in patients with mesenteric vascular occlusion undergoing laparotomy: A randomized single-blinded study. Anesth Essays Res 2016; 10:516-520. [PMID: 27746544 PMCID: PMC5062247 DOI: 10.4103/0259-1162.179315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Acute mesenteric ischemia is a life-threatening vascular emergency that requires early diagnosis, immediate anticoagulation, and intervention to restore mesenteric blood flow adequately. Aims: To investigate the effect of rectus sheath block (RSB) for postoperative analgesia in patients with mesenteric vascular occlusion. Settings and Design: Forty patients with mesenteric vascular occlusion, American Society of Anesthesiologists physical status I or II or III, scheduled for laparotomy were enrolled in this study. Subjects and Methods: Patients were randomized into two groups; control group (C Group) and rectus block group (RB Group). In both groups, general anesthesia was induced fentanyl 1 μg/kg with sleeping dose of propofol and 0.15 mg/kg cisatracurium. Then, anesthesia was maintained with sevoflurane in oxygen 100%. In RB Group, under aseptic condition, RSB guided by ultrasound was performed. Surgery is then continued and intravenous fentanyl patient-controlled analgesia pump started. Postoperative pain, sedation, and opioid side effects were assessed. Statistical Analysis Used: Statistical analysis was done using Statistical Package for Social Sciences (SPSS 19.0, Chicago, IL, USA). Results: Patients in the RB Group consumed statistically significant less opioid in comparison to control group either intraoperatively or postoperatively. Mean pain scores were statistically significant less in RB Group than in the control group at 2, 4, and 6 h postoperatively. Sedation score, incidence of nausea and vomiting were statistically significant less in the RB Group in comparison to control group. More patients’ satisfaction was reported in the RB Group. Conclusions: Ultrasound-guided RSB resulted in postoperative reduction of pain scores and opioid consumption compared with general anesthesia alone. Moreover, RSB was associated with better patient satisfaction and less nausea and vomiting.
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Affiliation(s)
| | - Alaa El-Deeb
- Department of Anaesthesia, Mansoura University, Mansoura, Egypt
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Jin F, Li XQ, Tan WF, Ma H, Lu HW. Preoperative versus postoperative ultrasound-guided rectus sheath block for improving pain, sleep quality and cytokine levels of patients with open midline incisions undergoing transabdominal gynaecological operation: study protocol for a randomised controlled trial. Trials 2015; 16:568. [PMID: 26652009 PMCID: PMC4676186 DOI: 10.1186/s13063-015-1096-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/01/2015] [Indexed: 12/15/2022] Open
Abstract
Background Rectus sheath block (RSB) is used for postoperative pain relief in patients undergoing abdominal surgery with midline incision. Preoperative RSB has been shown to be effective, but it has not been compared with postoperative RSB. The aim of the present study is to evaluate postoperative pain, sleep quality and changes in the cytokine levels of patients undergoing gynaecological surgery with RSB performed preoperatively versus postoperatively. Methods/Design This study is a prospective, randomised, controlled (randomised, parallel group, concealed allocation), single-blinded trial. All patients undergoing transabdominal gynaecological surgery will be randomised 1:1 to the treatment intervention with general anaesthesia as an adjunct to preoperative or postoperative RSB. The objective of the trial is to evaluate postoperative pain, sleep quality and changes in the cytokine levels of patients undergoing gynaecological surgery with RSB performed preoperatively (n = 32) versus postoperatively (n = 32). All of the patients, irrespective of group allocation, will receive patient-controlled intravenous analgesia (PCIA) with oxycodone. The primary objective is to compare the interval between leaving the post-anaesthesia care unit and receiving the first PCIA bolus injection on the first postoperative night between patients who receive preoperative versus postoperative RSB. The secondary objectives will be to compare (1) cumulative oxycodone consumption at 24 hours after surgery; (2) postoperative sleep quality, as measured using a BIS-Vista monitor during the first night after surgery; and (3) cytokine levels (interleukin-1, interleukin-6, tumour necrosis factor-α and interferon-γ) during surgery and at 24 and 48 hours postoperatively. Discussion Clinical experience has suggested that RSB is a very effective postoperative analgesic technique, and we will answer the following questions with this trial. Do preoperative block and postoperative block have the same duration of analgesic effects? Can postoperative block extend the analgesic time? The results of this study could have actual clinical applications that could help to reduce postoperative pain and shorten hospital stays. Trial registration Current Controlled Trials NCT02477098 15 June 2015.
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Affiliation(s)
- Feng Jin
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Xiao-Qian Li
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Wen-Fei Tan
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Hong Ma
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
| | - Huang-Wei Lu
- Department of Anaesthesiology, the First Hospital of China Medical University, Shenyang, China.
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Bashandy GMN, Elkholy AHH. Reducing postoperative opioid consumption by adding an ultrasound-guided rectus sheath block to multimodal analgesia for abdominal cancer surgery with midline incision. Anesth Pain Med 2014; 4:e18263. [PMID: 25289373 PMCID: PMC4183078 DOI: 10.5812/aapm.18263] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/05/2014] [Accepted: 03/21/2014] [Indexed: 11/17/2022] Open
Abstract
Background: Many multimodal analgesia techniques have been tried to provide adequate analgesia for midline incisions extending above and below the umbilicus aiming at limiting the perioperative use of morphine thus limiting side effects. Ultrasound (US) guidance made the anesthesiologist reconsider old techniques for wider clinical use. The rectus sheath block (RSB) is a useful technique under-utilized in the adult population. Objectives: Our study examined the efficacy of a preemptive single-injection rectus sheath block in providing better early postoperative pain scores compared to general anesthesia alone. Patients and Methods: Sixty patients were recruited in this randomized controlled trial. These patients were divided into two groups: RSB group had an RSB after induction of anesthesia and before surgical incision, and GA (general anesthesia) group had general anesthesia alone. Both groups were compared for verbal analogue scale (VAS) score, opioid consumption and hemodynamic variables in the post-anesthesia care unit (PACU). Analgesic requirements in surgical wards were recorded in postoperative days (POD) 0, 1 and 2. Results: The median VAS score was significantly lower in RSB group compared with GA group in all 5 time points in the PACU (P ˂ 0.05). Also PACU morphine consumption was lower in RSB group than GA group patients (95% confidence interval [CI] of the difference in means between groups, −4.59 to −2.23 mg). Morphine consumption was also less in the first 2 postoperative days (POD0 and POD1). Conclusions: Ultrasound-guided rectus sheath block is an easy technique to learn. This technique, when it is used with general anesthesia, will be more effective in reducing pain scores and opioid consumption compared with general anesthesia alone.
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Affiliation(s)
- Ghada Mohammad Nabih Bashandy
- Department of Anesthesiology and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
- Corresponding author: Ghada Mohammad Nabih Bashandy, Department of Anesthesiology and Pain Management, National Cancer Institute, Egypt-1 Fom Alkalij, Kasr Al-Einy St., Cairo, Egypt. Tel: +20-201125233337, E-mail:
| | - Abeer Hassan Hamed Elkholy
- Department of Anesthesiology and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
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