1
|
Romi R, Hoda W, Kumar S, Bharati B, Toppo S, Singh D, Oraon P, Kumari R, Lakra A, Priye S. Comparative Study of Levobupivacaine Versus Levobupivacaine With Dexmedetomidine as an Adjuvant in Transversus Abdominis Block for Postoperative Pain Relief in Abdominal Hysterectomy Patients: A Randomized, Double-Blind Study. Cureus 2024; 16:e59523. [PMID: 38826898 PMCID: PMC11144035 DOI: 10.7759/cureus.59523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Background Adjuvants have been discovered to prolong the analgesic impact of local anesthetics (LA), while the transversus abdominis plane (TAP) block offers sufficient postoperative pain relief after various abdominal procedures. Nevertheless, the impact of the given LA will determine the duration of the TAP block. Thus, in this investigation, we aimed to estimate the analgesic impact of combining dexmedetomidine (DEX) with levobupivacaine in the TAP block for patients having an infraumbilical incision for an abdominal hysterectomy while under spinal anesthetic. Aim This study aimed to determine the analgesic effect of DEX (0.5 mcg/kg) to 20 ml of 0.25% levobupivacaine on each side in the TAP block in patients undergoing total abdominal hysterectomy (TAH). Materials and methods Two groups of 30 patients each, with ASA grades 1 and 2, were randomly selected from patients. Group N, comprising 30 patients, had a bilateral TAP block using 2 mL of normal saline and 20 mL of 0.25% levobupivacaine. Group D (n = 30 patients) was given DEX at a dose of 0.5 mcg/kg (2 mL) in addition to 20 mL of 0.25% levobupivacaine given bilaterally. The TAP block was administered just after skin closure. Time of the initial analgesic dose administration; total fentanyl doses utilized as rescue analgesia; pain scores (numerical rating scale (NRS)) at 2, 4, 6, 8, 12, and 24 hours; and pre- and postoperative cortisol levels were also noted. For each group, 1 gram IV paracetamol was administered every eight hours. Drugs used for rescue analgesia (RA) were diclofenac 75 mg IV stat and fentanyl 1 mcg/kg. Results and discussion In addition to Group N having lower NRS scores at rest, Group D had a considerably longer time for initial rescue analgesia than Group N. There was also a significant decrease in the total fentanyl consumption and postoperative serum cortisol levels in Group D in contrast to Group N. Conclusion Potential adjuvant DEX prolongs postoperative analgesia in patients experiencing abdominal hysterectomy when used alongside LA in TAP.
Collapse
Affiliation(s)
- Romi Romi
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Wasimul Hoda
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Sourabh Kumar
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Bharati Bharati
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Saurabh Toppo
- Anaesthesiology, Bhagwan Mahavir Medica Superspecialty Hospital, Ranchi, IND
| | - Dipali Singh
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Priyanka Oraon
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Reena Kumari
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Alka Lakra
- Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Shio Priye
- Superspeciality Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| |
Collapse
|
2
|
Espadas-González L, Usón-Casaús JM, Pastor-Sirvent N, Santella M, Ezquerra-Calvo J, Pérez-Merino EM. The impact of the transversus abdominis plane block (TAP) on stress response measured through the complete blood- derived inflammatory markers. Vet Res Commun 2024; 48:497-506. [PMID: 37840089 PMCID: PMC10810931 DOI: 10.1007/s11259-023-10234-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
This study aims to evaluate the effect of the transversus abdominis plane (TAP) block on the blood cells and the inflammatory markers neutrophil- to- lymphocyte ratio (NLR), platelet- to- lymphocyte ratio (PLR), and systemic immune- inflammation index (SII) after the laparoscopic ovariectomy (LapOV) in dogs. 72 healthy bitches undergoing LapOV were randomly allocated to the no- TAP group of dogs under inhaled anesthesia (IA), the TAP- S group (IA and TAP with saline), and the TAP- B group (IA and TAP with bupivacaine). The NLR, PLR, and SII were calculated 1 h before ovariectomy (T0) and at 2-3 h (T1), 6-8 h (T2), and 20-24 h (T3) post- surgery. The number of dogs requiring postoperative analgesic rescue with buprenorphine and the doses administered in each group were recorded. Significant changes were observed in all groups' postoperative NLR, PLR, and SII over time. Between groups, no differences were observed in any of the ratios at any control point (NLR at T0-T3: p = 0.17, 0.36, 0.80, and 0.95; PLR at T0-T3: p = 0.70, 0.62, 0.21, 0.87; SII at T0-T3: p = 0.29, 0.65, 0.09, and 0.34). A significantly lower number of dogs required analgesic rescue in the TAP-B group (p = 0.0001) and a lower number of doses were administered (p = 0.001). There is no difference in the inflammatory response measured through the complete blood- derived inflammatory markers after the LapOV in dogs when the postoperative pain is managed entirely with opioids or with the TAP block with bupivacaine. The hydrodissection associated with the TAP block technique does not increase the inflammatory response.
Collapse
Affiliation(s)
- Lorena Espadas-González
- Unidad de Cirugía, Departamento de Medicina Animal, Facultad de Veterinaria UEx, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain
| | - Jesús M Usón-Casaús
- Unidad de Cirugía, Departamento de Medicina Animal, Facultad de Veterinaria UEx, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain
| | - Nieves Pastor-Sirvent
- Unidad de Cirugía, Departamento de Medicina Animal, Facultad de Veterinaria UEx, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain
| | - Massimo Santella
- Veterinary Teaching Hospital, Facultad de Veterinaria, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain
| | - Javier Ezquerra-Calvo
- Unidad de Cirugía, Departamento de Medicina Animal, Facultad de Veterinaria UEx, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain
| | - Eva M Pérez-Merino
- Unidad de Cirugía, Departamento de Medicina Animal, Facultad de Veterinaria UEx, Universidad de Extremadura, Avenida de la universidad s/n, Cáceres, 10003, Spain.
| |
Collapse
|
3
|
Singh S, Hooda B, Dwivedi D, Goyal R. Block: Component of a multimodal approach to taming the stress response in pheochromocytoma resection. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_98_21] [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
|
4
|
Abdallah MY, Abdallah MY. Levobupivacaine versus levobupivacaine plus dexmedetomidine in transversus abdominis plane block in patients undergoing abdominal aortic surgery. Anesth Essays Res 2022; 16:154-159. [PMID: 36249157 PMCID: PMC9558655 DOI: 10.4103/aer.aer_89_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Severe postoperative pain is a major dilemma for patients undergoing abdominal aortic surgery. Transversus abdominis plane (TAP) block has been described a successful pain management technique after major abdominal surgery. Dexmedetomidine was proved to enhance the analgesic action of local anesthetics. Aim: This study was aimed to assess the impact of adding dexmedetomidine to levobupivacaine during TAP block in patients undergoing abdominal aortic operations. Patients and Methods: We included 114 patients in this prospective trial, and they were enrolled into two groups; the L group received levobupivacaine only, and the LD group received levobupivacaine plus dexmedetomidine. The block was performed before anesthetic induction. Postoperative pain score was our main outcome. Statistical Analysis: The collected data were tabulated and analyzed through the SPSS software program IBM's Statistical Package for the Social Sciences (SPSS) statistics for Windows (version 25, 2017) (IBM Corporation, Armonk, NY, USA). The categorical data were expressed as numbers and percentages and then compared using the Chi-square test. The continuous data were expressed as mean and standard deviation if normally distributed, or median and range if abnormally distributed. The former data were compared through the one-way ANOVA, while the latter were compared through the Kruskal–Wallis test. Any P < 0.05 was considered statistically significant. Results: Group LD showed significantly earlier sensory blocks compared to the other group. Postoperative pain scores were comparable between the two groups for the initial 4 h following the surgery. Adjuvant dexmedetomidine was associated with better pain scores for the subsequent 12 h compared to Group L. The duration till the first analgesic request showed a significant increase in the LD group (13.3 vs. 11.09 h in Group L). In addition, the same group showed a significant decline in their opioid consumption after the operation (48.95 μg vs. 72.63 μg in the other group). Postoperative nausea and vomiting were significantly increased in Group L. Conclusion: Adjuvant dexmedetomidine has a significant beneficial impact on postoperative analgesic profile. Its use as an adjuvant to peripheral and neuraxial nerve blocks should be recommended in pain management practice.
Collapse
|
5
|
Ismail S, Ahmed A, Hoda MQ, Asghar S, Habib A, Aziz A. Mid-axillary transversus abdominis plane block and stress response after abdominal hysterectomy: A randomised controlled placebo trial. Eur J Anaesthesiol 2021; 38:768-776. [PMID: 33399377 DOI: 10.1097/eja.0000000000001413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The hormonal response to surgical trauma can have detrimental effects on patients. Transversus abdominis plane (TAP) block, which can improve analgesia after total abdominal hysterectomy (TAH) might attenuate the peri-operative stress response. OBJECTIVE To evaluate the ability of the TAP block to reduce stress response, opioid consumption and pain following TAH and multimodal analgesia. DESIGN Randomised, placebo-controlled double-blind study. SETTING The current study was conducted at a university hospital from July 2016 to September 2017. PATIENTS Fifty patients scheduled for TAH were included. Anaesthesia and postoperative analgesia were standardised. INTERVENTION After induction of anaesthesia, patients were allocated into two groups: ultrasound-guided bilateral mid-axillary TAP block with 20 ml of bupivacaine 0.25% (Group T) or 0.9% saline (Group C). MAIN OUTCOME MEASURES Levels of free serum cortisol, metanephrine and normetanephrine at 60 min and 6, 12 and 24 h after surgical incision. Pain scores and opioid consumption during the first 24 h after surgery. RESULTS There was no statistically significant difference between the median [IQR] peri-operative levels of stress hormones and pain scores between groups. Compared with baseline value 9.90 [4.2 to 23.1], free serum median cortisol levels were significantly high at 6 h in Group T, 23.6 [10.1 to 42.9] P = 0.015 and Group C 23.6 [9.9 to 46.3] P = 0.014. Only Group C showed significant elevation from the baseline median levels of plasma metanephrine at 60 min, 52.8 [33.4 to 193.2] P = 0.001, 6 h, 92.70 [2.4 to 202.6] P = 0.005 and normetanephrine at 60 min 83.44 [28.98 to 114.86] P = 0.004, 6 h 78.62 [36.6 to 162.31] P = 0.0005 and 24 h 80.96 [8.6 to 110.5] P = 0.025. Mean ± SD opioid consumption was similar in both groups: 39.60 ± 14.87 in Group T vs. 43.68 ± 14.93 in Group C (P = 0.338). CONCLUSION Mid-axillary TAP block does not improve stress response and analgesia in patients undergoing TAH receiving multimodal analgesia. TRAIL REGISTRATION ClinicalTrial.gov identifier: NCT03443271.
Collapse
Affiliation(s)
- Samina Ismail
- From the Department of Anaesthesiology (SI, AA, MQH, SA), Department of Pathology and Laboratory Medicine (AH) and Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan (AA)
| | | | | | | | | | | |
Collapse
|
6
|
Tang ZH, Chen Q, Wang X, Su N, Xia Z, Wang Y, Ma WH. A systematic review and meta-analysis of the safety and efficacy of remifentanil and dexmedetomidine for awake fiberoptic endoscope intubation. Medicine (Baltimore) 2021; 100:e25324. [PMID: 33832107 PMCID: PMC8036033 DOI: 10.1097/md.0000000000025324] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/01/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Awake fiberoptic endoscope intubation (AFOI) is the primary strategy for managing anticipated difficult airways. Adequate sedation, most commonly being achieved with remifentanil and dexmedetomidine, is integral to this procedure. This meta-analysis aimed to compare the safety and efficacy of these 2 sedatives. METHODS We conducted electronic searches in Embase, Web of Science, PubMed, Google Scholar, Medline, Springer, and Web of Science with no language restrictions. Studies comparing safety and efficacy between the sole use of remifentanil and dexmedetomidine among patients who underwent AFOI were included. Eight randomized controlled trials, comprising 412 patients, met the inclusion criteria. The primary outcomes were first attempt intubation success rate and incidence of hypoxia. The secondary outcomes were the Ramsay Sedation Scale score at intubation, memory recall of endoscopy, and unstable hemodynamic parameters during intubation. RESULTS Dexmedetomidine significantly reduced the incidence of hypoxemia during AFOI (risk ratio: 2.47; 95% confidence [CI]: 1.32-4.64]) compared with remifentanil; however, the first intubation success rates were equivalent (risk ratio: 1.12; 95% CI: 0.87-1.46]. No significant differences between the 2 sedatives were found for the Ramsay Sedation Scale score at intubation (mean difference: -0.14; 95% CI: -0.66-0.38) or unstable hemodynamic parameters during intubation (risk ratio: 0.83; 95% CI: 0.59-1.17). Dexmedetomidine reduced memory recall of endoscopy (risk ratio: 1.39; 95% CI: 1.13-1.72). CONCLUSIONS While both remifentanil and dexmedetomidine are effective for AFOI and well-tolerated, dexmedetomidine may be more effective in reducing the incidence of hypoxemia and memory recall of endoscopy. PROSPERP REGISTRATION NUMBER CRD42020169612.
Collapse
Affiliation(s)
- Zhi-hang Tang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| | - Qi Chen
- Anesthesiology Department of Chongqing University Cancer Hospital/Chongqing Cancer institute, Chongqing
| | - Xia Wang
- Guangzhou University of Chinese Medicine, Guangzhou
| | - Nan Su
- Inner Mongolia People's Hospital, Inner Mongolia
| | - Zhengyuan Xia
- Department of Anesthesiology, the University of Hong Kong, Hong Kong, China
| | - Yong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| | - Wu-hua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| |
Collapse
|
7
|
Mostafa MF, Hamed E, Amin AH, Herdan R. Dexmedetomidine versus clonidine adjuvants to levobupivacaine for ultrasound-guided transversus abdominis plane block in paediatric laparoscopic orchiopexy: Randomized, double-blind study. Eur J Pain 2020; 25:497-507. [PMID: 33128801 DOI: 10.1002/ejp.1689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic surgeries are associated with less postoperative pain and adverse events compared to open procedures. But, it still reduces the quality of life in children. Transversus abdominis plane (TAP) block is used to reduce pain. We hypothesized that dexmedetomidine or clonidine could improve the analgesic profile of levobupivacaine to the same extent during TAP block in children. METHODS Ninety children were randomly allocated in a randomized double-blind trial to receive bilateral TAP block with levobupivacaine plus normal saline (group B, n = 30), or dexmedetomidine (group D, n = 30) or clonidine (group C, n = 30). Primary outcome was the modified Children's Hospital of Eastern Ontario Pain Scale score. Secondary outcomes included time to initial analgesic request, number of analgesic claims, total analgesic consumption, parents' satisfaction, sedation score and complications. RESULTS Children of group D showed reduced pain scores compared to other groups. They represented the longest period of analgesia (565.00 ± 71.5 min) with p < 0.001, and fewer patients required two doses of analgesia during the first postoperative day. The cumulative amount of backup analgesia was significantly different between these groups (p = 0.026). Higher parents' satisfaction scores were recorded in groups D and C compared to group B. Sedation among the study groups revealed significant differences (p = 0.035), but no severe complications were recorded. CONCLUSIONS Adding dexmedetomidine to levobupivacaine can extend the time of analgesia and reduce the use of postoperative backup analgesics with minimal sedation effects when used in TAP block in paediatrics undergoing laparoscopic orchiopexy. Clonidine can be used as an alternative adjuvant to local anaesthetics with good postoperative analgesic profiles. SIGNIFICANCE Clonidine can alternate dexmedetomidine during TAP block with local anesthetics for pediatrics laparoscopies. Both can lead to better postoperative analgesic profiles. Clonidine may be preferred, especially in our developing regions, because of its easy availability and lower cost than that of dexmedetomidine.
Collapse
Affiliation(s)
- Mohamed F Mostafa
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esam Hamed
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed H Amin
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ragaa Herdan
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| |
Collapse
|