1
|
De Cassai A, Geraldini F. Response to "Comment on Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis". Korean J Anesthesiol 2024; 77:406-407. [PMID: 38499438 PMCID: PMC11150118 DOI: 10.4097/kja.23703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Federico Geraldini
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| |
Collapse
|
2
|
Ökmen K. Reply: do we really need new approaches for laparoscopic cholecystectomy analgesia? Minerva Anestesiol 2024; 90:463-464. [PMID: 38289298 DOI: 10.23736/s0375-9393.23.17960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Korgün Ökmen
- Department of Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Türkiye -
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Sethuraman RM. Comment on "Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis". Korean J Anesthesiol 2024; 77:164. [PMID: 38302289 PMCID: PMC10834720 DOI: 10.4097/kja.23143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 02/03/2024] Open
Affiliation(s)
- Raghuraman M Sethuraman
- Department of Anesthesiology, Sree Balaji Medical College & Hospital, Bharath Institute of Higher Education and Research, Chennai, India
| |
Collapse
|
5
|
Dost B, De Cassai A, Balzani E, Geraldini F, Tulgar S, Ahiskalioglu A, Karapinar YE, Beldagli M, Navalesi P, Kaya C. Analgesic benefits of pre-operative versus postoperative transversus abdominis plane block for laparoscopic cholecystectomy: a frequentist network meta-analysis of randomized controlled trials. BMC Anesthesiol 2023; 23:408. [PMID: 38087218 PMCID: PMC10714465 DOI: 10.1186/s12871-023-02369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Transversus abdominis plane (TAP) block has been utilized to alleviate pain following laparoscopic cholecystectomy (LC). However, the optimal timing of administration remains uncertain. This study aimed to compare the efficacy of pre-operative and postoperative TAP blocks as analgesic options after LC. METHODS A frequentist network meta-analysis of randomized controlled trials (RCTs) was conducted. We systematically searched PubMed (via the National Library of Medicine), EMBASE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science up to March 2023. The study included RCTs that enrolled adult patients (≥ 18 years) who underwent LC and received either pre-operative or postoperative TAP blocks. The primary outcome assessed was 24-hour postoperative morphine consumption (mg). Additionally, pain rest scores within 3 hours, 12 hours, and 24 hours, as well as postoperative nausea and vomiting (PONV), were considered as pre-specified secondary outcomes. RESULTS A total of 34 trials with 2317 patients were included in the analysis. Postoperative TAP block demonstrated superiority over the pre-operative TAP block in reducing opioid consumption (MD 2.02, 95% CI 0.87 to 3.18, I2 98.6%, p < 0.001). However, with regards to postoperative pain, neither pre-operative nor postoperative TAP blocks exhibited superiority over each other at any of the assessed time points. The postoperative TAP block consistently ranked as the best intervention using SUCRA analysis. Moreover, the postoperative TAP block led to the most significant reduction in PONV. CONCLUSIONS The findings suggest that the postoperative TAP block may be slightly more effective in reducing 24-hour postoperative opioid consumption and PONV when compared to the pre-operative TAP block. TRIAL REGISTRATION PROSPERO, CRD42023396880 .
Collapse
Affiliation(s)
- Burhan Dost
- Department of Anesthesiology and Reanimation, School of Medicine, Ondokuz Mayis University Faculty of Medicine, Kurupelit, Samsun, TR55139, Turkey.
| | - Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit "Sant'Antonio", University Hospital of Padua, Padua, Italy
| | - Eleonora Balzani
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Federico Geraldini
- UOC Anesthesia and Intensive Care Unit "Sant'Antonio", University Hospital of Padua, Padua, Italy
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Yunus Emre Karapinar
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Müzeyyen Beldagli
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Paolo Navalesi
- UOC Institute of Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- DIMED Department of Medicine, University of Padua, Padua, Italy
| | - Cengiz Kaya
- Department of Anesthesiology and Reanimation, School of Medicine, Ondokuz Mayis University Faculty of Medicine, Kurupelit, Samsun, TR55139, Turkey
| |
Collapse
|
6
|
Sharma R, Damiano J, Al-Saidi I, Dizdarevic A. Chest Wall and Abdominal Blocks for Thoracic and Abdominal Surgeries: A Review. Curr Pain Headache Rep 2023; 27:587-600. [PMID: 37624474 DOI: 10.1007/s11916-023-01158-7] [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] [Accepted: 06/28/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an up-to-date description and overview of the rapidly growing literature pertaining to techniques and clinical applications of chest wall and abdominal fascial plane blocks in managing perioperative pain. RECENT FINDINGS Clinical evidence suggests that regional anesthesia blocks, including fascial plane blocks, such as pectoralis, serratus, erector spinae, transversus abdominis, and quadratus lumborum blocks, are effective in providing analgesia for various surgical procedures and have more desirable side effect profile when compared to traditional neuraxial techniques. They offer advantages such as reduced opioid consumption, improved pain control, and decreased opioid-related side effects. Further research is needed to establish optimal techniques and indications for these blocks. Presently, they are a vital instrument in a gamut of multimodal analgesia options, especially when there are contraindications to neuraxial or para-neuraxial procedures. Ultimately, clinical judgment and provider skill set determine which blocks-alone or in combination-should be offered to any patient.
Collapse
Affiliation(s)
- Richa Sharma
- Department of Anesthesiology, Weill-Cornell Medicine, New York, NY, 10065, USA.
| | - James Damiano
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Ibrahim Al-Saidi
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Anis Dizdarevic
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, 10032, USA
| |
Collapse
|
7
|
Hwang SM. How to prevent opioid abuse and addiction. Korean J Anesthesiol 2023; 76:169-170. [PMID: 37259283 DOI: 10.4097/kja.23304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Sung Mi Hwang
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon, Korea
| |
Collapse
|
8
|
Cheng Y, Zhou X, Wang G. The Efficacy of Foot Massage for Pain Relief of Laparoscopic Cholecystectomy: A Meta-analysis Study. Surg Laparosc Endosc Percutan Tech 2023; 33:286-290. [PMID: 37010361 DOI: 10.1097/sle.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/28/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Foot massage may have some potential in improving pain relief in patients undergoing laparoscopic cholecystectomy, and this meta-analysis aims to explore the impact of foot massage on pain control after laparoscopic cholecystectomy. MATERIALS AND METHODS PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched, and we included randomized controlled trials assessing the effect of foot massage on pain control after laparoscopic cholecystectomy. RESULTS Five randomized controlled trials were included in the meta-analysis. Overall, compared with control intervention for laparoscopic cholecystectomy, foot massage was associated with significantly lower pain scores at 60 minutes [mean difference (MD)=-1.19; 95% CI=-2.01 to -0.38; P =0.004), pain scores at 90 minutes (MD=-1.41; 95% CI=-1.73 to -1.10; P <0.00001), pain scores at 120 to 150 minutes (MD=-2.20; 95% CI=-2.49 to -1.90; P <0.00001) and reduced need of additional analgesia (odd ratio=0.04; 95% CI=0.02-0.08; P <0.00001), but demonstrated no obvious effect on pain scores at 10 to 30 minutes (MD=-0.25; 95% CI=-0.79 to 0.29; P =0.37). CONCLUSIONS Foot massage benefits to improve pain control after laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- Yunlan Cheng
- Department of Anesthesia Operation, People's Hospital of Chongqing Liang jiang New Area, Chongqing, China
| | | | | |
Collapse
|
9
|
Choi YJ. Updated evidence for optimal anesthesia following laparoscopic cholecystectomies. Korean J Anesthesiol 2023; 76:1-2. [PMID: 36746178 PMCID: PMC9902191 DOI: 10.4097/kja.23018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Affiliation(s)
- Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea,Corresponding author: Yoon Ji Choi, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, KoreaTel: +82-31-412-5289Fax: +82-31-412-5294
| |
Collapse
|