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Zeng J, Hong A, Gu Z, Jian J, Liang X. Efficacy of transversus abdominis plane block on postoperative nausea and vomiting: a meta-analysis of randomized controlled trial. BMC Anesthesiol 2024; 24:87. [PMID: 38429757 PMCID: PMC10905943 DOI: 10.1186/s12871-024-02469-x] [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: 06/04/2023] [Accepted: 02/24/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a common postoperative complication, and Transversus abdominis plane (TAP) block can provide effective analgesia for surgical operation. However, but there is not enough evidence to prove its advantage for nausea and vomiting. The objective of this meta-analysis was to evaluate the efficacy of TAP block on PONV. METHODS Two independent researchers conducted searches for randomized controlled trials (RCTs) in PubMed, Embase, and Cochrane Central Register of Controlled Trials. We used Review Manager software for meta-analysis. RESULTS In this meta-analysis, twenty-six trials with 1981 patients were examined. The results showed that TAP block reduced postoperative nausea (Risk Difference (RD) = -0.10, 95% confidence interval (CI): -0.15 to -0.05) compared with no TAP block. TAP block reduced the dose of fentanyl (Standardized Mean Difference (SMD) = -1.17, 95% CI: -2.07 to -0.26) and morphine (SMD = -1.12, 95% CI: -2.10 to -0.13) compared with no TAP block, when the timing of administration was before surgery (RD = -0.13, 95% CI: -0.19 to -0.07). TAP block reduced postoperative nausea when the ropivacaine dosage is ≤ 100 mg (RD = -0.13, 95% CI: -0.21 to -0.06), bupivacaine dosage ≥ 100 mg ( RD = -0.08, 95% CI: -0.13 to -0.03), and when the ropivacaine concentration was ≤ 0.375% (RD = -0.11, 95% CI: -0.18 to -0.04). TAP block significantly reduced the incidence of nausea when the types of opioid drugs in PCA is tramadol (RD = -0.13, 95% CI: -0.24 to -0.03). TAP block could reduce the VAS (SMD= -0.99, 95% CI: -1.29 to -0.70) and reduce the time of extubation (SMD = -0.71, 95% CI: -1.34 to -0.08). CONCLUSION The meta-analysis conducted in this study revealed that TAP block could reduce the incidence of PONV, and the efficacy of TAP block may be influenced by factors such as administration time, local anesthetic dosage and concentration, types of opioid drugs in PCA.
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Affiliation(s)
- Jinfang Zeng
- Department of Anesthesiology, Jiangnan University Medical Center, Affiliated Wuxi Clinical College of Nantong University, Wuxi, 214002, China.
| | - Aonan Hong
- Department of Anesthesiology, Affiliated Hospital of Nanjing, University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210000, China
| | - Zhen Gu
- Department of Anesthesiology, Jiangnan University Medical Center, Affiliated Wuxi Clinical College of Nantong University, Wuxi, 214002, China
| | - Jinjin Jian
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, Wuxi, 214002, China
| | - Xiao Liang
- Department of Anesthesiology, Jiangnan University Medical Center, Affiliated Wuxi Clinical College of Nantong University, Wuxi, 214002, China.
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Ismail S, Mistry AA, Siddiqui AS, Aziz A, Zuberi NF. The analgesic efficacy of ultrasound-guided transversus abdominis plane block vs. local anesthetic infiltration technique in major gynecologic surgery: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2023; 39:557-564. [PMID: 38269169 PMCID: PMC10805223 DOI: 10.4103/joacp.joacp_78_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/23/2022] [Indexed: 01/26/2024] Open
Abstract
Background and Aim Transversus abdominis plane (TAP) block and local anesthetic infiltration (LAI) technique are used as part of the multimodal analgesic regimen after abdominal surgery. Postoperative opioid consumption and analgesic efficacy was compared using TAP and LAI techniques in patients undergoing gynecologic surgery in a randomized, controlled clinical trial. Material and Methods Total of 135 patients scheduled for major gynecological surgeries were allocated into three groups: group T received bilateral TAP block with bupivacaine 0.25%; group I received LAI with 0.25% bupivacaine with epinephrine 5 μ/mL in the peritoneum and abdominal wall, and group C was control group. Anesthesia and postoperative analgesia were standardized. Outcome measures were cumulative and rescue tramadol consumption, numerical rating score (NRS) for pain and side effects in post-anesthesia care unit (PACU) at 4, 8, 12 hours postoperatively. Results Tramadol consumption, need for rescue analgesia, and NRS for pain between three groups at 4, 8, and 12 hours postoperatively had no statistically significant difference (P < 0.05). In PACU, median tramadol consumption used for rescue analgesia between group T (15 (15-30)) and group C (30 (15-45)) (P = 0.035), and between group T (15 (15-30)) and group I (30 (15-52)) was statistically significant (P = 0.034). In PACU, the percentage of patients having NRS >4 on movement in group C (72%) compared to group T (46.5%) and group I (46.5%) was significant (P = 0.034). No statistically significant difference was observed in the incidence of side effects among study groups (P > 0.05). Conclusion Except for the immediate postoperative period, neither TAP block nor LAI had added benefit to the multimodal analgesia regimen in patients undergoing gynecological surgeries.
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Affiliation(s)
- Samina Ismail
- Department of Anaesthesiology, Aga Khan University Hospital, Pakistan
| | - Akbar A. Mistry
- Department of Anaesthesiology, Aga Khan University Hospital, Pakistan
| | - Ali S. Siddiqui
- Department of Anaesthesiology, Aga Khan University Hospital, Pakistan
| | - Aliya Aziz
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Pakistan
| | - Nadeem F. Zuberi
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Pakistan
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Sethi D, Garg G. Analgesic efficacy of ultrasound-guided transversus abdominis plane block for laparoscopic gynecological surgery: a randomized controlled trial. Anesth Pain Med (Seoul) 2022; 17:67-74. [PMID: 34991187 PMCID: PMC8841257 DOI: 10.17085/apm.21030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to determine whether ultrasound-guided transversus abdominis plane (TAP) block is more effective in reducing postoperative pain and analgesic consumption than local anesthetic infiltration (LAI) at the port site for elective laparoscopic gynecological surgeries. Methods Eighty patients with the American Society of Anesthesiologists status I/II undergoing laparoscopic gynecology surgery were enrolled for this randomized control trial. After general anesthesia was administered, patients in group C received LAI at each port site, and patients in group T received bilateral ultrasound-guided TAP block. Postoperative pain was assessed at time intervals of 1/2, 2, 4, 6, 8, and 24 h using the numeric rating scale (NRS). Clinical metrics such as postoperative analgesic diclofenac consumption, need for rescue fentanyl, nausea-vomiting scores, and antiemetic requirements were also recorded. Results Seventy-four patients were included in the final analysis. Postoperatively, patients in group T had significantly lower NRS than those in group C (P < 0.05). The highest difference in the postoperative NRS was observed at 2 h (median [1Q, 3Q]; group C = 3 [2, 4]; group T = 1 [0, 2]; P < 0.001). A statistically significant difference was observed in the frequency of diclofenac (75 mg intravenous) requirement between the groups (P = 0.010). No significant difference was observed between the groups in need of rescue fentanyl or antiemetic and the nausea-vomiting scores. Conclusions In patients undergoing laparoscopic gynecological surgery, ultrasound-guided TAP block provided greater postoperative analgesic benefits in terms of lower NRS and reduced analgesic requirements than port site LAI.
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Affiliation(s)
- Divya Sethi
- Department of Anesthesia and Critical Care, Employees' State Insurance Cooperation Postgraduate Institute of Medical Sciences and Research (ESIC-PGIMSR), New Delhi, India
| | - Garima Garg
- Department of Anesthesia and Critical Care, Employees' State Insurance Cooperation Postgraduate Institute of Medical Sciences and Research (ESIC-PGIMSR), New Delhi, India
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Dengler KL, Craig ER, DiCarlo-Meacham AM, Welch EK, Brooks DI, Vaccaro CM, Gruber DD. Preoperative pudendal block with liposomal and plain bupivacaine reduces pain associated with posterior colporrhaphy: a double-blinded, randomized controlled trial. Am J Obstet Gynecol 2021; 225:556.e1-556.e10. [PMID: 34473963 DOI: 10.1016/j.ajog.2021.08.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/08/2021] [Accepted: 08/24/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pelvic reconstructive surgery may cause significant postoperative pain, especially with posterior colporrhaphy, contributing to a longer hospital stay and increased pain medication utilization. Regional blocks are being increasingly utilized in gynecologic surgery to improve postoperative pain and decrease opioid usage, yet preoperative pudendal blocks have not been used routinely during posterior colporrhaphy. OBJECTIVE This study aimed to compare the effect of preoperative regional pudendal nerve block using a combination of 1.3% liposomal and 0.25% plain bupivacaine vs 0.25% plain bupivacaine alone on vaginal pain after posterior colporrhaphy on postoperative days 1, 2, and 3. We hypothesized that there would be a reduction in vaginal pain scores for the study group vs the control group over the first 72 hours. STUDY DESIGN This was a double-blinded, randomized controlled trial that included patients undergoing a posterior colporrhaphy, either independently or in conjunction with other vaginal or abdominal reconstructive procedures. Patients were block randomized to receive 20 mL of either a combination of 1.3% liposomal and 0.25% plain bupivacaine (study) or 20 mL of 0.25% plain bupivacaine (control) in a regional pudendal block before the start of surgery. Double blinding was achieved by covering four 5-mL syringes containing the randomized local anesthetic. After induction of anesthesia, a pudendal nerve block was performed per standard technique (5 mL superiorly and 5 mL inferiorly each ischial spine) using a pudendal kit. The primary outcome was to evaluate postoperative vaginal pain using a visual analog scale on postoperative days 1, 2, and 3. Secondary outcomes included total analgesic medication usage through postoperative day 3, postoperative voiding and defecatory dysfunction, and impact of vaginal pain on quality of life factors. RESULTS A total of 120 patients were enrolled (60 in each group). There were no significant differences in demographic data, including baseline vaginal pain (P=.88). Postoperative vaginal pain scores were significantly lower in the combined liposomal and bupivacaine group at all time points vs the plain bupivacaine group. Median pain scores for the study and control groups, respectively, were 0 (0-2) and 2 (0-4) for postoperative day 1 (P=.03), 2 (1-4) and 3 (2-5) for postoperative day 2 (P=.05), and 2 (1-4) and 3 (2-5) for postoperative day 3 (P=.02). Vaginal pain scores increased from postoperative day 1 to postoperative days 2 and 3 in both groups. There was a significant decrease in ibuprofen (P=.01) and acetaminophen (P=.03) usage in the study group; however, there was no difference between groups in total opioid consumption through postoperative day 3 (P=.82). There was no difference in successful voiding trials (study 72%, control 82%, P=.30), return of bowel function (P>.99), or quality of life factors (sleep, stress, mood, and activity). CONCLUSION Preoperative regional pudendal block with a combination of liposomal and plain bupivacaine provided more effective vaginal pain control than plain bupivacaine alone for reconstructive surgery that included posterior colporrhaphy. Given the statistically significant decrease in vaginal pain in the study group, this block may be considered as a potential adjunct for multimodal pain reduction in this patient population.
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Affiliation(s)
- Katherine L Dengler
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD.
| | - Eric R Craig
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Angela M DiCarlo-Meacham
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Eva K Welch
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Daniel I Brooks
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, MD
| | - Christine M Vaccaro
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Daniel D Gruber
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD; Urogynecology Department, Sibley Memorial Hospital, Johns Hopkins Medicine, Washington, DC
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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: 21] [Impact Index Per Article: 7.0] [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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Benabou K, Kim S, Tierney CH, Messom JE, Kyriakides TC, Kashani SM, Silasi DA, Azodi M, Seifi F. Laparoscopic Posterior Versus Lateral Transversus Abdominis Plane Block in Gynecology. JSLS 2021; 24:JSLS.2020.00032. [PMID: 32831540 PMCID: PMC7434395 DOI: 10.4293/jsls.2020.00032] [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] [Indexed: 01/06/2023] Open
Abstract
Background and Objectives Transversus abdominis plane (TAP) block is a safe and effective type of regional anesthesia technique used in laparoscopic gynecologic surgery to minimize postoperative pain. Our study aimed to compare the analgesic effects of the posterior versus lateral approaches to laparoscopic-assisted TAP block in minimally invasive gynecologic surgery. Methods We performed a randomized controlled trial with 82 patients allocated to either posterior (n = 38) or lateral (n = 44) TAP block groups. Laparoscopic-assisted posterior or lateral TAP block was administered using liposomal bupivacaine mixture. All subjects were asked to fill out a questionnaire, which included postoperative pain scores at 6 h, 12 h, 24 h, 48 h, and 72 h, as well as narcotic utilization postoperatively. Both groups were compared for postoperative pain scores, opioid consumption, perioperative, and demographic characteristics. Results A total of 67 patients were analyzed in our study (n = 33 in posterior arm, n = 34 in lateral arm). Demographic characteristics including race, body mass index, comorbidities, American Society of Anesthesiologists classification, pre-operative diagnosis, complication rates, length of stay, and estimated blood loss were comparable between the two groups. The distribution of different operative procedures was similar between the two groups. There was no statistically significant difference in pain scores at 6 h, 12 h, 24 h, 48 h, and 72 h postoperatively between the two groups. However, patients receiving posterior TAP had a significant reduction in narcotic intake (p = 0.0009). Conclusion Laparoscopic-assisted TAP block is a safe and effective option for regional analgesia in laparoscopic gynecologic surgery. Posterior TAP block may help to reduce narcotic usage postoperatively.
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Affiliation(s)
- Kelly Benabou
- Department of Obstetrics and Gynecology, Yale University School of Medicine
| | - Soorin Kim
- Department of Obstetrics and Gynecology, Yale University School of Medicine
| | | | - Joel E Messom
- Department of Obstetrics and Gynecology, Yale University School of Medicine
| | | | - Shabnam M Kashani
- Department of Obstetrics and Gynecology, Yale University School of Medicine
| | - Dan-Arin Silasi
- Department of Obstetrics and Gynecology, Yale University School of Medicine
| | - Masoud Azodi
- Department of Obstetrics and Gynecology, Yale University School of Medicine
| | - Farinaz Seifi
- Department of Obstetrics and Gynecology, Yale University School of Medicine
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Abstract
Abstract
In this narrative review article, the authors discuss the anatomy, nomenclature, history, approaches (posterior vs. lateral vs. subcostal), techniques, pharmacology, indications, and complications of transversus abdominis plane blocks, as well as possible alternative truncal blocks.
Despite the scarcity of evidence and contradictory findings, certain clinical suggestions can nonetheless be made. Overall transversus abdominis plane blocks appear most beneficial in the setting of open appendectomy (posterior or lateral approach). Lateral transversus abdominis plane blocks are not suggested for laparoscopic hysterectomy, laparoscopic appendectomy, or open prostatectomy. However, transversus abdominis plane blocks could serve as an analgesic option for Cesarean delivery (posterior or lateral approach) and open colorectal section (subcostal or lateral approach) if there exist contraindications to intrathecal morphine and thoracic epidural analgesia, respectively.
Future investigation is required to compare posterior and subcostal transversus abdominis plane blocks in clinical settings. Furthermore, posterior transversus abdominis plane blocks should be investigated for surgical interventions in which their lateral counterparts have proven not to be beneficial (e.g., laparoscopic hysterectomy/appendectomy, open prostatectomy). More importantly, because posterior transversus abdominis plane blocks can purportedly provide sympathetic blockade and visceral analgesia, they should be compared with thoracic epidural analgesia for open colorectal surgery. Finally, transversus abdominis plane blocks should be compared with newer truncal blocks (e.g., erector spinae plane and quadratus lumborum blocks) with well-designed and adequately powered trials.
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Qiao XF, Jia WD, Li YQ, Lv JG, Zhou H. Effectiveness of Parecoxib Sodium Combined with Transversus Abdominis Plane Block for Pain Management After Hepatectomy for Hepatocellular Carcinoma: A Prospective Controlled Study. Med Sci Monit 2019; 25:1053-1060. [PMID: 30730866 PMCID: PMC6375540 DOI: 10.12659/msm.912843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/31/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effectiveness of perioperative parecoxib sodium combined with transversus abdominis plane (TAP) block on postoperative pain management following hepatectomy in patients with hepatocellular carcinoma (HCC). MATERIAL AND METHODS One hundred patients with HCC who underwent hepatectomy were randomized into a study group (n=51) and a control group (n=49). The study group received 40 mg of parecoxib sodium 30 minutes before anesthetic induction, and 150 mg of 0.375% ropivacaine with 5 mg dexamethasone as TAP inhibitors, before closing the abdominal incision. The control group received 40 mg of placebo 30 minutes before anesthetic induction, without TAP block. Postoperatively, all patients received patient-controlled intravenous analgesia (PCIA) and evaluation with subjective visual analog scale (VAS) pain scores. Data on adverse events, postoperative ambulation (>6 hours/day), time of flatus and defecation, and hospitalization duration were recorded. RESULTS Pain scores of the study group were significantly lower compared with the control group on the first three postoperative days. No significant differences were found between the two groups in terms of adverse events. In the study group, the number of cases of postoperative ambulation was significantly more than the control group. The onset of flatus and defecation and duration of hospital stay in the study group were significantly shorter in the study group compared with the control group. CONCLUSIONS Parecoxib sodium combined with TAP block effectively reduced postoperative pain, improved ambulation, improved gastrointestinal function, and shortened hospitalization time following hepatectomy in patients with HCC without adverse effects.
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Affiliation(s)
- Xiao-Fei Qiao
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
- Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, P.R. China
| | - Wei-Dong Jia
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
- Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, P.R. China
| | - Yue-Qing Li
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Jian-Guo Lv
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
- Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, P.R. China
| | - Hong Zhou
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
- Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, P.R. China
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Long JB, Bevil K, Giles DL. Preemptive Analgesia in Minimally Invasive Gynecologic Surgery. J Minim Invasive Gynecol 2019; 26:198-218. [DOI: 10.1016/j.jmig.2018.07.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 11/24/2022]
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Laparoscopic-guided transversus abdominis plane block versus trocar site local anesthetic infiltration in gynecologic laparoscopy. ACTA ACUST UNITED AC 2018. [DOI: 10.1186/s10397-018-1047-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Relieving postoperative pain and prompt resumption of physical activity are of the utmost importance for the patients and surgeons. Infiltration of local anesthetic is frequently used methods of pain control postoperatively. Laparoscopically delivered transversus abdominis plane block is a new modification of ultrasound-guided transversus abdominis plane block.
This study was conducted to compare the efficacy of laparoscopic-guided transversus abdominis plane block with trocar site local anesthetic infiltration for pain control after gynecologic laparoscopy.
Results
No statistically significant difference between the two groups in mean visual analogue scale at 1, 18, and 24 h (P = 0.34, P = 0.41, and P = 0.61, respectively), while the mean visual analogue scale was significantly lower in the laparoscopic-guided transversus abdominis plane block group than in the trocar site local anesthetic infiltration group at 3, 6, and 12 h (P = 0.049, P = 0.011, and P = 0.042, respectively). No statistically significant difference was observed in the cumulative narcotics consumed at 3 h (P = 0.52); however, women with transversus abdominis plane block have consumed significantly less amount of narcotics than women with trocar site infiltration at 6, 12, and 24 h (P = 0.04, P = 0.038, and P = 0.031 respectively). Patient satisfaction was significantly higher in the laparoscopic-guided transversus abdominis plane block group (P = 0.035).
Conclusion
Laparoscopic-guided transversus abdominis plane block is more effective in reduction of both pain scores in the early postoperative period and the cumulative narcotics consumption than trocar site local anesthetic infiltration in gynecologic laparoscopy.
Trial registration
Clinical Trials.gov NCT02973451
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Bialka S, Copik M, Daszkiewicz A, Rivas E, Ruetzler K, Szarpak L, Misiolek H. Comparison of different methods of postoperative analgesia after thoracotomy-a randomized controlled trial. J Thorac Dis 2018; 10:4874-4882. [PMID: 30233861 DOI: 10.21037/jtd.2018.07.88] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Continuous thoracic epidural analgesia (TEA) is a preferred method of postoperative analgesia in thoracic surgery. Intravenous patient-controlled analgesia (IVPCA) may be an effective alternative. One of the most commonly used opioids in PCA is morphine. It has high antinociceptive efficacy but is associated with many adverse events. Oxycodone can be an alternative. A small number of scientific reports comparing morphine and oxycodone in PCA for the treatment of acute postoperative pain after thoracotomy was the reason to conduct this study. Methods Prospective, randomised, observational study. In total of 99 patients scheduled for elective thoracotomy were randomized into three study groups. TEA group received continuous TEA as a method of postoperative pain management, morphine (MF) group received morphine IVPCA, and morphine (OXY) group oxycodone IVPCA. For 48 hours' hemodynamic parameters, level of pain, sedation and the need for rescue analgesia were monitored. After 48 hours' patients were asked about their satisfaction with pain treatment using Likert scale and assessment of opioid related adverse events via overall benefit of analgesia score (OBAS). Results The level of pain in visual analogic score (VAS) and Prince Henry Hospital Pain Score (PHHPS) scales was significantly lower in TEA group with no significant difference between groups MF and OXY. Using morphine in PCA was associated with a significantly higher likelihood of need of rescue analgesia. The level of sedation in Ramsay scale was significantly higher in MF compared to OXY and TEA group. There were no significant differences between groups in OBAS scale. TEA group was characterized by the highest degree of patient satisfaction. Conclusions TEA provided superior anaesthesia compared to PCA in our study group. Use of PCA oxycodone in postoperative pain management after open thoracotomy provides similar nociception control compared to morphine but is associated with less sedation and patients using oxycodone IVPCA require smaller doses of rescue analgesia compared to systemic morphine IVPCA.
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Affiliation(s)
- Szymon Bialka
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Maja Copik
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Andrzej Daszkiewicz
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Eva Rivas
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Lukasz Szarpak
- Faculty of Medicine, Lazarski University, Warsaw, Poland.,Department of Emergency Medicine, Warsaw Medical University, Warsaw, Poland
| | - Hanna Misiolek
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
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Postoperative Analgesia by a Transversus Abdominis Plane Block Using Different Concentrations of Ropivacaine for Abdominal Surgery: A Meta-Analysis. Clin J Pain 2018; 33:853-863. [PMID: 28002093 DOI: 10.1097/ajp.0000000000000468] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transversus abdominis plane block (TAPB) has been proven to be an effective means of postoperative anesthesia, but the optimum effective concentration of ropivacaine warrants further research. OBJECTIVE This study aimed to identify the optimal ropivacaine concentration of TAPB using a meta-analysis. MATERIALS AND METHODS This study consisted of a meta-analysis of randomized controlled trials (RCTs). We searched online databases, including PubMed, Embase, the Cochrane Database of Systematic Reviews, and Web of Science. RCTs investigating the 24-hour postoperative opioid consumption and the rest and dynamic pain scores 2, 12, and 24 hours after surgery were included in this analysis. We also assessed opioid-related side-effects and patient satisfaction 24 hours after surgery. RESULTS Nineteen RCTs (1217 patients) were included in this meta-analysis, which showed that only TAPB with 0.375% and 0.5% ropivacaine was able to reduce opioid consumption 24 hours after surgery by weighted mean differences of -6.55 and -4.44 mg (morphine IV equivalents), respectively (P<0.05). A meta-regression analysis did not reveal an association between the local anesthetic dose (in mg), surgery, anesthesia, block timing, and the TAPB effect on opioid consumption. Ropivacaine concentrations of 0.375% and 0.5% reduced the 2-hour postoperative pain score and reduced the incidence of nausea and vomiting, but this analgesic effect disappeared at 12 and 24 hours. Only TAPB with 0.375% ropivacaine improved the degree of satisfaction 24 hours after surgery (weighted mean difference of 0.87 [0.08-1.66], P=0.03). CONCLUSION In terms of efficacy and safety, the use of 0.375% ropivacaine for TAPB is preferred in the clinical work.
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Erdogan MA, Ozgul U, Uçar M, Yalin MR, Colak YZ, Çolak C, Toprak HI. Effect of transversus abdominis plane block in combination with general anesthesia on perioperative opioid consumption, hemodynamics, and recovery in living liver donors: The prospective, double-blinded, randomized study. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12931] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Mehmet A. Erdogan
- Department of Anaesthesiology and Reanimation; School of Medicine; Inonu University; Malatya Turkey
| | - Ulku Ozgul
- Department of Anaesthesiology and Reanimation; School of Medicine; Inonu University; Malatya Turkey
| | - Muharrem Uçar
- Department of Anaesthesiology and Reanimation; School of Medicine; Inonu University; Malatya Turkey
| | - Mehmet R. Yalin
- Department of Anaesthesiology and Reanimation; School of Medicine; Inonu University; Malatya Turkey
| | - Yusuf Z. Colak
- Department of Anaesthesiology and Reanimation; School of Medicine; Inonu University; Malatya Turkey
| | - Cemil Çolak
- Department of Biostatistics and Medical Informatics; School of Medicine; Inonu University; Malatya Turkey
| | - Huseyin I. Toprak
- Department of Anaesthesiology and Reanimation; School of Medicine; Inonu University; Malatya Turkey
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14
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Şahin AS, Ay N, Şahbaz NA, Akay MK, Demiraran Y, Derbent A. Analgesic effects of ultrasound-guided transverse abdominis plane block using different volumes and concentrations of local analgesics after laparoscopic cholecystectomy. J Int Med Res 2017; 45:211-219. [PMID: 28222631 PMCID: PMC5536595 DOI: 10.1177/0300060516682883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the effects of an ultrasound-guided transverse abdominis plane (US-TAP) block used for postoperative pain relief by comparing the efficacy of two different volumes/concentrations of the local anaesthetic bupivacaine in patients undergoing laparoscopic cholecystectomies. Methods This randomized study enrolled patients undergoing laparoscopic cholecystectomies. They were randomized to two groups: group A received a 20 ml US-TAP block (50 mg bupivacaine +10 ml saline solution) and group B received a 30 ml US-TAP block (50 mg bupivacaine + 20 ml saline solution). The intraoperative consumption of remifentanil, the requirement for postoperative rescue analgesics, patient satisfaction scores, postoperative complications, and postoperative pain as measured by a visual analogue scale at 20 min, 12 h, and 24 h were recorded. Results A total of 60 patients enrolled in the study. There were no differences between the two groups with respect to demographic characteristics, duration of anaesthesia and patient satisfaction scores. The intraoperative consumption of remifentanil, postoperative VAS scores (20 min, 12 h and 24 h) and the requirement for postoperative analgesics were all significantly lower in group B who received a larger volume but a lower concentration of local anaesthetic solution compared with group A. Conclusion A US-TAP block can form part of a balanced postoperative analgesic regimen following laparoscopic cholecystectomy.
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Affiliation(s)
- Ayça Sultan Şahin
- 1 Department of Anaesthesiology and Reanimation, Istanbul Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Necmiye Ay
- 1 Department of Anaesthesiology and Reanimation, Istanbul Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Nuri Alper Şahbaz
- 2 Department of General Surgery, Istanbul Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Mehlika Kocabaş Akay
- 3 Engineering Faculty of Industrial Engineering, Kocaeli University, Kocaeli, Turkey
| | - Yavuz Demiraran
- 1 Department of Anaesthesiology and Reanimation, Istanbul Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Abdurrahim Derbent
- 1 Department of Anaesthesiology and Reanimation, Istanbul Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
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16
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Hotta K, Inoue S, Taira K, Sata N, Tamai K, Takeuchi M. Comparison of the analgesic effect between continuous wound infiltration and single-injection transversus abdominis plane block after gynecologic laparotomy. J Anesth 2015; 30:31-8. [PMID: 26467038 DOI: 10.1007/s00540-015-2083-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/20/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE Both single-injection transversus abdominis plane (TAP) block and continuous wound infiltration (CWI) provide postoperative analgesia, but no study has compared the two regional techniques. We tested the hypothesis that CWI is more effective for controlling postoperative pain compared with single-injection TAP block after laparotomy. METHODS We conducted a prospective randomized study of patients undergoing gynecologic laparotomy with midline incision through the umbilicus under general anesthesia. The patients were allocated to receive either single-injection TAP block (TAP group) or CWI (CWI group) for postoperative analgesia. All patients received intravenous patient-controlled analgesia with morphine and intravenous flurbiprofen twice daily after surgery. Postoperative pain at rest and on coughing, postoperative morphine consumption, incidence of postoperative nausea and vomiting (PONV), pruritus and urinary retention, ambulation, and satisfaction score were recorded. Patients were assessed at 3 h after surgery and twice daily on postoperative days (POD) 1 and 2. RESULTS Data of 54 patients were analyzed. Compared to the TAP group (n = 27), pain score on coughing was significantly lower in the CWI group (n = 27) on POD1 and POD2 (P < 0.05). Pain score on coughing at 3 h after surgery, pain score at rest at all assessed time points, morphine consumption, incidence of PONV, pruritus and urinary retention, ambulation, and satisfaction score were not different between the two groups. CONCLUSION CWI reduced pain on coughing after the day of surgery compared with single-injection TAP block when performed as part of multimodal analgesia in patients undergoing gynecologic laparotomy.
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Affiliation(s)
- Kunihisa Hotta
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Soichiro Inoue
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.,Department of Anesthesiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Koki Taira
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Naho Sata
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kenji Tamai
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Mamoru Takeuchi
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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