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Richards DC, Dunn BA, Chellappa VR, John CR, Davis WB. Postoperative pain control and opioid use with transversus abdominis plane block and scheduled multimodal pain management in patients undergoing cesarean section. Int J Gynaecol Obstet 2024. [PMID: 38798146 DOI: 10.1002/ijgo.15699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/19/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE The impact of a transversus abdominis plane (TAP) block in patients undergoing cesarean section requires further evaluation. The aim of this study was to compare postoperative pain scores and opioid use in cesarean surgery patients undergoing either a TAP block and scheduled multimodal pain management (SMPM) or SMPM alone. METHODS In this retrospective, dual cohort study, cesarean surgery patients underwent neuraxial anesthesia and a TAP block (SMPM/TAP) or SMPM; the TAP block incorporated ropivacaine (20-30 mL) administered bilaterally. The group analyses involved a comparison of postoperative pain scores using the visual analog scale and opioid consumption at 24 and 24-48 h. RESULTS There were 94 (52.8%) patients in the SMPM/TAP group and 84 (47.2%) subjects in the SMPM alone group. At 24 h postoperatively, the SMPM/TAP group exhibited significantly lower pain scores (4.07 vs 4.54) than the SMPM group (P < 0.001) and reduced opioid consumption (2.29 vs 3.28 mg; P < 0.001). However, at 24-48 h, the SMPM group demonstrated lower pain scores (5.46 vs 5.98) compared to the SMPM/TAP group (P < 0.001) and reduced opioid consumption (8.75 vs 10.21 mg; P < 0.001); overall opioid consumption was higher (12.50 vs 12.02 mg) in the SMPM/TAP group (P < 0.001). CONCLUSION The TAP block improved cesarean surgery patients' pain scores and reduced opioid consumption at 24 h postoperatively but the effect of the TAP block was ephemeral as the SMPM/TAP group exhibited inferior pain scores and greater opioid consumption compared to the SMPM group at 24-48 h postoperatively.
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Affiliation(s)
- David C Richards
- Newport Harbor Anesthesia Consultants, Newport Beach, California, USA
| | - Brian A Dunn
- Newport Harbor Anesthesia Consultants, Newport Beach, California, USA
| | - Vivek R Chellappa
- Newport Harbor Anesthesia Consultants, Newport Beach, California, USA
| | - Cameron R John
- Department of Behavioral Sciences, Utah Valley University, Orem, Utah, USA
| | - Warren B Davis
- Newport Harbor Anesthesia Consultants, Newport Beach, California, USA
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2
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Belfiore J, Castellani Niccolini N, Fleissner Z, Chadha R, Biancofiore G. Pain management in liver transplant recipients: a focus on current and future strategies. Minerva Anestesiol 2024; 90:452-461. [PMID: 38571405 DOI: 10.23736/s0375-9393.24.17805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Liver transplantation is the only curative treatment option for patients with end-stage liver disease. Anesthesiologists and intensivists are fully involved in this procedure due to the perioperative care focus on hemodynamic, respiratory and metabolic support. However, quite surprisingly, postoperative pain management does not have clinical primary consideration in this class of patients due to a combination of factors including the thought that liver transplantation recipients have less pain and require lower doses of analgesics than patients who undergo other types of major abdominal surgery. Other factors contribute to make the management of postoperative pain somewhat complex in this class of patients: 1) drug pharmacokinetics and metabolism by the new liver is not predictable; 2) the multifactorial nature of liver graft recovery; and 3) the alterations of homeostasis, including circulatory, respiratory and metabolic vulnerability, in the days postoperative period. As a result, post-liver transplantation analgesia is underestimated not only from the clinical point of view but also in the literature and only a few papers deal with the management of postoperative pain in this particular class of patients. Thus, in the experts' opinion paper we aimed to report the possible strategies for managing post-LT pain with a focus on opioids alternatives and possible future developments in this particular clinical setting also in the view that improvements in perioperative care have made it possible to adopt fast track and Enhanced Recovery After Surgery-oriented protocols also in this class of patients.
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Affiliation(s)
- Jacopo Belfiore
- Unit of Transplant Anesthesia and Critical Care, AOU Pisana, University of Pisa, Pisa, Italy
| | | | - Zachary Fleissner
- Unit of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ryan Chadha
- Unit of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Gianni Biancofiore
- Unit of Transplant Anesthesia and Critical Care, AOU Pisana, University of Pisa, Pisa, Italy -
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Lohmöller K, Carstensen V, Pogatzki-Zahn EM, Freys SM, Weibel S, Schnabel A. Regional anaesthesia for postoperative pain management following laparoscopic, visceral, non-oncological surgery a systematic review and meta-analysis. Surg Endosc 2024; 38:1844-1866. [PMID: 38307961 DOI: 10.1007/s00464-023-10667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Postoperative pain management following laparoscopic, non-oncological visceral surgery in adults is challenging. Regional anaesthesia could be a promising component in multimodal pain management. METHODS We performed a systematic review and meta-analysis with GRADE assessment. Primary outcomes were postoperative acute pain intensity at rest/during movement after 24 h, the number of patients with block-related adverse events and the number of patients with postoperative paralytic ileus. RESULTS 82 trials were included. Peripheral regional anaesthesia combined with general anaesthesia versus general anaesthesia may result in a slight reduction of pain intensity at rest at 24 h (mean difference (MD) - 0.72 points; 95% confidence interval (CI) - 0.91 to - 0.54; I2 = 97%; low-certainty evidence), which was not clinically relevant. The evidence is very uncertain regarding the effect on pain intensity during activity at 24 h (MD -0.8 points; 95%CI - 1.17 to - 0.42; I2 = 99%; very low-certainty evidence) and on the incidence of block-related adverse events. In contrast, neuraxial regional analgesia combined with general anaesthesia (versus general anaesthesia) may reduce postoperative pain intensity at rest in a clinical relevant matter (MD - 1.19 points; 95%CI - 1.99 to - 0.39; I2 = 97%; low-certainty evidence), but the effect is uncertain during activity (MD - 1.13 points; 95%CI - 2.31 to 0.06; I2 = 95%; very low-certainty evidence). There is uncertain evidence, that neuraxial regional analgesia combined with general anaesthesia (versus general anaesthesia) increases the risk for block-related adverse events (relative risk (RR) 5.11; 95%CI 1.13 to 23.03; I2 = 0%; very low-certainty evidence). CONCLUSION This meta-analysis confirms that regional anaesthesia might be an important part of multimodal postoperative analgesia in laparoscopic visceral surgery, e.g. in patients at risk for severe postoperative pain, and with large differences between surgical procedures and settings. Further research is required to evaluate the use of adjuvants and the additional benefit of regional anaesthesia in ERAS programmes. PROTOCOL REGISTRATION PROSPERO CRD42021258281.
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Affiliation(s)
- Katharina Lohmöller
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer Campus 1 A, 48149, Münster, Germany
| | - Vivian Carstensen
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer Campus 1 A, 48149, Münster, Germany
| | - Esther M Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer Campus 1 A, 48149, Münster, Germany
| | - Stephan M Freys
- Department of Surgery, DIAKO Diakonie Hospital, Bremen, Germany
| | - Stephanie Weibel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Schnabel
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer Campus 1 A, 48149, Münster, Germany.
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Bungart B, Joudeh L, Fettiplace M. Local anesthetic dosing and toxicity of adult truncal catheters: a narrative review of published practice. Reg Anesth Pain Med 2024; 49:209-222. [PMID: 37451826 PMCID: PMC10787820 DOI: 10.1136/rapm-2023-104667] [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: 05/10/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND/IMPORTANCE Anesthesiologists frequently use truncal catheters for postoperative pain control but with limited characterization of dosing and toxicity. OBJECTIVE We reviewed the published literature to characterize local anesthetic dosing and toxicity of paravertebral and transversus abdominis plane catheters in adults. EVIDENCE REVIEW We searched the literature for bupivacaine or ropivacaine infusions in the paravertebral or transversus abdominis space in humans dosed for 24 hours. We evaluated bolus dosing, infusion dosing and cumulative 24-hour dosing in adults. We also identified cases of local anesthetic systemic toxicity and toxic blood levels. FINDINGS Following screening, we extracted data from 121 and 108 papers for ropivacaine and bupivacaine respectively with a total of 6802 patients. For ropivacaine and bupivacaine, respectively, bolus dose was 1.4 mg/kg (95% CI 0.4 to 3.0, n=2978) and 1.0 mg/kg (95% CI 0.18 to 2.1, n=2724); infusion dose was 0.26 mg/kg/hour (95% CI 0.06 to 0.63, n=3579) and 0.2 mg/kg/hour (95% CI 0.06 to 0.5, n=3199); 24-hour dose was 7.75 mg/kg (95% CI 2.1 to 15.7, n=3579) and 6.0 mg/kg (95% CI 2.1 to 13.6, n=3223). Twenty-four hour doses exceeded the package insert recommended upper limit in 28% (range: 17%-40% based on maximum and minimum patient weights) of ropivacaine infusions and 51% (range: 45%-71%) of bupivacaine infusions. Toxicity occurred in 30 patients and was associated with high 24-hour dose, bilateral catheters, cardiac surgery, cytochrome P-450 inhibitors and hypoalbuminemia. CONCLUSION Practitioners frequently administer ropivacaine and bupivacaine above the package insert limits, at doses associated with toxicity. Patient safety would benefit from more specific recommendations to limit excessive dose and risk of toxicity.
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Affiliation(s)
- Brittani Bungart
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Lana Joudeh
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Fettiplace
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
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Jalali SM, Bahri MH, Yazd SMM, Karoobi M, Shababi N. Efficacy of laparoscopic transversus abdominis plane block on postoperative pain management and surgery side effects in laparoscopic bariatric surgeries. Langenbecks Arch Surg 2022; 407:549-557. [PMID: 35064301 DOI: 10.1007/s00423-021-02400-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Transversus abdominis plane (TAP) block is a new option for reducing postoperative pain. This study investigated the effects of laparoscopic TAP block on postoperative adverse events and analgesia and antiemetics requirements after bariatric surgery. METHODS In this randomized clinical trial study, patients were randomly divided into control (N = 20) or TAP block (N = 20) groups. In the TAP block group, the block was performed under direct laparoscopic guidance after surgery and before the removal of trocars. RESULTS Fifteen patients (75%) versus four patients (20%) received opioids within the first 6 h in the control and TAP groups, respectively (p-value < 0.001). The cumulative amount of opioids consumed in the 24 and 48 h after surgery was lower in the TAP group (p-value < 0.001). The visual analog scale (VAS) regarding general and wound-specific pain was significantly lower in the TAP group compared to the control group at 6 and 24 h both at rest and in movement. However, there was no significant difference at 48 h postoperatively. The percentages of patients having postoperative nausea and vomiting (PONV), pruritus, and resumption of bowel movement were not significantly different between the two groups at any time (6, 24, and 48 h) postoperatively. CONCLUSION Laparoscopic-guided TAP block is a pragmatic, applicable, and minimally invasive regional technique and can be part of effective postoperative pain management in morbidly obese patients undergoing bariatric surgery. Applying it laparoscopically without the need for ultrasound is also useful and effective.
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Affiliation(s)
- Sayed Mehdi Jalali
- Department of Surgery, Imam Khomeini Hospital Complex, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hadi Bahri
- Department of Surgery, Shahid Madani Hospital, Faculty of Medicine, Alborz University of Medical Sciences, Alborz, Iran.
| | | | - Mohamadreza Karoobi
- Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloufar Shababi
- Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Pai Bh P, Jinadu S. Anesthesiologist Provided Regional Nerve Block Against Surgeon Provided Infiltration Block for Abdominal Surgery: Case Series. Cureus 2021; 13:e19606. [PMID: 34926075 PMCID: PMC8674117 DOI: 10.7759/cureus.19606] [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] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
We present two patients who underwent double mastectomy and breast reconstruction with deep inferior epigastric artery perforator (DIEP) flap. The goal of this case series was to compare surgeon-provided infiltration block against anesthesiologist-provided regional nerve block, focusing on abdominal analgesia. This case report highlights that pain control for a patient could be successful when done collaboratively. To achieve this, it is important for both the surgical and anesthesia team to discuss the best analgesic plan for the patient while taking into consideration the confidence, experience, and technique that both the surgical and anesthesiology team can offer.
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Affiliation(s)
- Poonam Pai Bh
- Anesthesiology, Mount Sinai Hospital, New York City, USA
| | - Samiat Jinadu
- Anesthesiology, Oregon Health & Science University, Portland, USA
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7
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Liu X, Ou C, Peng F, Mu G. Comparison of analgesic efficacy of continuous transversus abdominis plane block with continuous epidural analgesia in patients undergoing abdominal surgery: a systematic review and meta-analysis. J Int Med Res 2021; 48:300060520922691. [PMID: 32485123 PMCID: PMC7273870 DOI: 10.1177/0300060520922691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background A novel technique of continuous transversus abdominis plane block (TAPB) has
been reported to be beneficial to patients undergoing abdominal surgery
because it can significantly relieve postoperative pain. The aim of our
study is to compare this novel technique with a traditional technique of
continuous epidural analgesia (EA). Methods We conducted our meta-analysis in accordance with Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only
randomized controlled trials (RCTs) that compared the efficacy of continuous
TAPB and continuous EA to relieve postoperative pain were included. Patients
were classified by nationality (Chinese, non-Chinese) for the subgroup
analysis. Results Nine RCTs with 598 patients were included in our study. Pain levels measured
by visual analog scale (VAS) scores at rest on postoperative day 1 were
equivalent for continuous TAPB groups and continuous EA groups in
non-Chinese and Chinese patients. The TAPB groups experienced a lower rate
of hypotension, sensorimotor disorder, and nausea compared with the
continuous EA group within 48 hours after surgery. Conclusion Continuous TAPB and continuous EA are equally effective in relieving
postoperative pain at rest 24 hours after surgery, but EA was associated
with more side effects such as hypotension, nausea, and sensorimotor
disorder.
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Affiliation(s)
- Xiangbo Liu
- Southwest Medical University, Luzhou, Sichuan Province, China
| | - Cehua Ou
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Fei Peng
- Southwest Medical University, Luzhou, Sichuan Province, China
| | - Guo Mu
- Southwest Medical University, Luzhou, Sichuan Province, China
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8
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Bailey JG, Morgan CW, Christie R, Ke JXC, Kwofie MK, Uppal V. Continuous peripheral nerve blocks compared to thoracic epidurals or multimodal analgesia for midline laparotomy: a systematic review and meta-analysis. Korean J Anesthesiol 2020; 74:394-408. [PMID: 32962328 PMCID: PMC8497905 DOI: 10.4097/kja.20304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Continuous peripheral nerve blocks (CPNBs) have been investigated to control pain for abdominal surgery via midline laparotomy while avoiding the adverse events of opioid or epidural analgesia. The review compiles the evidence comparing CPNBs to multimodal and epidural analgesia. METHODS We conducted a systematic review using broad search terms in MEDLINE, EMBASE, Cochrane. Primary outcomes were pain scores and cumulative opioid consumption at 48 hours. Secondary outcomes were length of stay and postoperative nausea and vomiting (PONV). We rated the quality of the evidence using Cochrane and GRADE recommendations. The results were synthesized by meta-analysis using Revman. RESULTS Our final selection included 26 studies (1,646 patients). There was no statistically significant difference in pain control comparing CPNBs to either multimodal or epidural analgesia (low quality evidence). Less opioids were consumed when receiving epidural analgesia than CPNBs (mean difference [MD]: -16.13, 95% CI [-32.36, 0.10]), low quality evidence) and less when receiving CPNBs than multimodal analgesia (MD: -31.52, 95% CI [-42.81, -20.22], low quality evidence). The length of hospital stay was shorter when receiving epidural analgesia than CPNBs (MD: -0.78 days, 95% CI [-1.29, -0.27], low quality evidence) and shorter when receiving CPNBs than multimodal analgesia (MD: -1.41 days, 95% CI [-2.45, -0.36], low quality evidence). There was no statistically significant difference in PONV comparing CPNBs to multimodal (high quality evidence) or epidural analgesia (moderate quality evidence). CONCLUSIONS CPNBs should be considered a viable alternative to epidural analgesia when contraindications to epidural placement exist for patients undergoing midline laparotomies.
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Affiliation(s)
- Jonathan G Bailey
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Catherine W Morgan
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.,Department of Family Medicine, McGill University Health Centre, Unité de médecine familiale, Montreal, Quebec, Canada
| | - Russell Christie
- Department of Anesthesiology and Pain Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Janny Xue Chen Ke
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - M Kwesi Kwofie
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vishal Uppal
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Boules ML, Goda AS, Abdelhady MA, Abu El-Nour Abd El-Azeem SA, Hamed MA. Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study. J Pain Res 2020; 13:1073-1080. [PMID: 32547172 PMCID: PMC7245460 DOI: 10.2147/jpr.s253343] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/01/2020] [Indexed: 12/13/2022] Open
Abstract
Background This study compared the analgesic efficacy of a bilateral erector spinae plane (ESP) block with that of a bilateral transversus abdominis plane (TAP) block after elective cesarean delivery. Methods Sixty mothers scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated to receive either ESP block or TAP block. The ESP group received ESP block at the level of the ninth thoracic transverse process with 20 mL of 0.25% bupivacaine at the end of surgery. The TAP group received an ultrasound-guided TAP block with 20 mL of 0.25% bupivacaine on completion of delivery. The primary outcome was the duration of analgesia achieved by each block. Secondary outcome measures were the postoperative pain severity, total tramadol consumption, patient satisfaction. Results The median (interquartile range) duration of block was longer in the ESP group than in the TAP group (12 hours [10, 14] vs 8 hours [8, 8], p<0.0001). In the first 24 hours, the mean visual analog pain score at rest was lower by 0.32 units in the ESP group. The median tramadol consumption in the first 24 hours was significantly higher in the TAP group than in the ESP group (125 mg [100, 150] vs 100 mg [75, 100, p=0.003]). Conclusion Compared with the TAP block, the ESP block provides more effective pain relief, has a longer duration of analgesic action, prolongs time to first analgesic requirement, is associated with less tramadol consumption, and can be used in multimodal analgesia and opioid-sparing regimens after cesarean section.
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Affiliation(s)
- Maged Labib Boules
- Department of Anesthesiology, Faculty of Medicine, Fayoum University, Cairo, Egypt
| | - Abeer Shaban Goda
- Department of Anesthesiology, Faculty of Medicine, Fayoum University, Cairo, Egypt
| | | | | | - Mohamed Ahmed Hamed
- Department of Anesthesiology, Faculty of Medicine, Fayoum University, Cairo, Egypt
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Ibrahim M. Erector Spinae Plane Block in Laparoscopic Cholecystectomy, Is There a Difference? A Randomized Controlled Trial. Anesth Essays Res 2020; 14:119-126. [PMID: 32843804 PMCID: PMC7428093 DOI: 10.4103/aer.aer_144_19] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 11/04/2022] Open
Abstract
Background The ultrasound (US)-guided erector spinae plane (ESP) block and oblique subcostal transversus abdominis plane (OSTAP) block are used to decrease postoperative pain and subsequently opioids consumption. Aim The aim was to test the hypothesis that US-guided ESP blocks can produce more reduction in opioid usage during the first 24 h after laparoscopic cholecystectomy when compared to OSTAP block. Settings and Design Seventy adult patients (20-60 years old) who were planned to undergo elective laparoscopic cholecystectomy were allocated in three groups in randomized controlled trial. Materials and Methods The three groups received either port site infiltration, US-guided bilateral ESP block (ESP group), or OSTAP (OSTAP group) with bupivacaine hydrochloride 0.25%. Statistical Analysis Postoperative 24 h Morphine consumption, visual analogue scale (VAS), the intraoperative fentanyl (μg) and equivalent morphine dose in the recovery unit were recorded and analyzed using one-way analysis of variance. Results The mean 24-h morphine consumption was statistically significant between groups (P < 0.001), but it was insignificant between ESP and OSTAP (P = 0.173). Median (range) and interquartile range of intraoperatively consumed fentanyl showed significance between the three groups (P < 0.001). There was insignificance between ESP block Group II and OSTAP block Group III (P = 0.95) by post hoc analysis. The mean values of VAS at both rest and movement of the control group were significantly higher than the ESP block group at 6 and 12 h postoperative. Conclusion Bilateral US-guided ESP block was found to be as effective as bilateral US OSTAP block. There was more decrease in intraoperative rescue fentanyl, PACU morphine analgesia, 24-h morphine, and pain assessment score in both groups than the control port-site infiltration group.Clinical trial registration number: NCT03398564.
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Affiliation(s)
- Mohamed Ibrahim
- Department of Anaesthesiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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11
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Sharma A, Goel AD, Sharma PP, Vyas V, Agrawal SP. The Effect of Transversus Abdominis Plane Block for Analgesia in Patients Undergoing Liver Transplantation: A Systematic Review and Meta-Analysis. Turk J Anaesthesiol Reanim 2019; 47:359-366. [PMID: 31572985 DOI: 10.5152/tjar.2019.60251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 01/04/2019] [Indexed: 12/23/2022] Open
Abstract
Objective Ultrasound-guided regional anaesthesia using transversus abdominis plane (TAP) block is a newer and safer method that can be used in patients undergoing liver transplant surgeries. This systematic review and meta-analysis was done to quantify the analgesic potential and opioid-sparing capability of TAP block in these patients. Methods The studies comparing TAP-block to conventional analgesic regimens for liver transplant were searched. The studies evaluating the comparative 24-h morphine consumption during postoperative period in patients undergoing liver transplant surgeries were searched and included as the primary outcome in the analysis. Results We found two randomised controlled trials and two retrospective studies that on meta-analysis showed that TAP block group had significantly lower requirement of morphine (WMD=27.59 mg; 95% CI: 33.47-21.70) at 24 h for pain mitigation. Also, postoperative nausea and vomiting was lower (RR=0.76; 95% CI: 0.47-1.22) but not statistically significant. Conclusion Ultrasound-guided TAP block provides postoperative analgesic efficacy in patients undergoing liver transplant surgeries. This study was registered in International prospective register of systematic reviews [PROSPERO: CRD42018094595].
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Affiliation(s)
- Ankur Sharma
- Department of Trauma and Emergency (Anaesthesiology), All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Akhil Dhanesh Goel
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Prem Prakash Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Varuna Vyas
- Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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12
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Efficacy of ultrasound-guided oblique subcostal transversus abdominis plane block after laparoscopic sleeve gastrectomy: A double blind, randomized, placebo controlled study. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2014.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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13
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Kadam VR, Van Wijk RM, Moran JL, Miller D. Epidural versus Continuous Transversus Abdominis Plane Catheter Technique for Postoperative Analgesia after Abdominal Surgery. Anaesth Intensive Care 2019; 41:476-81. [DOI: 10.1177/0310057x1304100407] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- V. Rao Kadam
- Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- University of Adelaide, Adelaide
| | - R. M. Van Wijk
- Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Department of Anaesthesia, University of Adelaide, Adelaide
| | - J. L. Moran
- Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- University of Adelaide, Adelaide
| | - D. Miller
- Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- RN, BN, CertRecAnaes, Clinical Practice Consultant, Acute Pain Service
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Khandelwal H, Parag K, Singh A, Anand N, Govil N. Comparison of Subcostal Transversus Abdominis Block with Intraperitoneal Instillation of Levobupivacaine for Pain Relief after Laparoscopic Cholecystectomy: A Prospective Study. Anesth Essays Res 2019; 13:144-148. [PMID: 31031495 PMCID: PMC6444963 DOI: 10.4103/aer.aer_3_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background There are several methods employed in the management of postoperative pain after laparoscopic cholecystectomy such as conventional systemic analgesics, including paracetamol, non-steroidal anti-inflammatory drugs, systemic opioids, and thoracic epidural analgesia with all having its limitations and side effects. Aims The present study aims to compare ultrasound-guided subcostal transversus abdominis (STA) block with intraperitoneal instillation of levobupivacaine in reducing postoperative pain, total analgesic consumption, nausea and vomiting, and recovery time in patients after elective laparoscopic cholecystectomy. Settings and Design A prospective study was conducted between January 2017 and December 2017 in 80 patients undergoing elective laparoscopic cholecystectomy after approval of the Institutional Ethical Committee (Reference No: SGRR/IEC/05/16). Materials and Methods Patients were randomly divided into two equal-sized (n = 40) study groups. Group 1 patients received ultrasonography-guided STA block with 0.25% levobupivacaine both sides and Group 2 patients received 0.25% levobupivacaine through intraperitoneal route. Statistical Analysis Quantitative data were expressed in mean and standard deviation. Qualitative data were expressed in proportion and percentages. Independent t-test was applied to compare the means of quantitative data and the Chi-square test was used to compare categorical data. P < 0.05 was considered to be statistically significant. Survival curve was drawn using the log-rank test for comparing two groups. Results Patient characteristics regarding age, gender, and weight were comparable in the two groups. The mean Numerical Rating Scale scores were less in Group 1 than in Group 2 in the first 6 h, which was found to be statistically significant. There was no significant difference noted in pain scores after 6 h up to 24 h in postoperative area among the two groups. Pain scores for shoulder tip pain were lower in Group 2 as compared to Group 1 in the first 24 h, which was not significant statistically. Conclusion STA block is a better modality for analgesia compared to intraperitoneal instillation in patients undergoing elective laparoscopic cholecystectomy.
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Affiliation(s)
- Hariom Khandelwal
- Department of Anesthesiology and Critical Care, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Kumar Parag
- Department of Anesthesiology and Critical Care, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Ashutosh Singh
- Department of Anesthesiology and Critical Care, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Nidhi Anand
- Department of Anesthesiology and Critical Care, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Nishith Govil
- Department of Anesthesiology and Critical Care, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
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Contemporary Preoperative and Intraoperative Management of the Radical Cystectomy Patient. Urol Clin North Am 2018; 45:169-181. [DOI: 10.1016/j.ucl.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Holmes R, Smith SR, Carroll R, Holz P, Mehrotra R, Pockney P. Randomized clinical trial to assess the ideal mode of delivery for local anaesthetic abdominal wall blocks. ANZ J Surg 2017; 88:786-791. [DOI: 10.1111/ans.14317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Ryan Holmes
- The University of Newcastle; Newcastle New South Wales Australia
| | - Stephen R. Smith
- The University of Newcastle; Newcastle New South Wales Australia
- Department of Colorectal Surgery; John Hunter Hospital; Newcastle New South Wales Australia
| | - Rosemary Carroll
- Department of Surgery; John Hunter Hospital; Newcastle New South Wales Australia
| | - Phillip Holz
- Department of Anaesthesia and Intensive Care; John Hunter Hospital; Newcastle New South Wales Australia
| | - Rahul Mehrotra
- Department of Surgery; John Hunter Hospital; Newcastle New South Wales Australia
| | - Peter Pockney
- The University of Newcastle; Newcastle New South Wales Australia
- Department of Surgery; John Hunter Hospital; Newcastle New South Wales Australia
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Rao Kadam V, Van Wijk RM, Moran JL, Ganesh S, Kumar A, Sethi R, Williams P. Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial. J Pain Res 2017; 10:1705-1712. [PMID: 28761375 PMCID: PMC5522678 DOI: 10.2147/jpr.s132891] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Continuous and intermittent bolus techniques of transversus abdominis plane (TAP) blocks have been used for analgesia after abdominal surgery. Although both are effective, there are no studies comparing them. The aim of this study is to compare analgesia and cost-effectiveness between these groups. METHODS After obtaining ethical approval, 20 American Society of Anesthesiologists ASA grade I to III patients undergoing elective abdominal surgery were recruited with 10 patients allocated to each arm. Bilateral ultrasound-guided TAP blocks were performed with an initial bolus of 0.5% ropivacaine 20 mL per side, followed by catheter insertion. After surgery, the continuous infusion group received 0.2% ropivacaine 8 mL/hour on each side and the intermittent bolus group received doses of 0.2% ropivacaine 20 mL per side every 8 hours for 48 hours. Both groups received intravenous fentanyl patient-controlled analgesia and regular oral paracetamol. Parameters recorded included numerical rating scores for pain and post-operative analgesic consumption at baseline (time 0) and at 1 hour, 1 day and 2 days post-operatively. The duration of catheter insertion, complications, patient satisfaction and information regarding costs were also recorded. Patient satisfaction was assessed utilizing a 4-point "Likert" scale on day 2 and on day 30. Pain and Likert scores were analysed by non-parametric sum rank test and all two-sampled t-tests assumed unequal variances. RESULTS There was no difference between duration of TAP block, anesthetic and surgical technique and length of stay (p=0.23). Primary outcomes: pain scores at rest and cough were not significantly different (p=0.20) between the groups. Satisfaction scores were similar at day 2 and 30 (p=0.77). However, the bolus group was more cost-effective (AU$347.98 vs AU$429.43). CONCLUSION Continuous or bolus TAP blocks are effective analgesic techniques in abdominal surgery, with bolus technique being more economical.
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Affiliation(s)
- Vasanth Rao Kadam
- Department of Anaesthesia, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA
| | - Roelof M Van Wijk
- Department of Anaesthesia, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA
| | - John L Moran
- Intensive Care Unit, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA
| | - Shantan Ganesh
- Department of Surgery, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA
| | - A Kumar
- Department of Anaesthesia, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA
| | - Rajesh Sethi
- Department of Anaesthesia, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA
| | - Patricia Williams
- Intensive Care Unit, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA.,Department of Epidemiology and Preventive Medicine, School Public Health and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
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18
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Rashid A, Gorissen KJ, Ris F, Gosselink MP, Shorthouse JR, Smith AD, Pandit JJ, Lindsey I, Crabtree NA. No benefit of ultrasound-guided transversus abdominis plane blocks over wound infiltration with local anaesthetic in elective laparoscopic colonic surgery: results of a double-blind randomized controlled trial. Colorectal Dis 2017; 19:681-689. [PMID: 27943522 DOI: 10.1111/codi.13578] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 09/12/2016] [Indexed: 02/08/2023]
Abstract
AIM Advances in laparoscopic techniques combined with enhanced recovery pathways have led to faster recuperation and discharge after colorectal surgery. Peripheral nerve blockade using transversus abdominis plane (TAP) blocks reduce opioid requirements and provide better analgesia for laparoscopic colectomies than do inactive controls. This double-blind randomized study was performed to compare TAP blocks using bupivacaine with standardized wound infiltration with local anaesthetic (LA). METHOD Seventy-one patients were randomized to receive either TAP block or wound infiltration. The TAP blocks were performed by experienced anaesthetists who used ultrasound guidance to deliver 40 ml of 0.25% bupivacaine post-induction into the transverse abdominis plane. In the control group, 40 ml of 0.25% bupivacaine was injected around the trocar and the extraction site by the surgeon. Both groups received patient-controlled analgesia (PCA) with intravenous morphine. Patients and nursing staff assessed pain scores 6, 12, 24 and 48 h after surgery. The primary outcome was overall morphine use in the first 48 h. RESULTS Of the 71 patients, 20 underwent a right hemicolectomy and 51 a high anterior resection. The modified intention-to-treat analysis showed no significant differences in overall morphine use [47.3 (36.2-58.5) mg vs 46.7 (36.2-57.3) mg; mean (95% CI), P = 0.8663] in the first 48 h. Pain scores were similar at 6, 12, 24 and 48 h. No differences were found regarding time to mobilization, resumption of diet and length of hospital stay. CONCLUSION In elective laparoscopic colectomies, standardized wound infiltration with LA has the same analgesic effect as TAP blocks post-induction using bupivacaine at 48 h.
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Affiliation(s)
- A Rashid
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K J Gorissen
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - F Ris
- Service of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - M P Gosselink
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J R Shorthouse
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A D Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - I Lindsey
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - N A Crabtree
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Choi YM, Byeon GJ, Park SJ, Ok YM, Shin SW, Yang K. Postoperative analgesic efficacy of single-shot and continuous transversus abdominis plane block after laparoscopic cholecystectomy: A randomized controlled clinical trial. J Clin Anesth 2017; 39:146-151. [PMID: 28494892 DOI: 10.1016/j.jclinane.2017.03.050] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 03/08/2017] [Accepted: 03/31/2017] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To compare the analgesic efficacy of ultrasound-guided single-shot and continuous transversus abdominis plane (TAP) block to that of IV-PCA in patients undergoing laparoscopic cholecystectomy. DESIGN Prospective randomized controlled trial. SETTING Post-anesthesia care unit and General ward. PATIENTS 108 American Society of Anesthesiologist (ASA) physical status I-II patients undergoing laparoscopic cholecystectomy. INTERVENTIONS Group A received IV-PCA; group B received both ultrasound-guided single-shot TAP block with 0.2% ropivacaine (20mL) and IV-PCA; and group C received continuous TAP block using an ultrasound-guidance-inserted indwelling catheter. In group C, infusion of 0.2% ropivacaine at a basal rate of 3mL/h, bolus dose of 4mL, and a lockout interval of 30min was maintained for 48h postoperatively. The primary outcome was evaluated analgesic efficacy using the numeric rating scale (NRS) for 48h postoperatively. Other outcomes included the number of patients requiring additional analgesics, patient satisfaction with postoperative pain control, and incidence of postoperative adverse events. MAIN RESULTS Compared to other groups, group C had higher deep abdominal NRS at 1h postoperatively (P<0.05), and lower incidence of postoperative urinary retention (P<0.05). There were no significant intergroup differences in the number of patients requiring additional analgesics, and patient satisfaction with postoperative pain control. CONCLUSIONS Compared to IV-PCA with or without single-shot TAP block, ultrasound-guided continuous TAP block provided similar analgesia in somatic pain and less analgesia in visceral pain. Moreover, the latter resulted in a lower incidence of postoperative urinary retention.
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Affiliation(s)
- Yun-Mi Choi
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Republic of Korea
| | - Gyeong-Jo Byeon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Republic of Korea.
| | - Soon-Ji Park
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Republic of Korea
| | - Young-Min Ok
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Republic of Korea
| | - Sang-Wook Shin
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Republic of Korea
| | - Kwangho Yang
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Republic of Korea
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20
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Tikuisis R, Miliauskas P, Lukoseviciene V, Samalavicius N, Dulskas A, Zabuliene L, Zabulis V, Urboniene J. Transversus abdominis plane block for postoperative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial. Tech Coloproctol 2016; 20:835-844. [DOI: 10.1007/s10151-016-1550-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
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21
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Continuous subcostal oblique transversus abdominis plane block provides more effective analgesia than single-shot block after gynaecological laparotomy: A randomised controlled trial. Eur J Anaesthesiol 2016; 32:514-5. [PMID: 25303968 DOI: 10.1097/eja.0000000000000167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Tihan D, Totoz T, Tokocin M, Ercan G, Calikoglu TK, Vartanoglu T, Celebi F, Dandin O, Kafa IM. Efficacy of laparoscopic transversus abdominis plane block for elective laparoscopic cholecystectomy in elderly patients. Bosn J Basic Med Sci 2016; 16. [PMID: 26773187 PMCID: PMC4852996 DOI: 10.17305/bjbms.2015.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transversus abdominis plane (TAP) block technique seems to offer one of the most efficient methods for a local pain control. Our aim is to demonstrate the effectiveness and safety of TAP block for post-operative pain control under laparoscopic vision in elderly patients during laparoscopic cholecystectomy. The patients aged more than 65 years old, who had cholecystectomy due to symptomatic cholelithiasis, were retrospectively evaluated. The patients that were operated under general anesthesia + laparoscopic TAP block and those who were operated only under only general anesthesia were compared according to their' age and gender, comorbidities, American Society of Anesthesiologists scores, visual analog scale (VAS) for pain and length of stay in the hospital. Median (±interquartile range) values of post-operative 24th-hour-VAS for pain was found consecutively 2 (±1-3) in TAP block + group and 3 (±2-5) in TAP block - group. The median post-operative 24th-hour-VAS value in overall patients was three. Patients' VAS values were higher in the TAP block - group with a statistically significant difference (p = 0.001). Furthermore, no statistically significant difference was found for other parameters in two groups. The laparoscopic-guided TAP block can easily be performed and has potential for lower visceral injury risk and shorter operational time. Efficacy, safety and other advantages (analgesic requirements, etc.) make it an ideal abdominal field block in elderly patients.
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Affiliation(s)
- Deniz Tihan
- Department of General Surgery, Sevket Yilmaz Training and Research Hospital, Bursa, Turkey,Department of Anatomy, Uludag University School of Medicine, Bursa, Turkey,Corresponding author: Deniz Tihan, Department of General Surgery, Sevket Yilmaz Training and Research Hospital, Bursa, Turkey. Tel.: +90 536 222 44 17. Fax: +90 224 295 52 82. E-mail:
| | - Tolga Totoz
- Department of Anesthesiology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Merve Tokocin
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Gulcin Ercan
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Tugba Koc Calikoglu
- Department of Anesthesiology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Talar Vartanoglu
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Fatih Celebi
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Dandin
- Department of General Surgery, Bursa Military Hospital, Bursa, Turkey
| | - Ilker Mustafa Kafa
- Department of Anatomy, Uludag University School of Medicine, Bursa, Turkey
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Feldheiser A, Aziz O, Baldini G, Cox BPBW, Fearon KCH, Feldman LS, Gan TJ, Kennedy RH, Ljungqvist O, Lobo DN, Miller T, Radtke FF, Ruiz Garces T, Schricker T, Scott MJ, Thacker JK, Ytrebø LM, Carli F. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand 2016; 60:289-334. [PMID: 26514824 PMCID: PMC5061107 DOI: 10.1111/aas.12651] [Citation(s) in RCA: 386] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 12/17/2022]
Abstract
Background The present interdisciplinary consensus review proposes clinical considerations and recommendations for anaesthetic practice in patients undergoing gastrointestinal surgery with an Enhanced Recovery after Surgery (ERAS) programme. Methods Studies were selected with particular attention being paid to meta‐analyses, randomized controlled trials and large prospective cohort studies. For each item of the perioperative treatment pathway, available English‐language literature was examined and reviewed. The group reached a consensus recommendation after critical appraisal of the literature. Results This consensus statement demonstrates that anaesthesiologists control several preoperative, intraoperative and postoperative ERAS elements. Further research is needed to verify the strength of these recommendations. Conclusions Based on the evidence available for each element of perioperative care pathways, the Enhanced Recovery After Surgery (ERAS ®) Society presents a comprehensive consensus review, clinical considerations and recommendations for anaesthesia care in patients undergoing gastrointestinal surgery within an ERAS programme. This unified protocol facilitates involvement of anaesthesiologists in the implementation of the ERAS programmes and allows for comparison between centres and it eventually might facilitate the design of multi‐institutional prospective and adequately powered randomized trials.
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Affiliation(s)
- A. Feldheiser
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow‐Klinikum Charité University Medicine Berlin Germany
| | - O. Aziz
- St. Mark's Hospital Harrow Middlesex UK
| | - G. Baldini
- Department of Anesthesia McGill University Health Centre Montreal General Hospital Montreal Quebec Canada
| | - B. P. B. W. Cox
- Department of Anesthesiology and Pain Therapy University Hospital Maastricht (azM) Maastricht The Netherlands
| | - K. C. H. Fearon
- University of Edinburgh The Royal Infirmary Clinical Surgery Edinburgh UK
| | - L. S. Feldman
- Department of Surgery McGill University Health Centre Montreal General Hospital Montreal Quebec Canada
| | - T. J. Gan
- Department of Anesthesiology Duke University Medical Center Durham North Carolina USA
| | - R. H. Kennedy
- St. Mark's Hospital/Imperial College Harrow, Middlesex/London UK
| | - O. Ljungqvist
- Department of Surgery Faculty of Medicine and Health Örebro University Örebro Sweden
| | - D. N. Lobo
- Gastrointestinal Surgery National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit Nottingham University Hospitals and University of Nottingham Queen's Medical Centre Nottingham UK
| | - T. Miller
- Department of Anesthesiology Duke University Medical Center Durham North Carolina USA
| | - F. F. Radtke
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow‐Klinikum Charité University Medicine Berlin Germany
| | - T. Ruiz Garces
- Anestesiologa y Reanimacin Hospital Clinico Lozano Blesa Universidad de Zaragoza Zaragoza Spain
| | - T. Schricker
- Department of Anesthesia McGill University Health Centre Royal Victoria Hospital Montreal Quebec Canada
| | - M. J. Scott
- Royal Surrey County Hospital NHS Foundation Trust University of Surrey Surrey UK
| | - J. K. Thacker
- Department of Surgery Duke University Medical Center Durham North Carolina USA
| | - L. M. Ytrebø
- Department of Anaesthesiology University Hospital of North Norway Tromso Norway
| | - F. Carli
- Department of Anesthesia McGill University Health Centre Montreal General Hospital Montreal Quebec Canada
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Baeriswyl M, Kirkham KR, Kern C, Albrecht E. The Analgesic Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block in Adult Patients: A Meta-Analysis. Anesth Analg 2016; 121:1640-54. [PMID: 26397443 DOI: 10.1213/ane.0000000000000967] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Previous meta-analyses of the transversus abdominis plane (TAP) block have examined a maximum of 12 articles, including fewer than 650 participants, and have not examined the effect of ultrasound-guided techniques specifically. Recently, many trials that use ultrasound approaches to TAP block have been published, which report conflicting analgesic results. This meta-analysis aims to evaluate the analgesic efficacy of ultrasound-guided TAP blocks exclusively for all types of abdominal surgeries in adult patients. METHODS This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The primary outcome was cumulative IV morphine consumption at 6 hours postoperatively, analyzed according to the type of surgery, the type of surgical anesthesia, the timing of injection, the block approach adopted, and the presence of postoperative multimodal analgesia. Secondary outcomes included IV morphine consumption at 24 hours postoperatively; pain scores at rest and on movement at 6 and 24 hours postoperatively; and postoperative nausea and vomiting, pruritus, and rates of complications. RESULTS Thirty-one controlled trials including 1611 adult participants were identified. Independent of the type of surgery (abdominal laparotomy, abdominal laparoscopy, and cesarean delivery) but not independent of the type of surgical anesthesia (general anesthesia, spinal anesthesia with or without intrathecal long-acting opioid), ultrasound-guided TAP block reduced IV morphine consumption at 6 hours postoperatively by a mean difference of 6 mg (95% confidence interval [CI], -7 to -4 mg; I2 = 94%; P < 0.00001). The magnitude of the reduction in morphine consumption at 6 hours postoperatively was not influenced by the timing of injection (I2 = 0%; P = 0.72), the block approach adopted (I2 = 0%; P = 0.72), or the presence of postoperative multimodal analgesia (I2 = 73%; P = 0.05). This difference persisted at 24 hours postoperatively (mean difference, -11 mg; 95% CI, -14 to -8 mg; I2 = 99%; P < 0.00001). Pain scores at rest and on movement were reduced at 6 hours postoperatively (mean difference at rest, -10; 95% CI, -15 to -5; I2 = 92%; P = 0.0002; mean difference on movement, -9; 95% CI, -14 to -5; I2 = 58%; P < 0.00001). There were neither differences in the incidence of postoperative nausea and vomiting (I2 = 1%; P = 0.59) nor in the pruritus (I2 = 12%; P = 0.58) Two minor complications (1 bruise and 1 anaphylactoid reaction) were reported in 1028 patients. CONCLUSIONS Ultrasound-guided TAP block provides marginal postoperative analgesic efficacy after abdominal laparotomy or laparoscopy and cesarean delivery. However, it does not provide additional analgesic effect in patients who also received spinal anesthesia containing a long-acting opioid. The minimal analgesic efficacy is independent of the timing of injection, the approach adopted, or the presence of postoperative multimodal analgesia. Because of heterogeneity of the results, these findings should be interpreted with caution.
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Affiliation(s)
- Moira Baeriswyl
- From the *Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland; and †Department of Anesthesiology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Tihan D, Totoz T, Tokocin M, Ercan G, Koc Calıkoglu T, Vartanoglu T, Celebi F, Dandin O, Kafa IM. Efficacy of laparoscopic transversus abdominis plane block for elective laparoscopic cholecystectomy in elderly patients. Bosn J Basic Med Sci 2016; 16:139-44. [PMID: 26773187 DOI: 10.17305/bjbms.2016.841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 12/06/2015] [Accepted: 12/07/2015] [Indexed: 12/22/2022] Open
Abstract
Transversus abdominis plane (TAP) block technique seems to offer one of the most efficient methods for a local pain control. Our aim is to demonstrate the effectiveness and safety of TAP block for post-operative pain control under laparoscopic vision in elderly patients during laparoscopic cholecystectomy. The patients aged more than 65 years old, who had cholecystectomy due to symptomatic cholelithiasis, were retrospectively evaluated. The patients that were operated under general anesthesia + laparoscopic TAP block and those who were operated only under only general anesthesia were compared according to their' age and gender, comorbidities, American Society of Anesthesiologists scores, visual analog scale (VAS) for pain and length of stay in the hospital. Median (±interquartile range) values of post-operative 24th-hour-VAS for pain was found consecutively 2 (±1-3) in TAP block + group and 3 (±2-5) in TAP block - group. The median post-operative 24th-hour-VAS value in overall patients was three. Patients' VAS values were higher in the TAP block - group with a statistically significant difference (p = 0.001). Furthermore, no statistically significant difference was found for other parameters in two groups. The laparoscopic-guided TAP block can easily be performed and has potential for lower visceral injury risk and shorter operational time. Efficacy, safety and other advantages (analgesic requirements, etc.) make it an ideal abdominal field block in elderly patients.
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Affiliation(s)
- Deniz Tihan
- Sevket Yilmaz Training and Research Hospital, Department of General Surgery, Bursa.
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The efficacy of continuous subcostal transversus abdominis plane block for analgesia after living liver donation: a retrospective study. J Anesth 2015; 30:39-46. [PMID: 26511998 DOI: 10.1007/s00540-015-2085-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Postoperative pain management for living liver donors has become a major concern as a result of the increasing number of living liver donations. Transversus abdominis plane (TAP) block has been known to provide effective analgesia for abdominal surgery. The aim of this study was to evaluate the efficacy of ultrasound-guided continuous subcostal TAP block as a part of a multimodal analgesic regimen in comparison with conventional intravenous (IV) fentanyl-based analgesia in living liver donors. METHODS Thirty-two donors were retrospectively classified into either the continuous subcostal TAP block group (TAP group) or the IV fentanyl-based analgesia group (control group). TAP group donors received bilateral continuous subcostal TAP infusion of 0.125 % levobupivacaine at 6 ml/h. Control group donors did not receive any neural blockade. RESULTS Cumulative fentanyl consumption was significantly lower in the TAP group for 48 h (P < 0.01) as compared to the control group. Further, the donors in the TAP group had significantly lower incidence of nausea and vomiting during 24-48 h postoperatively (P < 0.01) and fewer delays in the initiation of oral intake than those in the control group (P = 0.02). CONCLUSIONS In conclusion, continuous subcostal TAP block provided an effective opioid-sparing analgesia for living liver donors.
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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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Adame-Coronel D, Muñoz-Maldonado G, Rodríguez-Briseño J. US-TAP BLOCK. An Alternative in the management of pain posterior to a laparoscopic cholecystectomy at our University Hospital. MEDICINA UNIVERSITARIA 2015. [DOI: 10.1016/j.rmu.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Matulewicz RS, Brennan J, Pruthi RS, Kundu SD, Gonzalez CM, Meeks JJ. Radical Cystectomy Perioperative Care Redesign. Urology 2015; 86:1076-86. [PMID: 26383615 DOI: 10.1016/j.urology.2015.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/19/2015] [Accepted: 09/01/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To present an evidence-based review of the perioperative management of the radical cystectomy (RC) patient in the context of a care redesign initiative. METHODS A comprehensive review of the key factors associated with perioperative management of the RC patient was completed. PubMed, Medline, and the Cochrane databases were queried via a computerized search. Specific topics were reviewed within the scope of the three major phases of perioperative management: preoperative, intraoperative, and postoperative. Preference was given to evidence from prospective randomized trials, meta-analyses, and systematic reviews. RESULTS Preoperative considerations to improve care in the RC patient should include multi-disciplinary medical optimization, patient education, and formal coordination of care. Efforts to mitigate the risk of malnutrition and reduce postoperative gastrointestinal complications may include carbohydrate loading, protein nutrition supplementation, and avoiding bowel preparation. Intraoperatively, a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus. Finally, enhanced recovery protocols including novel medications, early feeding, and multi-modal analgesia approaches are associated with earlier postoperative convalescence. CONCLUSION RC is a complex and morbid procedure that may benefit from care redesign. Evidence based quality improvement is integral to this process. We hope that this review will help guide further improvement initiatives for RC.
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Affiliation(s)
- Richard S Matulewicz
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Jeffrey Brennan
- Department of Anesthesia, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Raj S Pruthi
- Department of Urology, UNC School of Medicine, Chapel Hill, NC
| | - Shilajit D Kundu
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Chris M Gonzalez
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Joshua J Meeks
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
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Ropivacaine (total and unbound) and AGP concentrations after transversus abdominis plane block for analgesia after abdominal surgery. Ther Drug Monit 2015; 36:759-64. [PMID: 24819972 DOI: 10.1097/ftd.0000000000000091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of this study was to assess the safety of single bolus dose of ropivacaine (ROP) followed by continuous infusion through transversus abdominis plane block catheter. The aim was to determine ROP absorbed from the infusion site, changes in protein binding after surgery, and clinical determinants of adverse effects. METHODS Twelve patients undergoing laparotomy, received bilateral transversus abdominis plane block under ultrasound guidance using a 20-mL bolus of 0.5% ROP followed by 10 mL/h of 0.2% ROP infusion for 48 hours. Serial blood samples were drawn presurgery and to 48 hours postbolus. Plasma concentrations of total and unbound ROP were measured by high performance liquid chromatography with ultraviolet detection. Alpha-1 acid glycoprotein concentrations were measured by enzyme-linked immunosorbent assay. Patients were monitored for any signs or symptoms of central nervous system and chorionic villus sampling toxicity. RESULTS After the bolus dose, the mean (±SD) peak plasma total (bound plus unbound) ROP concentration (Cmax) was 2.1 (±0.8) mg/L and unbound ROP concentration was 0.04 (±0.02) mg/L. During the infusion phase, total ROP concentration continued to rise to a mean (±) Cmax of 3.3 (±1.6) mg/L, and the peak unbound concentration was 0.06 (±0.0) mg/L. No patients showed symptoms of ROP toxicity or unacceptable QTc intervals. CONCLUSIONS Although the total ROP concentrations approached or exceeded reported neurotoxicity thresholds, no patients had unbound ROP concentrations approaching the unbound toxicity threshold, nor showed any signs or symptoms of toxicity. This result was consistent with changes in protein binding to alpha-1 acid glycoprotein after surgery.
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Chaudhuri S, Goyal SS. Ultrasound-guided transversus abdominis plane block: A technically easier analgesic option in obese compared to epidural. Anesth Essays Res 2015; 6:226-8. [PMID: 25885625 PMCID: PMC4173451 DOI: 10.4103/0259-1162.108344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ultrasound-guided transversus abdominis plane (TAP) block is an extremely attractive alternative to the technically difficult epidural in obese patients. It provides adequate perioperative analgesia and reduces the opioid requirement. The use of ultrasound has enhanced the accuracy of local anaesthetic deposition in the plane between internal oblique and transversus abdominis, thereby blocking the spinal nerves more effectively and hence enhancing the efficacy of analgesia. We present a case of 65-year-old male patient weighing 96 kg who underwent umbilical hernia repair and had adequate perioperative pain relief after the ultrasound-guided TAP block. Epidural analgesia planned for him was abandoned after we faced technical difficulty in securing the epidural, but the TAP block administered under ultrasound guidance ensured adequate pain relief perioperatively.
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Affiliation(s)
- Souvik Chaudhuri
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Karnataka, India
| | - Sham Sunder Goyal
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Karnataka, India
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Heil JW, Nakanote KA, Madison SJ, Loland VJ, Mariano ER, Sandhu NS, Bishop ML, Agarwal RR, Proudfoot JA, Ferguson EJ, Morgan AC, Ilfeld BM. Continuous Transversus Abdominis Plane (TAP) Blocks for Postoperative Pain Control after Hernia Surgery: A Randomized, Triple-Masked, Placebo-Controlled Study. PAIN MEDICINE 2014; 15:1957-64. [DOI: 10.1111/pme.12530] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol 2013; 29:550-2. [PMID: 24249997 PMCID: PMC3819854 DOI: 10.4103/0970-9185.119148] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The quadratus lumborum (QL) block as a postoperative analgesic method following abdominal surgery has been described by Blanco for superficial surgeries but not used for major laparotomy. This ipsilateral QL block had low pain scores and opioid use on day one with sensory block upto T8-L1. The options of various volume used and pros and cons are discussed.
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Affiliation(s)
- Vasanth Rao Kadam
- Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
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Ultrasound-guided bilateral transversus abdominis plane blocks in conjunction with intrathecal morphine for postcesarean analgesia. J Clin Anesth 2013; 25:475-82. [DOI: 10.1016/j.jclinane.2013.05.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 05/05/2013] [Accepted: 05/11/2013] [Indexed: 01/09/2023]
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„Transversus-abdominis-plane“-Blockade. Anaesthesist 2013; 62:389-91. [DOI: 10.1007/s00101-013-2171-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/13/2013] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
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Abstract
The transversus abdominis plane block has been used as a component of postoperative analgesia after hysterectomy and open abdominal surgery. This block involves the injection of anesthetic between the internal oblique and transversus abdominis muscles. We demonstrate an improved method by the use of laparoscopic guidance for transversus abdominis plane blocks.Transversus abdominis plane blocks are performed at the conclusion of an elective laparoscopic procedure by an experienced colorectal surgeon. With the use of direct visualization with a laparoscope, a Braun Stimuplex A insulated needle is passed through the skin at the level of the midaxillary line, midway between the iliac crest and the costal margin. The needle is inserted further until 2 distinct "pops" are felt, indicating the correct needle position between the internal oblique and transversus abdominis muscle. The laparoscope confirms a bulge, which signifies the injectate covered by the transversus abdominis muscle. The procedure is performed at a second injection site on the same side and bilaterally.The transversus abdominis plane block is useful as an adjunct to reduce postoperative analgesia in patients undergoing laparoscopic colorectal surgery. Our method for transversus abdominis plane blocks with the use of laparoscopy is easily performed at the conclusion of any laparoscopic procedure. Prospective randomized trials are necessary to assess the significance of these blocks in postoperative pain control, length of stay, and cost benefit.
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Abstract
PURPOSE OF REVIEW Since the publication of original work on the transversus abdominis plane (TAP) block, the translation of the research into clinical practice has resulted in some 146 articles being published in peer-reviewed journals. However, there continues to be controversies over the best approach to be used. The introduction of ultrasound should have aided the development of this block, but in fact it has caused more questions to be asked. There are a number of reviews of the block already published, but were they published too early and what is our current understanding of the TAP block and its mechanisms of action? RECENT FINDINGS The TAP block continues to develop. We now understand that the TAP block is a multifaceted block, working with both localized field effects as well as distal effects due to a distant spread of local anesthetic. Recent research would suggest that the location of needle tip placement causes variation in the block characteristics obtained. The more anterior approaches adopted for use since the introduction of ultrasound might be better described as RAFI (regional abdominal field infiltration) blocks. SUMMARY The TAP block, in all its guises, is an effective analgesic tool, but what is the best approach? Randomized controlled trials comparing the TAP/RAFI blocks to epidural based analgesia are required.
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Tolchard S, Davies R, Martindale S. Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Comparison with conventional port-site infiltration. J Anaesthesiol Clin Pharmacol 2012; 28:339-43. [PMID: 22869941 PMCID: PMC3409944 DOI: 10.4103/0970-9185.98331] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Pain experienced following laparoscopic cholecystectomy is largely contributed by the anterior abdominal wall incisions. This study investigated whether subcostal transversus abdominis (STA) block was superior to traditional port-site infiltration of local anesthetic in reducing postoperative pain, opioid consumption, and time for recovery. Materials and Methods: Forty-three patients presenting for day case laparoscopic cholecystectomy were randomly allocated to receive either an ultrasound-guided STA block (n = 21) or port-site infiltration of local anesthetic (n = 22). Visual analog pain scores were measured at 1 and 4 h postoperatively to assess pain severity, and opioid requirement was measured in recovery and up to 8 h postoperatively. The time to discharge from recovery was recorded. Results: STA block resulted in a significant reduction in serial visual pain analog score values and significantly reduced the fentanyl requirement in recovery by >35% compared to the group that received local port-site infiltration (median 0.9 vs. 1.5 μcg/kg). Furthermore, STA block was associated with nearly a 50% reduction in overall 8-h equivalent morphine consumption (median 10 mg vs. 19 mg). In addition, STA block significantly reduced median time to discharge from recovery from 110 to 65 min. Conclusion: The results suggest that STA block provides superior postoperative analgesia and reduces opioid requirement following laparoscopic cholecystectomy. It may also improve theater efficiency by reducing time to discharge from the recovery unit.
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Johns N, O'Neill S, Ventham NT, Barron F, Brady RR, Daniel T. Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: a systematic review and meta-analysis. Colorectal Dis 2012; 14:e635-42. [PMID: 22632762 DOI: 10.1111/j.1463-1318.2012.03104.x] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Reduced opioid use in the immediate postoperative period is associated with decreased complications. This study aimed to determine the effect of transversus abdominis plane (TAP) block on morphine requirements 24 h after abdominal surgery. Secondary outcomes included the effect of TAP block on morphine use 48 h after surgery, incidence of postoperative nausea and vomiting (PONV) and impact on reported pain scores (visual analogue scale). METHOD A systematic review of the literature was conducted for randomised controlled trials (RCTs) evaluating the effects of TAP block in adults undergoing abdominal surgery. For continuous data, weighted mean differences (WMD) were formulated; for dichotomous data, odds ratios (OR) were calculated. Results were produced with a random effects model with 95% confidence intervals (CI). RESULTS Nine studies, including published and unpublished data, containing a total of 413 patients were included. Of these 205 received a TAP block and 208 a placebo. Cumulative morphine utilization was statistically significantly reduced at 24 h. [WMD=23.71mg (38.66-8.76); P=0.002] and 48h [WMD=38.08mg (18.97-57.19); P<0.0001] in patients who received a TAP block and the incidence of PONV was significantly reduced [OR=0.41(0.22-0.74); P=0.003]. There was a nonsignificant reduction in the visual analogue scales of postoperative pain [WMD=0.73cm (1.84-0.38), P=0.2]. There were no reported adverse events following TAP block. CONCLUSION Transversus abdominis plane block is safe, reduces postoperative morphine requirements, nausea and vomiting and possibly the severity of pain after abdominal surgery. It should be considered as part of a multimodal approach to anaesthesia and enhanced recovery in patients undergoing abdominal surgery.
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Affiliation(s)
- N Johns
- Department of Surgery, Victoria Hospital, Kirkcaldy, UK
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Gurney MA. Pharmacological options for intra-operative and early postoperative analgesia: an update. J Small Anim Pract 2012; 53:377-86. [DOI: 10.1111/j.1748-5827.2012.01243.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. A. Gurney
- Department of Anaesthesia; Northwest Surgeons; Cheshire; WA7 3FW
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Desroches J, Grabs U, Grabs D. Selective ultrasound guided pectoral nerve targeting in breast augmentation: How to spare the brachial plexus cords? Clin Anat 2012; 26:49-55. [DOI: 10.1002/ca.22117] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 05/04/2012] [Accepted: 05/17/2012] [Indexed: 11/06/2022]
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Transversus abdominis plane catheter bolus analgesia after major abdominal surgery. Anesthesiol Res Pract 2012; 2012:596536. [PMID: 22666242 PMCID: PMC3361995 DOI: 10.1155/2012/596536] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/13/2012] [Indexed: 11/24/2022] Open
Abstract
Purpose. Transversus abdominis plane (TAP) blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20 mL bupivacaine 2.5 mg/mL with epinephrine 5 μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36 hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0–10) at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36 hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23–48) mg (median, IQR) within the first 48 postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery.
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Kishore K, Agarwal A. Ultrasound-guided continuous transverse abdominis plane block for abdominal surgery. J Anaesthesiol Clin Pharmacol 2011; 27:336-8. [PMID: 21897503 PMCID: PMC3161457 DOI: 10.4103/0970-9185.83677] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kamal Kishore
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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