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Yoon JP, Kim HY, Jung J, Lee J, Park S, Byeon GJ. Analgesic effect of ultrasound-guided transversus abdominis plane block with or without rectus sheath block in laparoscopic cholecystectomy: a randomized, controlled trial. BMC Anesthesiol 2024; 24:203. [PMID: 38851689 PMCID: PMC11162032 DOI: 10.1186/s12871-024-02590-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: 11/29/2023] [Accepted: 05/31/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Ultrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists, affecting patient recovery and sleep quality on the day of surgery. We compared the analgesic effect of ultrasound-guided TAP block with or without rectus sheath (RS) block in patients undergoing laparoscopic cholecystectomy using the visual analog scale (VAS) scores. METHODS The study was registered before patient enrollment at the Clinical Research Information Service (registration number: KCT0006468, 19/08/2021). 88 American Society of Anesthesiologist physical status I-III patients undergoing laparoscopic cholecystectomy were divided into two groups. RS-TAP group received right lateral and right subcostal TAP block, and RS block with 0.2% ropivacaine (30 mL); Bi-TAP group received bilateral and right subcostal TAP block with same amount of ropivacaine. The primary outcome was visual analogue scale (VAS) for 48 h postoperatively. Secondary outcomes included the use of rescue analgesics, cumulative intravenous patient-controlled analgesia (IV-PCA) consumption, patient satisfaction, sleep quality, and incidence of adverse events. RESULTS There was no significant difference in VAS score between two groups for 48 h postoperatively. We found no difference between the groups in any of the secondary outcomes: the use of rescue analgesics, consumption of IV-PCA, patient satisfaction with postoperative pain control, sleep quality, and the incidence of postoperative adverse events. CONCLUSION Both RS-TAP and Bi-TAP blocks provided clinically acceptable pain control in patients undergoing laparoscopic cholecystectomy, although there was no significant difference between two combination blocks in postoperative analgesia or sleep quality.
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Affiliation(s)
- Jung-Pil Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hee Young Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jieun Jung
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea
| | - Jimin Lee
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Seyeon Park
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Gyeong-Jo Byeon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea.
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
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Mehmet Selim Ç, Halide S, Erkan Cem Ç, Onur K, Sedat H, Senem U. Efficacy of Unilateral External Oblique Intercostal Fascial Plane Block Versus Subcostal TAP Block in Laparoscopic Cholecystectomy: Randomized, Prospective Study. Surg Innov 2024:15533506241256529. [PMID: 38780355 DOI: 10.1177/15533506241256529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of unilateral external oblique intercostal nerve block (EOIB) in laparoscopic cholecystectomy surgery. MATERIAL AND METHODS After ethics committee approval, ASA I-II patients aged 18-70 who would undergo laparoscopic cholecystectomy surgery were included in the study. The patients were divided into two groups, external oblique intercostal nerve block (Group EOIB) and oblique subcostal transversus abdominis plane block (Group OSTAP). After surgery, EOIB or OSTAP block was administered with 20 mL of .25% bupivacaine then routine analgesia protocol was applied with iv paracetamol, and tramadol. Visual analog scale (VAS) scores and patient-controlled analgesia (PCA) consumption were monitored 24 hours after the operation. It was administered 25 mg pethidine as a rescue analgesic to patients with VAS ≥4. RESULTS Thirty six patients for Group EOIB and thirty four patients for Group OSTAP were included in the study. Lower VAS scores were observed in all groups. When PCA consumption, side effects, rescue analgesia consumption, and patient satisfaction were evaluated, there was no statistically significant difference between the groups (P > .05). CONCLUSION It was observed that EOIB showed similar analgesic activity to the OSTAP block. EOIB may also be a part of postoperative multimodal analgesia by reducing postoperative opioid consumption in LC.
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Affiliation(s)
- Çömez Mehmet Selim
- Department of Anesthesiology and Reanimation, Hatay Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Hatay, Türkiye
| | - Sağlambilen Halide
- Department of Anesthesiology and Reanimation, Hatay Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Hatay, Türkiye
| | - Çelik Erkan Cem
- Department of Anesthesiology and Reanimation, Atatürk University, Medical Faculty, Erzurum, Türkiye
| | - Koyuncu Onur
- Department of Anesthesiology and Reanimation, Hatay Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Hatay, Türkiye
| | - Hakimoğlu Sedat
- Department of Anesthesiology and Reanimation, Hatay Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Hatay, Türkiye
| | - Urfalı Senem
- Department of Anesthesiology and Reanimation, Hatay Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Hatay, Türkiye
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Park S, Park JH, Park S, Jang JN, Kim C, Choi YS. Ultrasound-guided subcostal approach of transversus abdominis plane block compared with wound infiltration for postoperative analgesia following laparoscopic cholecystectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38044. [PMID: 38701299 PMCID: PMC11062739 DOI: 10.1097/md.0000000000038044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Despite laparoscopic cholecystectomy (LC) is a commonly performed operation under ambulatory setting, significant postoperative pain is still a major concern. The ultrasound-guided subcostal approach of transversus abdominis plane (sTAP) blocks and wound infiltration (WI) are both widely practiced techniques to reduce postoperative pain in patients undergoing LC. Although these methods have been shown to relieve postoperative pain effectively, the relative analgesic efficacy between ultrasound-guided sTAP blocks and WI is not well known. METHODS We searched PubMed, EMBASE, and CENTRAL to identify all randomized controlled trials (RCTs) comparing ultrasound-guided sTAP block versus WI for postoperative pain control in adult patients undergone LC. The search was performed until May 2023. Primary outcome was defined as 24-hour cumulative opioid consumption. Secondary outcomes were postoperative pain scores and the incidence of postoperative nausea and vomiting (PONV). RESULTS Finally, 6 RCTs were included, and data from 314 participants were retrieved. Postoperative 24-hour opioid consumption was significantly lower in ultrasound-guided sTAP group than in the WI group with a mean difference of -6.67 (95% confidence interval: -9.39 to - 3.95). The ultrasound-guided sTAP group also showed significantly lower pain scores. Incidence of PONV did not significantly differ between the 2 groups. CONCLUSIONS We conclude that there is low to moderate evidence to advocate that ultrasound-guided sTAP block has better analgesic effects than WI in patients undergoing LC. Further trials are needed with robust methodology and clearly defined outcomes.
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Affiliation(s)
- Sukhee Park
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Ji-Hoon Park
- Department of Anesthesiology and Pain Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Soyoon Park
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Jae Ni Jang
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
| | - Chaeeun Kim
- Department of Anesthesiology and Pain Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University School of Medicine, Incheon, Korea
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Dost B, De Cassai A, Balzani E, Geraldini F, Tulgar S, Ahiskalioglu A, Karapinar YE, Beldagli M, Navalesi P, Kaya C. Analgesic benefits of pre-operative versus postoperative transversus abdominis plane block for laparoscopic cholecystectomy: a frequentist network meta-analysis of randomized controlled trials. BMC Anesthesiol 2023; 23:408. [PMID: 38087218 PMCID: PMC10714465 DOI: 10.1186/s12871-023-02369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Transversus abdominis plane (TAP) block has been utilized to alleviate pain following laparoscopic cholecystectomy (LC). However, the optimal timing of administration remains uncertain. This study aimed to compare the efficacy of pre-operative and postoperative TAP blocks as analgesic options after LC. METHODS A frequentist network meta-analysis of randomized controlled trials (RCTs) was conducted. We systematically searched PubMed (via the National Library of Medicine), EMBASE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science up to March 2023. The study included RCTs that enrolled adult patients (≥ 18 years) who underwent LC and received either pre-operative or postoperative TAP blocks. The primary outcome assessed was 24-hour postoperative morphine consumption (mg). Additionally, pain rest scores within 3 hours, 12 hours, and 24 hours, as well as postoperative nausea and vomiting (PONV), were considered as pre-specified secondary outcomes. RESULTS A total of 34 trials with 2317 patients were included in the analysis. Postoperative TAP block demonstrated superiority over the pre-operative TAP block in reducing opioid consumption (MD 2.02, 95% CI 0.87 to 3.18, I2 98.6%, p < 0.001). However, with regards to postoperative pain, neither pre-operative nor postoperative TAP blocks exhibited superiority over each other at any of the assessed time points. The postoperative TAP block consistently ranked as the best intervention using SUCRA analysis. Moreover, the postoperative TAP block led to the most significant reduction in PONV. CONCLUSIONS The findings suggest that the postoperative TAP block may be slightly more effective in reducing 24-hour postoperative opioid consumption and PONV when compared to the pre-operative TAP block. TRIAL REGISTRATION PROSPERO, CRD42023396880 .
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Affiliation(s)
- Burhan Dost
- Department of Anesthesiology and Reanimation, School of Medicine, Ondokuz Mayis University Faculty of Medicine, Kurupelit, Samsun, TR55139, Turkey.
| | - Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit "Sant'Antonio", University Hospital of Padua, Padua, Italy
| | - Eleonora Balzani
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Federico Geraldini
- UOC Anesthesia and Intensive Care Unit "Sant'Antonio", University Hospital of Padua, Padua, Italy
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Yunus Emre Karapinar
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Müzeyyen Beldagli
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Paolo Navalesi
- UOC Institute of Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- DIMED Department of Medicine, University of Padua, Padua, Italy
| | - Cengiz Kaya
- Department of Anesthesiology and Reanimation, School of Medicine, Ondokuz Mayis University Faculty of Medicine, Kurupelit, Samsun, TR55139, Turkey
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Haitov Ben Zikri Z, Volis M, Mazur A, Orlova T, Alon H, Bar Yehuda S, Gofman V. The Effect of Various Combinations of Peripheral Nerve Blocks on Postoperative Pain in Laparoscopic Cholecystectomy: A Comparative Prospective Study. Int J Clin Pract 2023; 2023:8864012. [PMID: 38045655 PMCID: PMC10689066 DOI: 10.1155/2023/8864012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/30/2023] [Accepted: 10/09/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives Most patients who undergo laparoscopic cholecystectomy (LC) experience moderate to severe pain in the first 24 hours after surgery. The transversus abdominal plane (TAP) is currently used for post-LC analgesia. Posterior, subcostal, or rectus sheath TAP blocks are the conventional approaches used. The aim of the current study was to compare the efficacy of combinations of various peripheral blocks on pain intensity and the use of pain killers, shortly after LC. Methods This was a prospective, double-blind study, in which 200 patients who were about to undergo a LC procedure were recruited and randomized into 4 groups: patients receiving one of the following: TAP block alone, subcostal Tap block alone, subcostal TAP block with a TAP block, or subcostal TAP with a rectus sheath block. The intensity of pain (VAS score) and the use of painkillers were monitored in the recovery unit and in the department for up to 24 hours after surgery. Results Pain levels decreased with time from 3.6 ± 3.2 at 30 minutes to 0.9 ± 2.0 at 24 hours after the surgery. Nevertheless, no difference between the various block types groups was noted. The percentage of patients who consumed analgesic medications decreased over time, from 83% at 30 to 21% at 24 hours after surgery. The mean/median number of medications consumed by each of the patients was lower among the patients who received a combination of 2 blocks compared to those who received a single one (mean/median of 2.7/3 and 2.8/3 for the TAP or subcostal TAP blocks, respectively; 2.5/2 and 2.3/2 for the subcostal TAP + TAP or subcostal TAP + rectus sheath blocks, respectively). Conclusion A combination of peripheral nerve blocks reduced the use of analgesic consumption during the 24 hours after LC surgery, compared to standalone blocks.
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Affiliation(s)
- Zoya Haitov Ben Zikri
- Anesthesiology Department, Shamir Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Maryna Volis
- Anesthesiology Department, Shamir Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Andrei Mazur
- Anesthesiology Department, Shamir Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Tatjana Orlova
- Anesthesiology Department, Shamir Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Hana Alon
- Anesthesiology Department, Shamir Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Sara Bar Yehuda
- Anesthesiology Department, Shamir Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Vladislav Gofman
- Anesthesiology Department, Shamir Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
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Zhu M, Sun W. Analgesic Effects of Ropivacaine Combined With Dexmedetomidine in Transversus Abdominis Plane Block in Patients Undergoing Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis. J Perianesth Nurs 2023; 38:493-503. [PMID: 36710235 DOI: 10.1016/j.jopan.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE This review aimed to conduct a meta-analysis of published randomized controlled studies (RCTs) comparing the effectiveness of dexmedetomidine (DEX) combined with ropivacaine versus single ropivacaine in transversus abdominis plane block (TAPB) for postoperative analgesia after laparoscopic cholecystectomy (LC). The purpose was to investigate whether DEX combined with ropivacaine in TAPB for postoperative analgesia in LC is superior to single ropivacaine administration. DESIGN A Systematic Review and Meta-analysis. METHODS Five electronic database systems were searched for RCTs on the effects of DEX combined with ropivacaine (joint group) and single ropivacaine on postoperative analgesia in LC. The standardized mean difference (SMD) or odds ratio (OR) and their corresponding 95% confidence interval (CI) of the indicators were calculated for comparison. FINDINGS As of December 23, 2021, 153 articles were retrieved, but only 16 articles were finally included in this meta-analysis. The results showed that compared with single ropivacaine, DEX combined with ropivacaine in TAPB had better analgesia and lighter sedative effect in patients after LC. After LC 2h(T1), 4h(T2), 8h(T3), 12h(T4) and 24h (T5), the joint group participants have lower VAS scores (T1: SMD = -0.32, 95%CI: -0.49, -0.14; T2: SMD = -1.11, 95%CI: -1.56, -0.65; T3: SMD = -2.88, 95%CI: -3.74, -2.02; T4: SMD = -2.56, 95%CI: -3.04, -2.08; T5: SMD = -1.44, 95%CI: -1.81, -1.06). Also, the Ramsay score of the joint group is higher than the single group (T1: SMD = 1.05, 95%CI: 0.39, 1.71; T2: SMD = 1.57, 95%CI: 0.57, 2.57; T3: SMD = 1.64, 95%CI: 0.65, 2.63; T4: SMD = 1.72, 95%CI: 0.54, 2.89; T5: SMD = 0.57, 95%CI: 0.21, 0.94). CONCLUSIONS The results of this review and meta-analysis suggest that DEX combined with ropivacaine has less postoperative pain, more patients got the status of sober and cooperative, and longer postoperative analgesia lasted than ropivacaine alone in TAPB, especially in the group of combined treatment with 1.0 mcg/kg DEX. Furthermore, the flow dynamics of the two groups are stable, and there is no notable difference in the incidence of adverse reactions.
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Affiliation(s)
- Miao Zhu
- Department of Anesthesiology, the Sixth Hospital of Ningbo, Ningbo, Zhejiang, China
| | - Wenchao Sun
- Department of Anesthesiology, the Sixth Hospital of Ningbo, Ningbo, Zhejiang, China.
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Alsharari AF, Abuadas FH, Alnassrallah YS, Salihu D. Transversus Abdominis Plane Block as a Strategy for Effective Pain Management in Patients with Pain during Laparoscopic Cholecystectomy: A Systematic Review. J Clin Med 2022; 11:jcm11236896. [PMID: 36498471 PMCID: PMC9735918 DOI: 10.3390/jcm11236896] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
Laparoscopic cholecystectomy (LC), unlike laparotomy, is an invasive surgical procedure, and some patients report mild to moderate pain after surgery. Transversus abdominis plane (TAP) block has been shown to be an appropriate method for postoperative analgesia in patients undergoing abdominal surgery. However, there have been few studies on the efficacy of TAP block after LC surgery, with unclear information on the optimal dose, long-term effects, and clinical significance, and the analgesic efficacy of various procedures, hence the need for this review. Five electronic databases (PubMed, Academic Search Premier, Web of Science, CINAHL, and Cochrane Library) were searched for eligible studies published from inception to the present. Post-mean and standard deviation values for pain assessed were extracted, and mean changes per group were calculated. Clinical significance was determined using the distribution-based approach. Four different local anesthetics (Bupivacaine, Ropivacaine, Lidocaine, and Levobupivacaine) were used at varying concentrations from 0.2% to 0.375%. Ten different drug solutions (i.e., esmolol, Dexamethasone, Magnesium Sulfate, Ketorolac, Oxycodone, Epinephrine, Sufentanil, Tropisetron, normal saline, and Dexmedetomidine) were used as adjuvants. The optimal dose of local anesthetics for LC could be 20 mL with 0.4 mL/kg for port infiltration. Various TAP procedures such as ultrasound-guided transversus abdominis plane (US-TAP) block and other strategies have been shown to be used for pain management in LC; however, TAP blockade procedures were reported to be the most effective method for analgesia compared with general anesthesia and port infiltration. Instead of 0.25% Bupivacaine, 1% Pethidine could be used for the TAP block procedures. Multimodal analgesia could be another strategy for pain management. Analgesia with TAP blockade decreases opioid consumption significantly and provides effective analgesia. Further studies should identify the long-term effects of different TAP block procedures.
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Affiliation(s)
| | | | | | - Dauda Salihu
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia
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Ozciftci S, Sahiner Y, Sahiner IT, Akkaya T. Is Right Unilateral Transversus Abdominis Plane (TAP) Block Successful in Postoperative Analgesia in Laparoscopic Cholecystectomy? Int J Clin Pract 2022; 2022:2668215. [PMID: 35685608 PMCID: PMC9159215 DOI: 10.1155/2022/2668215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transversus abdominis plane (TAP) block is used for postoperative analgesia in laparoscopic cholecystectomy. In laparoscopic cholecystectomy, the incisions are located mainly on the upper right side of the abdomen. AIMS We aim to determine the efficacy of less-invasive ultrasound-guided right unilateral oblique subcostal TAP block in laparoscopic cholecystectomy on postoperative analgesia by comparing patients undergoing bilateral TAP block and a control group. METHODS Ninety patients were equally divided into control, unilateral, and bilateral TAP block groups. TAP blocks were conducted before anesthesia. No block was applied to the control group. Patients' demographics and postoperative pain, satisfaction, and nausea-vomiting scores and tramadol/ondansetron doses were evaluated. RESULTS There was no significant difference in the verbal numerical rating scale for pain scores at rest and during coughing (VNRS-R and VNRS-C) between unilateral and bilateral TAP block groups at postoperative 1 hour, 2 hour, 4 hour, 8 hour, 12 hour, and 24 hours. In addition, VNRS-R and VNRS-C scores were significantly higher in the control group than in the other two groups. Tramadol consumption in the control group was significantly higher than in the unilateral and bilateral TAP block groups (p ≤ 0.01), while no significant difference was identified between unilateral and bilateral TAP block groups (p=0.303). Nausea-vomiting scores and ondansetron consumption did not differ significantly between all the groups. Patient satisfaction was significantly higher in unilateral and bilateral groups (p < 0.01, p < 0.01) than in the control group, while there was no significant difference between unilateral and bilateral TAP block groups (p=0.793). CONCLUSIONS Right unilateral TAP block provides postoperative analgesia as effective as bilateral TAP block in laparoscopic cholecystectomy.
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Affiliation(s)
- Serhat Ozciftci
- Hitit University Faculty of Medicine, Department of Anesthesiology and Reanimation, Çorum Merkez, Turkey
| | - Yeliz Sahiner
- Hitit University Faculty of Medicine, Department of Anesthesiology and Reanimation, Çorum Merkez, Turkey
| | - Ibrahim Tayfun Sahiner
- Hitit University Faculty of Medicine, Department of General Surgery, Çorum Merkez, Turkey
| | - Taylan Akkaya
- University of Health Science, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Anesthesiology and Reanimation and Pain Clinic, Ankara, Turkey
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Mohamed RHB, Al Jubran H, Alsaeed Z, Al-Sahwi S, Alhouri S, Al Turaik W. Ultrasound-Guided Transversus Abdominis Plane Block in laparoscopic surgeries: A scoping review. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.2001975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Radwa Hamdi Bakr Mohamed
- Vice Deanship for Quality and Development, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hawra Al Jubran
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zainab Alsaeed
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sukainah Al-Sahwi
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shahad Alhouri
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Walaa Al Turaik
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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10
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Erector spinae plane block reduces pain after laparoscopic cholecystectomy. Anaesthesist 2021; 70:48-52. [PMID: 34661682 DOI: 10.1007/s00101-021-01015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE After laparoscopic cholecystectomy patients have moderate pain in the early postoperative period. According to several studies an erector spinae plane (ESP) block can be a valuable part of multimodal analgesia. Our intention was to evaluate how ESP block influences postoperative pain scores and opioid consumption after laparoscopic cholecystectomy. METHODS This single-blinded, prospective, randomized study included 60 patients undergoing laparoscopic cholecystectomy to receive either bilateral ESP block at the Th 7 level (n = 30) with 20 ml of 0.25% levobupivacaine plus dexamethasone 2 mg per side, or standard multimodal analgesia (n = 30). Patients from the standard multimodal analgesia group received tramadol 100 mg at the end of the procedure. Postoperative analgesia for both groups was acetaminophen 1 g/8 h i.v. and ketorolac 30 mg/8 h. Tramadol 1 mg/kg was a rescue treatment for pain breakthrough (numeric rating scale/NRS ≥ 6) in both groups. Pain at rest was recorded at 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 24 h after surgery using NRS (0-10). RESULTS An ESP block significantly reduced postoperative pain scores compared to standard multimodal analgesia after 10 min (p = 0.011), 30 min (p = 0.004), 2 h (p = 0.011), 4 h (p = 0.003), 8 h (p = 0.013), 12 h (p = 0.004) and 24 h (p = 0.005). Tramadol consumption was significantly lower in the ESP group 25.02 ± 56.8g than in the standard analgesia group 208.3 ± 88.1g (p < 0.001). CONCLUSION An ESP block can provide superior postoperative analgesia and reduction in opioid requirement after laparoscopic cholecystectomy.
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Wang W, Wang L, Gao Y. A Meta-Analysis of Randomized Controlled Trials Concerning the Efficacy of Transversus Abdominis Plane Block for Pain Control After Laparoscopic Cholecystectomy. Front Surg 2021; 8:700318. [PMID: 34422893 PMCID: PMC8371254 DOI: 10.3389/fsurg.2021.700318] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background and Purpose: Transverse abdominis plane (TAP) block has been suggested to reduce post-operative pain after laparoscopic cholecystectomy (LC). However, the literature is divided on whether ultrasound (USG)-guided TAP block is effective for pain control after LC. The present meta-analysis therefore evaluated the efficacy of USG-guided TAP block vs. controls and port site infiltration for pain control after LC. Methods: A comprehensive literature search of online academic databases was performed for published randomized controlled trials (RCTs) for studies published to January 31, 2021. The primary outcome analyzed was post-operative pain score at 0, 6, 12, and 24 h post-surgery, both during rest and while coughing. Secondary outcomes included morphine consumption and post-operative nausea and vomiting (PONV) incidence. Results: A total of 23 studies with data on 1,450 LC patients were included in our meta-analysis. A reduction in pain intensity at certain post-operative timepoints was observed for USG-guided TAP block patients compared to control group patients. No reduction in pain intensity was observed for patients receiving USG-guided TAP block patients vs. conventional Port site infiltration. Conclusion: This meta-analysis concludes that TAP block is more effective than a conventional pain control, but not significatively different from another local incisional pain control that is port site infiltration. Additional prospective randomized controlled trials are required to further validate our findings.
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Affiliation(s)
- Weihua Wang
- Department of Thoracic Surgery, Weifang Second People's Hospital, Weifang, China
| | - Lishan Wang
- Department of Oral and Maxillofacial Surgery, Weifang Second People's Hospital, Weifang, China
| | - Yan Gao
- Department of Thoracic Surgery, Weifang Second People's Hospital, Weifang, China
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Grape S, Kirkham KR, Akiki L, Albrecht E. Transversus abdominis plane block versus local anesthetic wound infiltration for optimal analgesia after laparoscopic cholecystectomy: A systematic review and meta-analysis with trial sequential analysis. J Clin Anesth 2021; 75:110450. [PMID: 34243030 DOI: 10.1016/j.jclinane.2021.110450] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Both transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. We undertook this systematic review and meta-analysis with trial sequential analysis to determine the best analgesic technique. METHODS We systematically searched the literature for trials comparing TAP block with wound infiltration after laparoscopic cholecystectomy. The primary outcome was pain score during rest (analogue scale, 0-10) at 2 postoperative hours. Secondary pain-related outcomes included pain scores during rest at 12 and 24 h, pain scores during movement and intravenous morphine consumption at 2, 12 and 24 h, and postoperative nausea and vomiting. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, hematoma, visceral injury and local anesthetic systemic toxicity. RESULTS Ten trials including 668 patients were identified. There was a significant difference in pain score during rest at 2 postoperative hours in favour of TAP block when compared with wound infiltration (mean difference [95%CI]: -0.7 [-1.2, -0.2]; I2 = 71%; p = 0.008). Pain scores during rest at 12 and 24 h and pain scores during movement at 24 h were also significantly lower with TAP block than wound infiltration. Postoperative morphine consumption and the incidence of postoperative nausea and vomiting were significantly lower in patients who received a TAP block. Data were insufficient to compare block-related complications. The overall quality of evidence was moderate-to-high. CONCLUSIONS There is moderate-to-high level evidence that the TAP block provides superior analgesia when compared with wound infiltration in patients undergoing laparoscopic cholecystectomy. Trial registry number: PROSPERO CRD42020208057.
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Affiliation(s)
- Sina Grape
- Department of Anesthesia, Valais Hospital, Sion, and University of Lausanne, Lausanne, Switzerland.
| | - Kyle Robert Kirkham
- Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Liliane Akiki
- Department of Anesthesia, Valais Hospital, Sion, Switzerland
| | - Eric Albrecht
- Program Director of Regional Anaesthesia, Department of Anesthesia, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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Saravanan R, Venkatraman R, Karthika U. Comparison of Ultrasound-Guided Modified BRILMA Block with Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy - A Randomized Controlled Trial. Local Reg Anesth 2021; 14:109-116. [PMID: 34239324 PMCID: PMC8259940 DOI: 10.2147/lra.s316320] [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] [Received: 04/17/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims Subcostal Transversus Abdominis Plane (TAP) block is the standard practice for postoperative analgesia following laparoscopic cholecystectomy. This study aimed to compare the efficacy of modified BRILMA Block (blocking the BRanches of Intercostal nerves at the Level of Mid-Axillary line) with Subcostal TAP block for pain relief following laparoscopic cholecystectomy. Methods Sixty cases scheduled for laparoscopic cholecystectomy were randomly divided into two groups: modified BRILMA block (Group B) and Subcostal TAP block (Group T). General anesthesia was standardized for both groups. Blocks were performed with 20 mL of 0.2% Ropivacaine under ultrasound guidance after induction of anesthesia. Patients were administered morphine through patient controlled analgesia (PCA) pump with a bolus dose of 1 mg, 10 min lockout interval, and a basal infusion rate of 0.1 mg/h. The pain was assessed by the Visual Analog Scale (VAS) scores of one to ten. The total morphine consumption, time to first request for rescue analgesia, and VAS scores at rest and with movement, and complications, if any, were recorded. Results The morphine consumption in Group B was 5.67 ± 1.98 mg and in Group T was 5.17 ± 1.85 mg, which was found to be statistically insignificant (p-value = 0.317). The time to first request for rescue analgesia was 759.33 ± 80.29 min in Group B which was comparable to 854 ± 93.01 min in Group T and statistically insignificant (p-value = 0.295). The average VAS scores at rest as well as on movement were comparable in both the groups during the entire 24 h postoperative period. No complications were encountered in our study. Conclusion Ultrasound-guided modified BRILMA block is equally efficacious as subcostal TAP block in providing postoperative analgesia with similar morphine consumption and no significant difference in VAS scores at rest and movement following laparoscopic cholecystectomy. Trial Registration Number CTRI/2020/02/023457.
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Affiliation(s)
- Ravi Saravanan
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, 603203, India
| | - Rajagopalan Venkatraman
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, 603203, India
| | - Urkavalan Karthika
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, 603203, India
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Freitag FAV, Amora DDS, Muehlbauer E, Dornbusch PT, Machado M, Montiani-Ferreira F, Prisco Farias EL, Valverde A, Duque Moreno JC. Ultrasound-guided modified subcostal transversus abdominis plane block and influence of recumbency position on dye spread in equine cadavers. Vet Anaesth Analg 2021; 48:596-602. [PMID: 33903072 DOI: 10.1016/j.vaa.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/28/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe and evaluate an ultrasound-guided modified subcostal approach for the transversus abdominis plane (TAP) block in horse cadavers in lateral or dorsal recumbency. STUDY DESIGN Prospective, experimental cadaveric study. ANIMALS Study of one preserved foal and eight fresh adult horse cadavers. METHODS The lateral and ventral abdominal wall of a preserved cadaver was dissected to identify the muscles and nerves. A unilateral standard TAP block technique was performed (60 mL of methylene blue dye-bupivacaine) on a fresh cadaver in right lateral recumbency. A modified subcostal technique was performed on the opposite side using a linear ultrasound transducer and in-plane approach. Injection points (two 30 mL dye) were at the level of the TAP (between the rectus abdominis and transversus abdominis muscles and ventral to the cutaneous trunci muscle) perpendicular to: 1) the mid-point between the xiphoid cartilage and umbilical scar; and 2) at a point between the caudal and middle thirds of the abdomen measured from the first injection point to the umbilical scar. The modified subcostal approach was performed in seven additional cadavers in both hemiabdomens, with three cadavers in lateral and four cadavers in dorsal recumbency. Ultrasound guidance was used with all injections. RESULTS The standard approach stained the sixteenth to eighteenth thoracic nerves (T16-T18). The modified subcostal approach performed in lateral recumbency provided greater spread (T9-T17) than dorsal recumbency (T12-T18) (p = 0.016). CONCLUSIONS AND CLINICAL RELEVANCE The modified subcostal TAP approach resulted in extensive staining exceeding the standard approach. The nerves stained are consistent with production of ventral abdominal wall anesthesia in horses. Clinical studies are needed to verify these findings.
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Affiliation(s)
- Flavio A V Freitag
- Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil; Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Dorli da S Amora
- Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil
| | - Eloisa Muehlbauer
- Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil
| | - Peterson T Dornbusch
- Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil
| | - Marcello Machado
- Anatomy Department, Biological Science Sector, Federal University of Paraná, Curitiba, PR, Brazil
| | | | - Edison L Prisco Farias
- Anatomy Department, Biological Science Sector, Federal University of Paraná, Curitiba, PR, Brazil
| | - Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Amir S, Chitra K, Ali Q, Jha P, Saquib M. A comparative study of ultrasound-guided transversus abdominis plane block with local anesthetic infiltration in inguinal hernia repair: A prospective randomized study. INDIAN JOURNAL OF PAIN 2021. [DOI: 10.4103/ijpn.ijpn_130_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jones JH, Aldwinckle R. Interfascial Plane Blocks and Laparoscopic Abdominal Surgery: A Narrative Review. Local Reg Anesth 2020; 13:159-169. [PMID: 33122942 PMCID: PMC7591028 DOI: 10.2147/lra.s272694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Laparoscopic abdominal surgery has become a mainstay of modern surgical practice. Postoperative analgesia is an integral component of recovery following laparoscopic abdominal surgery and may be improved by regional anesthesia or intravenous lidocaine infusion. There is inconsistent evidence supporting the use of interfascial plane blocks, such as transversus abdominis plane (TAP) blocks, for patients undergoing laparoscopic abdominal surgery as evidenced by variable patterns of local anesthetic spread and conflicting results from studies comparing TAP blocks to local anesthetic infiltration of laparoscopic port sites and multimodal analgesia. Quadratus lumborum (QL) and erector spinae plane (ESP) blocks may provide greater areas of somatic analgesia as well as visceral analgesia, which may translate to more significant clinical benefits. Aside from the locations of the surgical incisions, it is unclear what other factors should be considered when choosing one regional technique over another or deciding to infuse lidocaine intravenously. We reviewed the current literature in attempt to clarify the roles of various regional anesthesia techniques for patients undergoing laparoscopic abdominal surgery and present one possible approach to evaluating postoperative pain.
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Affiliation(s)
- James Harvey Jones
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Robin Aldwinckle
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, Sacramento, CA, USA
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Abdelhamid BM, Khaled D, Mansour MA, Hassan MM. Comparison between the ultrasound-guided erector spinae block and the subcostal approach to the transversus abdominis plane block in obese patients undergoing sleeve gastrectomy: a randomized controlled trial. Minerva Anestesiol 2020; 86:816-826. [DOI: 10.23736/s0375-9393.20.14064-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Vindal A, Sarda H, Lal P. Laparoscopically guided transversus abdominis plane block offers better pain relief after laparoscopic cholecystectomy: results of a triple blind randomized controlled trial. Surg Endosc 2020; 35:1713-1721. [PMID: 32297054 DOI: 10.1007/s00464-020-07558-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transversus abdominis plane (TAP) block is a regional anaesthetic technique providing analgesia to the parietal peritoneum, muscles and skin of the anterior abdominal wall innervated by somatic nerves T6 to L1. We present the results of our randomized triple blind study comparing laparoscopically guided TAP block with the commonly used port site local anaesthetic infiltration for pain relief after laparoscopic cholecystectomy. METHODS A hundred patients with symptomatic gallstones planned for laparoscopic cholecystectomy were randomized into two groups of TAP block and port site infiltration. Group A received 4-quadrant TAP block with 10 ml of 0.25% bupivacaine at each of the four sites guided laparoscopically and port site infiltration with 10 ml of normal saline at each of the 4 ports for blinding the surgeon. Group B received port site infiltration with 0.25% bupivacaine, and infiltration with normal saline at TAP block sites for blinding the surgeon. Post-operative pain (at 3, 6, 24 h and 1-week post-operative) (VAS), time to return to activities of daily living and patient satisfaction (Capuzzo Score) were recorded by an observer blinded towards the groups of the patients. RESULTS The median VAS at 3, 6, 24 h, at discharge, and 1-week post-operative were lesser in Group A compared to Group B (p ≤ 0.001 for all). The median duration of hospital stay was also lesser in Group A compared to Group B (p = 0.48, not significant) as was the time to return to activities (p < 0.05). The median Capuzzo score was higher in Group A compared to Group B (p < 0.001). CONCLUSION This study shows that laparoscopically guided TAP block is a safe and easy-to-use technique. It reduces the severity of post-operative pain, helps in quick recovery, early discharge and improved patient satisfaction after laparoscopic cholecystectomy. Clinical Trials Registry of India 020227.
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Affiliation(s)
- Anubhav Vindal
- Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College (University of Delhi), New Delhi, India. .,Department of Surgery, Maulana Azad Medical College, Room No. 215, Bahadur Shah Zafar Marg, BL Taneja Block, New Delhi, 110002, India.
| | - Hitesh Sarda
- Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College (University of Delhi), New Delhi, India
| | - Pawanindra Lal
- Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College (University of Delhi), New Delhi, India
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Transversus Abdominis Plane Block versus Wound Infiltration with Conventional Local Anesthetics in Adult Patients Underwent Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8914953. [PMID: 32280705 PMCID: PMC7125448 DOI: 10.1155/2020/8914953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/16/2020] [Accepted: 03/07/2020] [Indexed: 11/18/2022]
Abstract
Background How to effectively control the postoperative pain of patients is extremely important to clinicians. Transversus abdominis plane (TAP) block is a novel analgesic method reported to greatly decrease postoperative pain. However, in many areas, there still exists a phenomenon of surgeons using wound infiltration (WI) with conventional local anesthetics (not liposome anesthetics) as the main means to decrease postoperative pain because of traditional wisdom or convenience. Here, we compared the analgesic effectiveness of the two different methods to determine which method is more suitable for adult patients. Materials and methods. A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TAP block and WI without liposome anesthetics in adult patients were performed. Frequently used databases were extensively searched. The main outcomes were postoperative pain scores in different situations (at rest or during movement) and the time until the first use of rescue analgesics. The secondary outcomes were postoperative nausea and vomiting (PONV) incidence and patient satisfaction scores. Results Fifteen studies with 983 participants met the inclusion criteria and were included in the present study. The heterogeneity in the final analysis regarding the pain score was low to moderate. The major results of the sensitivity analysis were stable. WI had the same analgesic effect as TAP block only at the one-hour postoperative time point (mean difference = -0.32, 95% confidence interval (-0.87, 0.24), P = 0.26) and was associated with a shorter time until the first rescue analgesic and poorer patient satisfaction. Conclusion TAP block results in a more effective and steady analgesic effect than WI with conventional local anesthetics in adult patients from the early postoperative period and obtains higher patient satisfaction.
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Unilateral transversus abdominis plane block and port-site infiltration. Anaesthesist 2020; 69:270-276. [DOI: 10.1007/s00101-020-00746-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/28/2019] [Accepted: 02/12/2020] [Indexed: 12/23/2022]
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Selvi O, Tulgar S, Senturk O, Serifsoy TE, Thomas DT, Deveci U, Ozer Z. Is a Combination of the Serratus Intercostal Plane Block and Rectus Sheath Block Superior to the Bilateral Oblique Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy? Eurasian J Med 2020; 52:34-37. [PMID: 32158311 DOI: 10.5152/eurasianjmed.2019.19048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The serratus intercostal plane block (SIPB) is a recently defined interfascial plane block. The oblique subcostal transversus abdominis plane block (OSTAP) is another type of interfascial plane block, and it is also used as a part of multimodal analgesia in patients undergoing laparoscopic cholecystectomy (LC). In this retrospective study, we evaluated the effects of the bilateral OSTAP and a combination of the right SIPB and bilateral rectus sheath block (RSB) on the postoperative pain and analgesia requirement in patients undergoing LC. Materials and Methods Data of the patients who underwent LC between May 2018 and November 2018 were evaluated retrospectively. Postoperative pain was evaluated using the numeric rating scale (NRS), and 24-hour tramadol consumption and rescue analgesia requirements were compared. Results Bilateral OSTAP was applied to 47 patients, and SIPB+RSB was applied to 25 patients. Postoperative pain scores were similar between the two groups. In the first 24 hours, tramadol requirement in the SIPB+RSB group was significantly lower than in the OSTAP block group (p<0.001). There was no statistically significant difference between the NRS averages at different time frames between the two block groups. Conclusion We found that when SIPB is used as a part of multimodal analgesia in a combination with RSB in LS, it improves the quality of analgesia and decreases the analgesic requirement compared to patients undergoing a bilateral OSTAP block. Randomized controlled trials are necessary to compare the effects of SIPB alone and in a combination with other blocks in LC.
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Affiliation(s)
- Onur Selvi
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
| | - Ozgur Senturk
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
| | - Talat Ercan Serifsoy
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
| | - David Terence Thomas
- Departments of Medical Education, Maltepe University School of Medicine, Istanbul, Turkey
| | - Ugur Deveci
- Department of General Surgery, Maltepe University School of Medicine, Istanbul, Turkey
| | - Zeliha Ozer
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
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Liu R, Qin H, Wang M, Li K, Zhao G. Transversus abdominis plane block with general anesthesia blunts the perioperative stress response in patients undergoing radical gastrectomy. BMC Anesthesiol 2019; 19:205. [PMID: 31699052 PMCID: PMC6839132 DOI: 10.1186/s12871-019-0861-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Surgical stress induces the release of neuroendocrine mediators and cytokines during perioperative period, which may have adverse effects on cancer patients. While the surgical stress responsse can be affected by anesthetic technique. Therefore, we designed this study to assess whether subcostal transversus abdominis plane (TAP) block can affect perioperative neuroendocrine stress response, postoperative analgesia and postoperative recovery in patients undergoing radical gastrectomy under general anesthesia. Methods Sixty-five patients were recruited. Patients randomly received general anesthesia (control group), or general anesthesia combined with TAP block (40 mL of 0.375% ropivacaine) (TAP group). The primary outcome was neuroendocrine levels including norepinephrine (NE), epinephrine (E), cortisol (Cor), glucose (Glu), interleukin (IL)-6 and IL-10 during 48 h after surgery. Secondary outcomes included pain score, hemodynamic variables and recovery characteristics. Results Data from 61 of 65 patients were analyzed. The levels of NE, E, Cor, and Glu were blunt by TAP block during perioperative period. The levels of IL-6 and IL-10 were significantly lower in TAP group than in control group. TAP block efficiently relieved postoperative acute pain up to 12 h postoperatively with more stable perioperative hemodynamics compared with control group. Conclusions Subcostal TAP block blunts perioperative stress response and provides efficient analgesia, with good hemodynamic stability and minimal adverse effects.
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Affiliation(s)
- Ruizhu Liu
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Road, Changchun, 130000, Jilin Province, China
| | - Haiyan Qin
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130000, Jilin Province, China
| | - Meng Wang
- Department of Cardiology, No. 965 Hospital of PLA, Jilin, 132000, Jilin Province, China
| | - Kai Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Road, Changchun, 130000, Jilin Province, China.
| | - Guoqing Zhao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Road, Changchun, 130000, Jilin Province, China.
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Kaushal-Deep SM, Lodhi M, Anees A, Khan S, Khan MA. Randomised prospective study of using intraoperative, intraincisional and intraperitoneal ropivacaine for the early discharge of post-laparoscopic cholecystectomy patients as a day case in a cost-effective way in government setup of low-income and middle-income countries: Opening new horizons. Postgrad Med J 2019; 95:78-84. [PMID: 31015318 DOI: 10.1136/postgradmedj-2018-135662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 10/30/2018] [Accepted: 04/07/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pain is the main reason for staying overnight at hospital after an uncomplicated laparoscopic cholecystectomy. OBJECTIVES A randomised prospective study was planned to compare the efficacy of intraincisional and intraperitoneal use of 0.2% ropivacaine so that patients undergoing an uncomplicated laparoscopic cholecystectomy can be discharged as a day case in a cost-effective way. METHODS 191 patients were operated by elective four-port laparoscopic cholecystectomy. They were randomised into three groups after triple blinding according to location of 0.2% ropivacaine use. All patients were given ~23 mL of solution (drug or normal saline depending on the group), 20 mL of which was given at intraperitoneal location and ~1 mL/cm of incision intraincisionally. Pain scores (Visual Analogue Scale (VAS), Numeric Rating Scale (NRS) and Faces Pain Scale-Revised (FPS-R)) were evaluated at 4 and 8 hours postoperatively. Only those patients with a VAS ≤3, NRS ≤3 and FPS-R ≤2, no requirement of rescue analgesia, no shoulder pain, ambulated at least once, passed urine and taking oral sips were offered discharge as a day case. RESULTS 31% of patients in intraperitoneal group (n=62) could be discharged as a day case as compared with 48% in intraincisional group (n=68) (p>0.05) and 89% in combined group (n=61) (p<0.05, with respect to both other groups). CONCLUSION The combined use of intraincisional and intraperitoneal ropivacaine is a cost-effective way of discharging approximately 9 in 10 patients as a day case. This study is unique as this is the first study in which only a local anaesthetic has been used to predict discharges as a day case.
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Affiliation(s)
| | - Mehershree Lodhi
- Anaesthesia, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Afzal Anees
- Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
| | - Shehtaj Khan
- Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
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Siriwardana RC, Kumarage SK, Gunathilake BM, Thilakarathne SB, Wijesinghe JS. Local infiltration versus laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: double-blinded randomized control trial. Surg Endosc 2019; 33:179-183. [PMID: 29943054 DOI: 10.1007/s00464-018-6291-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Transverse abdominal plane block (TAP) is a new technique of regional block described to reduce postoperative pain in laparoscopic cholecystectomy (LC). Recent reports describe an easy technique to deliver local anesthetic agent under laparoscopic guidance. METHODS This randomized control trial was designed to compare the effectiveness of additional laparoscopic-guided TAP block against the standard full thickness port site infiltration. 45 patients were randomized in to each arm after excluding emergency LC, conversions, ones with coagulopathy, pregnancy and allergy to local anesthetics. All cases were four ports LC. Interventions-Both groups received standard port site infiltration with 3-5 ml of 0.25% bupivacaine. The test group received additional laparoscopic-guided TAP block with 20 ml of 0.25% bupivacaine subcostally, between the anterior axillary and mid clavicular lines. As outcome measures the pain score, opioid requirement, episodes of nausea and vomiting and time to mobilize was measured at 6 hourly intervals. RESULTS The two groups were comparable in the age, gender, body mass index, indication for cholecystectomy difficulty index and surgery duration. The pain score at 6 h (P = 0.043) and opioid requirement at 6 h (P = 0.026) was higher in the TAP group. These were similar in subsequent assessments. Other secondary outcomes were similar in the two groups. CONCLUSION Laparoscopic-guided transverses abdominis plane block using plain bupivacaine does not give an additional pain relief or other favorable outcomes. It can worsen the pain scores. Pre registration: The trial was registered in Sri Lanka clinical trial registry-SLCTR/2016/011 ( http://www.slctr.lk/trials/357 ).
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Affiliation(s)
- Rohan C Siriwardana
- Department of Surgery, Faculty of Medicine Ragama, University of Kelaniya, Kelaniya, Sri Lanka.
| | - Sumudu K Kumarage
- Department of Surgery, Faculty of Medicine Ragama, University of Kelaniya, Kelaniya, Sri Lanka
| | - Bhagya M Gunathilake
- Department of Surgery, Faculty of Medicine Ragama, University of Kelaniya, Kelaniya, Sri Lanka
| | | | - Jeevani S Wijesinghe
- Department of Surgery, Faculty of Medicine Ragama, University of Kelaniya, Kelaniya, Sri Lanka
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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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Barazanchi A, MacFater W, Rahiri JL, Tutone S, Hill A, Joshi G, Kehlet H, Schug S, Van de Velde M, Vercauteren M, Lirk P, Rawal N, Bonnet F, Lavand'homme P, Beloeil H, Raeder J, Pogatzki-Zahn E. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth 2018; 121:787-803. [DOI: 10.1016/j.bja.2018.06.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/19/2018] [Accepted: 07/09/2018] [Indexed: 02/07/2023] Open
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Laparoscopic-assisted Tranversus Abdominis Plane (TAP) Block Versus Ultrasonography-guided Transversus Abdominis Plane Block in Postlaparoscopic Cholecystectomy Pain Relief: Randomized Controlled Trial. Surg Laparosc Endosc Percutan Tech 2018; 27:228-232. [PMID: 28472015 DOI: 10.1097/sle.0000000000000405] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic cholecystectomy is usually given under ultrasound guidance. Laparoscopic-assisted TAP block has been suggested as an alternative to ultrasonogram (USG)-guided block as it is less time consuming and does not need extra equipments. This study was done to compare the efficacy of both the techniques. PATIENTS AND METHODS We conducted a randomized controlled trial between October 2012 and June 2014 involving adult patients with symptomatic gall stone disease. Patients were randomly assigned to laparoscopic or ultrasound-guided TAP block. Both groups were compared for amount of opioid consumption, postoperative pain scores, postoperative nausea and vomiting, bowel movements, peak expiratory flow rate, and time taken for administering the block. RESULTS We included 60 adult patients in our study. The groups were comparable with respect to demographic characteristics, symptomatology, comorbidities, and intraoperative complications. Amount of opioid consumption and postoperative pain relief were comparable between the 2 groups. The time taken for laparoscopy-assisted block was shorter when compared with the time taken for USG-guided block (P≤0.05). Postoperative nausea and vomiting, bowel movements, and peak expiratory flow rate were comparable between the 2 groups. CONCLUSIONS Laparoscopy-assisted TAP block is faster and equally efficacious when compared with USG-guided block and has a definite role in centers where ultrasound is not available in operating rooms.
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Vrsajkov V, Mančić N, Mihajlović D, Milićević ST, Uvelin A, Vrsajkov JP. O bloqueio do plano transverso abdominal subcostal pode melhorar a analgesia após colecistectomia laparoscópica. Braz J Anesthesiol 2018; 68:149-153. [DOI: 10.1016/j.bjan.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/05/2017] [Indexed: 10/18/2022] Open
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Vrsajkov V, Mančić N, Mihajlović D, Milićević ST, Uvelin A, Vrsajkov JP. Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 29277312 PMCID: PMC9391710 DOI: 10.1016/j.bjane.2017.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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Ramkiran S, Jacob M, Honwad M, Vivekanand D, Krishnakumar M, Patrikar S. Ultrasound-guided Combined Fascial Plane Blocks as an Intervention for Pain Management after Laparoscopic Cholecystectomy: A Randomized Control Study. Anesth Essays Res 2018; 12:16-23. [PMID: 29628547 PMCID: PMC5872856 DOI: 10.4103/aer.aer_157_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Pain associated with laparoscopic cholecystectomy is most severe during the first 24 h and the port sites are the most painful. Recent multimodal approaches target incisional pain instead of visceral pain which has led to the emergence of abdominal fascial plane blocks. This study embraces a novel combination of two independently effective fascial plane blocks, namely rectus sheath block and subcostal transversus abdominis plane (TAP) block to alleviate postoperative pain. Study Objective The aim is to evaluate the effectiveness of the combination of rectus sheath block and subcostal TAP block, to compare its efficacy with that of subcostal TAP block alone and with conventional port site infiltration (PSI) in alleviating postoperative pain in patients undergoing laparoscopic cholecystectomy. Methodology This prospective, randomized control, pilot study included 61 patients scheduled for elective laparoscopic cholecystectomy and distributed among three groups, namely Group 1: Combined subcostal TAP block with rectus sheath block (n = 20); Group 2: Oblique subcostal TAP block alone (n = 21); and Group 3: PSI group as an active control (n = 20). Results Combined group had significantly lower pain scores, higher satisfaction scores, and reduced rescue analgesia both in early and late postoperative periods than the conventional PSI group. Conclusion Ultrasound-guided combined fascial plane blocks is a novel intervention in pain management of patients undergoing laparoscopic cholecystectomy and should become the standard of care.
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Affiliation(s)
- Seshadri Ramkiran
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Mathews Jacob
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Manish Honwad
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Desiraju Vivekanand
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Seema Patrikar
- Lecturer in Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
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Suseela I, Anandan K, Aravind A, Kaniyil S. Comparison of ultrasound-guided bilateral subcostal transversus abdominis plane block and port-site infiltration with bupivacaine in laparoscopic cholecystectomy. Indian J Anaesth 2018; 62:497-501. [PMID: 30078851 PMCID: PMC6053890 DOI: 10.4103/ija.ija_55_18] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background and Aims: Many patients experience moderate-to-severe pain after laparoscopic cholecystectomy. We aimed to compare the efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane (TAP) block with port-site infiltration for post-operative analgesia after laparoscopic cholecystectomy. Methods: Patients undergoing elective laparoscopic cholecystectomy under general anaesthesia were divided into two groups of 40 each to receive ultrasound-guided bilateral subcostal TAP block (T) with 0.25% bupivacaine 20 ml each side or port-site infiltration with 0.5% bupivacaine 5 ml each at 4 ports (I) at the end of the surgery before extubation. All patients received paracetamol 1 g intravenous 8th hourly. Tramadol 1 mg/kg intravenous bolus and diclofenac 1 mg/kg intravenous infusion were used as the first- and second-line rescue analgesics when Numerical Rating Scale (NRS) ≥4, or when the patient complained of pain. NRS at 1, 2, 3, 6, 12 and 24 h after surgery, time to first analgesic request and total dose of analgesics in 24 h were recorded. Chi-square test and independent t-test were used to compare qualitative and quantitative data, respectively. Results: Time to first analgesic (mean±SD) in Group I and Group T was 292.7 ± 67.03 and 510.3 ± 154.55 min and mean tramadol required was141.8 ± 60.01 mg and 48.69 ± 36.14 mg, respectively (P = 0.001 for both). Mean NRS at 2, 3, 6, 12 and 24 h was significantly lower in Group T. Conclusion: Ultrasound-guided bilateral subcostal TAP block provides superior post-operative analgesia after laparoscopic cholecystectomy compared to port-site infiltration.
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Affiliation(s)
- Indu Suseela
- Department of Anaesthesiology, Government Medical College, Kozhikode, Kerala, India
| | - Krishnadas Anandan
- Department of Anaesthesiology, Government Medical College, Kozhikode, Kerala, India
| | - Arun Aravind
- Department of Anaesthesiology, Government Medical College, Kozhikode, Kerala, India
| | - Suvarna Kaniyil
- Department of Anaesthesiology, Government Medical College, Kozhikode, Kerala, India
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Soliz JM, Lipski I, Hancher-Hodges S, Speer BB, Popat K. Subcostal Transverse Abdominis Plane Block for Acute Pain Management: A Review. Anesth Pain Med 2017; 7:e12923. [PMID: 29696110 PMCID: PMC5903215 DOI: 10.5812/aapm.12923] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/09/2017] [Accepted: 10/10/2017] [Indexed: 11/16/2022] Open
Abstract
The subcostal transverse abdominis plane (SCTAP) block is the deposition of local anesthetic in the transverse abdominis plane inferior and parallel to the costal margin. There is a growing consensus that the SCTAP block provides better analgesia for upper abdominal incisions than the traditional transverse abdominis plane block. In addition, when used as part of a four-quadrant transverse abdominis plane block, the SCTAP block may provide adequate analgesia for major abdominal surgery. The purpose of this review is to discuss the SCTAP block, including its indications, technique, local anesthetic solutions, and outcomes.
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Affiliation(s)
- Jose M Soliz
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Corresponding author: Jose M Soliz, M.D., Associate Professor, Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd.Houston, TX 77030, E-mail:
| | - Ian Lipski
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shannon Hancher-Hodges
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barbra Bryce Speer
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keyuri Popat
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Breazu CM, Ciobanu L, Bartos A, Bodea R, Mircea PA, Ionescu D. Pethidine efficacy in achieving the ultrasound-guided oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy: A prospective study. Bosn J Basic Med Sci 2017; 17:67-73. [PMID: 28027453 DOI: 10.17305/bjbms.2016.1647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/02/2016] [Accepted: 10/03/2016] [Indexed: 11/16/2022] Open
Abstract
Pethidine is a synthetic opioid with local anesthetic properties. Our goal was to evaluate the analgesic efficacy of pethidine for achieving the ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block in laparoscopic cholecystectomy. This prospective, double-blind study included 79 patients of physical status I and II according to American Society of Anesthesiologists, scheduled for elective laparoscopic cholecystectomy. The patients were randomly allocated into three groups, depending on the drug used to achieve preoperative bilateral OSTAP block: 1) OSTAP-Placebo (treated with normal saline); 2) OSTAP-Bupivacaine (treated with 0.25% bupivacaine); and 3) OSTAP-Pethidine (treated with 1% pethidine). The efficacy of pethidine in achieving the OSTAP block was analyzed using visual analog scale (VAS), intraoperative opioid dose, opioid consumption in post anesthesia care unit, and opioid consumption in the first 24 postoperative hours. The pain scores assessed by VAS at 0, 2, 4, 6, 12, and 24 hours were significantly lower in OSTAP-Pethidine than in OSTAP-Placebo group (p < 0.001). The mean intraoperative opioid consumption was significantly lower in OSTAP-Pethidine compared to OSTAP-Placebo group (150 versus 400 mg, p < 0.001), as well as the mean opioid consumption in the first 24 hours (20.4 versus 78 mg, p < 0.001). Comparing VAS assessment between OSTAP-Bupivacaine and OSTAP-Pethidine groups, statistically significant differences were observed only for the immediate postoperative pain assessment (0 hours), where lower values were observed in OSTAP-Pethidine group (p = 0.004). There were no statistically significant differences in the incidence of postoperative nausea and vomiting (p = 0.131) between the groups. The use of 1% pethidine can be an alternative to 0.25% bupivacaine in achieving OSTAP block for laparoscopic cholecystectomy.
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Affiliation(s)
- Caius Mihai Breazu
- University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; Regional Institute of Gastroenterology and Hepatology Prof. Dr. Octavian Fodor, Cluj-Napoca, Romania.
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Management of a centenarian who underwent emergency laparoscopic cholecystectomy under general anesthesia with subcostal transversus abdominis plane block. JA Clin Rep 2016; 2:24. [PMID: 29497679 PMCID: PMC5818852 DOI: 10.1186/s40981-016-0050-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/13/2016] [Indexed: 12/07/2022] Open
Abstract
The anesthetic management of centenarians is challenging, since they have loss of functional reserve in all organs. The mortality rate of 25 % is reported in patients over 100 years old who underwent emergency surgery. The transversus abdominis plane block has been shown to provide effective analgesia in laparoscopic cholecystectomy. A 101-year-old woman was diagnosed with grade I (mild) acute cholecystitis with gallstones. An emergency laparoscopic cholecystectomy was scheduled. The patient had a history of hypertension. The patient’s laboratory data showed that she had mild coagulopathy, anemia, thrombocytopenia, and decreased renal function. After induction of general anesthesia, an ultrasound-guided, bilateral subcostal transversus abdominis plane block was performed. Her postoperative course was uneventful. Using the preoperative subcostal transversus abdominis plane block, we were able to avoid hemodynamic instability and to reduce opioid dosage in a centenarian who underwent emergency laparoscopic cholecystectomy under general anesthesia.
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Saxena R, Joshi S, Srivastava K, Tiwari S, Sharma N, Valecha UK. Comparative study of ultrasound-guided abdominal field blocks versus port infiltration in laparoscopic cholecystectomies for post-operative pain relief. Indian J Anaesth 2016; 60:578-83. [PMID: 27601741 PMCID: PMC4989809 DOI: 10.4103/0019-5049.187790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Aims: Post-operative pain is a major concern for day care surgeries like laparoscopic cholecystectomy. This study aimed to compare the efficacy of ultrasound guided abdominal field blocks (USAFB) with port site infiltrations for post-operative analgesia in terms of quality of pain relief, opioid consumption and patient satisfaction for day care surgeries Methods: Eighty patients presenting for laparoscopic cholecystectomy were randomly allocated to two groups either to receive port-site infiltration of local anaesthetic (n = 40, Group A) or USAFB (n = 40, Group B group). Numeric rating scores (NRS) were measured postoperatively to primarily assess the pain severity and opioid requirements. Data were analysed using Chi-Square test/Fisher's exact test for categorical data and Mann–Whitney test/unpaired t-test for quantitative data. Results: The study group (Group B) had significantly reduced NRS and opioid consumption over 24 h. The overall fentanyl consumption in patients receiving port infiltrations was approximately twice (200 100 μg) as compared to patients in USAFB group (120 74 μg) (P < 0.0001). Maximum fentanyl consumption was 400 μg (Group A) and 262 μg (Group B) over 24 h and the minimum requirement was 50 μg and zero, respectively. Conclusion: Superior post-operative analgesia was observed with USAFB which may help in minimising opioid-related adverse effects and facilitating faster recovery.
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Affiliation(s)
- Ruchi Saxena
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Saurabh Joshi
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Kuldeep Srivastava
- Department of Community Medicine, TSM Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Shashank Tiwari
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Nitin Sharma
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Umesh K Valecha
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
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Saxena R, Joshi S, Srivastava K, Tiwari S, Sharma N, Valecha UK. Comparative study of ultrasound-guided abdominal field blocks versus port infiltration in laparoscopic cholecystectomies for post-operative pain relief. Indian J Anaesth 2016. [PMID: 27601741 DOI: 10.4103/0019-5049.187790.pmid:27601741;pmcid:pmc4989809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND AND AIMS Post-operative pain is a major concern for day care surgeries like laparoscopic cholecystectomy. This study aimed to compare the efficacy of ultrasound guided abdominal field blocks (USAFB) with port site infiltrations for post-operative analgesia in terms of quality of pain relief, opioid consumption and patient satisfaction for day care surgeries. METHODS Eighty patients presenting for laparoscopic cholecystectomy were randomly allocated to two groups either to receive port-site infiltration of local anaesthetic (n = 40, Group A) or USAFB (n = 40, Group B group). Numeric rating scores (NRS) were measured postoperatively to primarily assess the pain severity and opioid requirements. Data were analysed using Chi-Square test/Fisher's exact test for categorical data and Mann-Whitney test/unpaired t-test for quantitative data. RESULTS The study group (Group B) had significantly reduced NRS and opioid consumption over 24 h. The overall fentanyl consumption in patients receiving port infiltrations was approximately twice (200 100 μg) as compared to patients in USAFB group (120 74 μg) (P < 0.0001). Maximum fentanyl consumption was 400 μg (Group A) and 262 μg (Group B) over 24 h and the minimum requirement was 50 μg and zero, respectively. CONCLUSION Superior post-operative analgesia was observed with USAFB which may help in minimising opioid-related adverse effects and facilitating faster recovery.
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Affiliation(s)
- Ruchi Saxena
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Saurabh Joshi
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Kuldeep Srivastava
- Department of Community Medicine, TSM Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Shashank Tiwari
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Nitin Sharma
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
| | - Umesh K Valecha
- Department of Anaesthesiology, Dr. B L Kapur Superspeciality Hospital, Rajinder Nagar, New Delhi, India
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Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials. Can J Anaesth 2016; 63:1184-1196. [DOI: 10.1007/s12630-016-0679-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/25/2016] [Accepted: 06/01/2016] [Indexed: 11/27/2022] Open
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Siddiqui S, Anandan S. The use of four-point transversus abdominis plane block for liver resection. Indian J Anaesth 2016; 60:369-70. [PMID: 27212732 PMCID: PMC4870958 DOI: 10.4103/0019-5049.181617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shahla Siddiqui
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
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Breazu CM, Ciobanu L, Hadade A, Bartos A, Mitre C, Mircea PA, Ionescu D. The efficacy of oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy - a prospective, placebo controlled study. Rom J Anaesth Intensive Care 2016; 23:12-18. [PMID: 28913472 DOI: 10.21454/rjaic.7518.231.obq] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Pain control after a laparoscopic cholecystectomy can represent a challenge, considering the side effects due to standard analgesia methods. Recently the transversus abdominis plane block (TAP Block) has been used as a part of multimodal analgesia with promising results. The subcostal approach (OSTAP Block), a variant on the TAP block, produces reliable unilateral supraumbilical analgesia. This study evaluated the efficacy of the OSTAP block with bupivacaine in laparoscopic cholecystectomy compared with the placebo OSTAP block. MATERIAL AND METHODS Sixty ASA I/II adult patients listed for elective laparoscopic cholecystectomy were randomly allocated in one of two groups: Group A (OSTAP placebo) received preoperatively bilateral OSTAP block with sterile normal saline and Group B (OSTAP bupivacaine) received bilateral preoperatively OSTAP block with the same volumes of 0.25% bupivacaine. Twenty-four hours postoperative opioid consumption, the dose of opioid required during surgery, opioid dose in the recovery unit (PACU) and PACU length of stay were evaluated. The quality of analgesia was assessed by the Visual Analogue Scale (VAS) at specific interval hours during 24 h, at rest and with movement. RESULTS The mean intraoperative opioid consumption showed a significant difference between the two groups, (385 ± 72.52 mg in group A vs 173.67 ± 48.60 mg in group B, p < 0.001). The mean 24 h opioid consumption showed a statistically significant difference between groups (32 ± 26.05 mg vs 79 ± 16.68 mg, p < 0.001). PACU length of stay was significantly lower for group B patients compared with group A patients (20.67 ± 11.27 min vs 41.67 ± 12.41 min, p < 0.001). The OSTAP bupivacaine group had a statistically significant lower pain score than the OSTAP placebo group at 0, 2, 4, 6, 12, 24 h, both at rest and with movement. No signs or symptoms of local anaesthetic systemic toxicity or other complications were detected. CONCLUSION OSTAP block with bupivacaine 0.25% can provide effective analgesia up to 24 hours after laparoscopic cholecystectomy when combined with conventional multimodal analgesia regimen.
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Affiliation(s)
- Caius Mihai Breazu
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania.,Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor" Cluj-Napoca, Romania
| | - Lidia Ciobanu
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania.,Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor" Cluj-Napoca, Romania
| | - Adina Hadade
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania.,Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor" Cluj-Napoca, Romania
| | - Adrian Bartos
- Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor" Cluj-Napoca, Romania
| | - Călin Mitre
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania.,Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor" Cluj-Napoca, Romania
| | - Petru Adrian Mircea
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania.,Emergency County Hospital Cluj-Napoca, Romania
| | - Daniela Ionescu
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania.,Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor" Cluj-Napoca, Romania
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Kadam VR, Howell S, Kadam V. Evaluation of postoperative pain scores following ultrasound guided transversus abdominis plane block versus local infiltration following day surgery laparoscopic cholecystectomy-retrospective study. J Anaesthesiol Clin Pharmacol 2016; 32:80-3. [PMID: 27006547 PMCID: PMC4784220 DOI: 10.4103/0970-9185.168195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: Postoperative pain for day surgery laparoscopic cholecystectomy has traditionally been managed with the surgeon infiltrating the wound with local anesthetic (LA). However, transversus abdominis plane (TAP) block has recently been used, although its superiority over LA remains uncertain. The primary aim was to compare LA and TAP block pain scores and analgesia used. The secondary aim was to assess satisfaction score and cost. Material and Methods: This retrospective study was commenced after ethics committee approval and ANZ clinical trial registry (ACTRN: 12612000737831). The data were collected from the theatre database and medical records of patients presenting for day case laparoscopic cholecystectomy. The sample included patients who received either bilateral port site LA infiltration with 20 ml of 0.25% Bupivacaine or bilateral TAP block with 20 ml of 0.5% ropivacaine and fentanyl postoperative pain protocol. The patients with incomplete medical records were excluded as were those admitted to an inpatient ward. Demographics and clinical characteristics were obtained from the hospital record along with pain score and postsurgery analgesia use. Postoperative pain satisfaction scores were collected by telephonic interview 30-180 days postsurgery. Results: Of 51 patients analyzed, 19 were in TAP group 29 in LA group. There were no significant differences between the LA and TAP groups with respect to postoperative pain scores (P = 0.31) or patient satisfaction scores (1 and 2+) (P = 0.36). However, fentanyl consumption in the recovery room was significantly lower in TAP group (P = 0.0079.). The consumables cost were >3 times higher in the TAP when compared to LA group. Conclusion: The performance of the TAP block with respect to pain management was comparable to LA. However, LA remains more cost effective.
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Affiliation(s)
- Vasanth Rao Kadam
- Visiting Asso. Prof. RRMC, Senior Clinical Lecturer, The University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA Australia
| | - Stuart Howell
- Senior Statistician Data Management and Analysis Centre Discipline of Public Health, University of Adelaide, Adelaide, SA Australia
| | - V Kadam
- Department of Physiotherapy, University of South Australia, Australia
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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: 155] [Impact Index Per Article: 19.4] [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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Peng K, Ji FH, Liu HY, Wu SR. Ultrasound-Guided Transversus Abdominis Plane Block for Analgesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. Med Princ Pract 2016; 25:237-46. [PMID: 26885872 PMCID: PMC5588402 DOI: 10.1159/000444688] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 02/15/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To evaluate the analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) block for patients undergoing laparoscopic cholecystectomy (LC). MATERIALS AND METHODS A systematic literature search was conducted to identify randomized controlled trials that compared ultrasound-guided TAP block with control for analgesia in adult patients undergoing LC. The original data were pooled for the meta-analysis using Review Manager 5. The main outcomes included postoperative pain intensity, opioid consumption, and adverse events. Out of a total of 77 trials, 7 were included. RESULTS Compared with control, ultrasound-guided TAP block reduced the following: (1) postoperative pain intensity (visual analog scale: 0-10) both at rest and on movement at 0, 2, 4, 8, and 24 h (at rest: mean difference, MD(0 h) = -2.19, 95% confidence interval, CI: -3.46 to -0.91, p = 0.0008; on movement: MD(0 h) = -2.67, 95% CI: -3.86 to -1.48, p < 0.0001); (2) intraoperative fentanyl consumption (MD = -27.85 µg, 95% CI: -44.91 to -10.79, p = 0.001), and (3) morphine consumption in the recovery room (MD = -1.57 mg, 95% CI: -3.0 to -0.14, p = 0.03) and 0-24 h postoperatively. Fewer patients required analgesics in the recovery room when receiving TAP blocks (risk ratio, RR = 0.35, 95% CI: 0.20 to 0.62, p = 0.0003). TAP blocks also reduced postoperative nausea and vomiting (RR = 0.48, 95% CI: 0.28 to 0.81, p = 0.006). None of the studies reported symptoms of local anesthetic toxicity. CONCLUSIONS In this study, the ultrasound-guided TAP block was an effective strategy for analgesia in patients undergoing LC.
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Affiliation(s)
- Ke Peng
- *Ke Peng, Department of Anesthesiology, First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006 (China), E-Mail
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Guo Q, Li R, Wang L, Zhang D, Ma Y. Transversus abdominis plane block versus local anaesthetic wound infiltration for postoperative analgesia: A systematic review and meta-analysis. Int J Clin Exp Med 2015; 8:17343-17352. [PMID: 26770326 PMCID: PMC4694226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/13/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Transversus abdominis plane (TAP) block and local anaesthetic wound infiltration can provide effective pain relief at the wound site after surgery. However, the relative efficacy of two techniques for postoperative analgesia remains controversial. METHODS We searched PUBMED, EMBASE and CENTRAL databases for randomized controlled trials (RCTs) comparing TAP block with wound infiltration for pain relief after surgery. The primary outcomes were pain scores at rest and on movement at 1, 8 and 24 hours postoperatively and cumulative morphine consumption over 24 hours. The secondary outcomes were time to first rescue analgesic, number of rescue analgesic use and opioids-related side-effects. RESULTS Nine RCTs with a total of 500 participants were included. TAP block was associated with significant lower rest and dynamic pain scores at 8 hour [MD = -1.08, 95% CI (-1.89-0.26), P = 0.009] and 24 hour [MD = -0.83, 95% CI (-1.60, -0.06), P = 0.03] postoperatively than wound infiltration, but no significant difference was found at 1 hour [MD = -0.94, 95% CI (-1.97, 0.09), P = 0.08] postoperatively. In adults, TAP block significantly reduced 24-hour overall morphine consumption by 3.85 mg [MD = -3.85, 95% CI (-7.47, -0.22), P = 0.04] compared with wound infiltration. Subgroup analysis showed that adults received TAP block appeared to have lower rest pain scores at 24 hour than children (P = 0.008). CONCLUSION TAP block provides superior analgesia compared with wound infiltration in the setting of a multimodal analgesic regimen. Subgroup analysis indicated that adults may have benefits additional to the analgesic effect than children.
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Affiliation(s)
- Qingduo Guo
- Department Anesthesiology, Cangzhou City Central Hospital No. 16, Xinhua West Road, Canal Zone, Cangzhou 061001, Hebei Province, China
| | - Rui Li
- Department Anesthesiology, Cangzhou City Central Hospital No. 16, Xinhua West Road, Canal Zone, Cangzhou 061001, Hebei Province, China
| | - Lixian Wang
- Department Anesthesiology, Cangzhou City Central Hospital No. 16, Xinhua West Road, Canal Zone, Cangzhou 061001, Hebei Province, China
| | - Dong Zhang
- Department Anesthesiology, Cangzhou City Central Hospital No. 16, Xinhua West Road, Canal Zone, Cangzhou 061001, Hebei Province, China
| | - Yali Ma
- Department Anesthesiology, Cangzhou City Central Hospital No. 16, Xinhua West Road, Canal Zone, Cangzhou 061001, Hebei Province, China
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Ripollés J, Marmaña Mezquita S, Abad A, Calvo J. Eficácia analgésica do bloqueio ecoguiado do plano transverso do abdome – revisão sistemática. Braz J Anesthesiol 2015; 65:255-80. [DOI: 10.1016/j.bjan.2013.10.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/31/2013] [Indexed: 11/17/2022] Open
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Ripollés J, Mezquita SM, Abad A, Calvo J. Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane – a systematic review. Braz J Anesthesiol 2015; 65:255-80. [DOI: 10.1016/j.bjane.2013.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/19/2013] [Accepted: 10/31/2013] [Indexed: 12/11/2022] Open
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Mrunalini P, Raju NVR, Nath VN, Saheb SM. Efficacy of transversus abdominis plane block in patients undergoing emergency laparotomies. Anesth Essays Res 2015; 8:377-82. [PMID: 25886339 PMCID: PMC4258987 DOI: 10.4103/0259-1162.143153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Pain experienced following laparotomy is largely due to abdominal wall incision. Effective mitigation of this pain is vital to improve patient satisfaction and for early ambulation. We evaluated the efficacy of transversus abdominis plane (TAP) block for postoperative analgesia, as a component of multimodal analgesia. Materials and Methods: Sixty adult ASA physical status I to III patients undergoing emergency laparotomy under general anesthesia were recruited for this double-blind, randomized, controlled trial. The TAP block was performed before skin incision, using the double pop technique in the midaxillary line, at the level of the umbilicus with a 22 gauge blunt needle. The patients were randomly assigned to receive either 25 ml of 0.25% bupivacaine or normal saline (NS), bilaterally. Tramadol was used for postoperative analgesia via a patient-controlled analgesia pump (PCA) along with an intramuscular (IM) injection of diclofenac sodium, 12-hourly. Each patient was assessed in the Post Anesthesia Care Unit (PACU) immediately after shifting and every two hours thereafter, for 24 hours, for pain, nausea, sedation scores, and pruritus. The two-hourly and total tramadol consumption, over 24 hours, was assessed. Results: The mean total pain scores were significantly less in the TAP block group (48.07 ± 6.76) when compared to the control group (62.63 ± 6.66). The total tramadol consumption was decreased by 36% in the TAP block group (281.33 ± 69.66 mg) compared to the control group (439 ± 68.59 mg). Tramadol consumption measured every two hours was also less up to 18 hours postoperatively, after which, there was an increase in pain scores and tramadol consumption in the TAP block group. There was no statistically significant difference between the two groups in terms of nausea, vomiting, sedation or pruritis. Conclusion: TAP block is an effective component of the multimodal analgesia regimen for reducing postoperative pain and opioid requirement after emergency laparotomy.
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Affiliation(s)
- Parasa Mrunalini
- Department of Anesthesiology, NRI Medical College, Chinnakakani, Guntur, Andhra Pradesh, India
| | - N Vijaya Rama Raju
- Department of Anesthesiology, NRI Medical College, Chinnakakani, Guntur, Andhra Pradesh, India
| | - Vemuri Nagendra Nath
- Department of Anesthesiology, NRI Medical College, Chinnakakani, Guntur, Andhra Pradesh, India
| | - Shaik Mastan Saheb
- Department of Anesthesiology, NRI Medical College, Chinnakakani, Guntur, Andhra Pradesh, India
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Kawahara R, Tamai Y, Yamasaki K, Okuno S, Hanada R, Funato T. The analgesic efficacy of ultrasound-guided transversus abdominis plane block with mid-axillary approach after gynecologic laparoscopic surgery: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2015; 31:67-71. [PMID: 25788776 PMCID: PMC4353157 DOI: 10.4103/0970-9185.150547] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background and Aims: The transversus abdominis plane (TAP) block is widely used in clinical practice as a part of the multimodal analgesic regimen after abdominal surgery. The analgesic efficacy of ultrasound (US)-guided TAP block with the mid-axillary approach was investigated in patients undergoing laparoscopic gynecologic surgery in a randomized controlled clinical trial. Materials and Methods: Adult patients (n = 119) undergoing laparoscopic gynecologic surgery were randomized to undergo either TAP block with ropivacaine (Group A, n = 60) or that with saline (Group B, n = 59), in a blinded manner. Following general anesthesia, TAP block was performed bilaterally by infusion of either 20-mL 0.375% ropivacaine/one side in Group A or 20-mL saline/one side in Group B, under US guidance with a mid-axillary approach. Patient-controlled analgesia (PCA) was performed postoperatively with tramadol. The analgesic effect was postoperatively evaluated using a four-grade pain score and the prince Henry pain scale (PHS) at 0, 6, 12, and 24 h. Postoperative tramadol PCA consumption and vomiting/nausea were recorded. Statistical analyses were performed using the Mann-Whitney U-test or Fisher's exact probability test. A P < 0.05 was considered significant. Results: There was no statistically significant difference in background characteristics. The dose of remifentanil was significantly higher in Group B (P = 0.01). The pain score (P = 0.02) and PHS (P = 0.01) were significantly lower in Group A at 0 h. Tramadol PCA consumption in the period of 0-6 h (P = 0.01) and postoperative nausea (P = 0.04) were significantly less in Group A. Conclusion: Postoperative pain/nausea and PCA consumption were significantly lower in patients with TAP block in the early postoperative stage. TAP block with a mid-axillary approach holds considerable promise as a part of a balanced postoperative analgesic regimen following laparoscopic gynecologic surgery.
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Affiliation(s)
- Ryoko Kawahara
- Department of Anesthesiology and Palliative Care, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan
| | - Yutaka Tamai
- Department of Anesthesiology and Palliative Care, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan
| | - Kyoko Yamasaki
- Department of Anesthesiology and Palliative Care, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan
| | - Satoko Okuno
- Department of Anesthesiology and Palliative Care, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan
| | - Rumi Hanada
- Department of Anesthesiology and Palliative Care, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan
| | - Takao Funato
- Department of Obstetrics and Gynecology, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan
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Kim MG, Kim SI, Ok SY, Kim SH, Lee SJ, Park SY, Yoo JH, Cho A, Hur KY, Kim MJ. Is transverse abdominis plane block effective following local anesthetic infiltration in laparoscopic totally extraperitoneal hernia repair? Korean J Anesthesiol 2014; 67:398-403. [PMID: 25558340 PMCID: PMC4280477 DOI: 10.4097/kjae.2014.67.6.398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/18/2014] [Accepted: 07/30/2014] [Indexed: 12/02/2022] Open
Abstract
Background Transverse abdominis plane (TAP) block can be recommended as a multimodal method to reduce postoperative pain in laparoscopic abdominal surgery. However, it is unclear whether TAP block following local anesthetic infiltration is effective. We planned this study to evaluate the effectiveness of the latter technique in laparoscopic totally extraperitoneal hernia repair (TEP). Methods We randomly divided patients into two groups: the control group (n = 37) and TAP group (n = 37). Following the induction of general anesthesia, as a preemptive method, all of the patients were subjected to local anesthetic infiltration at the trocar sites, and the TAP group was subjected to ultrasound-guided bilateral TAP block with 30 ml of 0.375% ropivacaine in addition before TEP. Pain was assessed in the recovery room and post-surgery at 4, 8, and 24 h. Additionally, during the postoperative 24 h, the total injected dose of analgesics and incidence of nausea were recorded. Results: On arrival in the recovery room, the pain score of the TAP group (4.33 ± 1.83) was found to be significantly lower than that of the control group (5.73 ± 2.04). However, the pain score was not significantly different between the TAP group and control group at 4, 8, and 24 h post-surgery. The total amounts of analgesics used in the TAP group were significantly less than in the control group. No significant difference was found in the incidence of nausea between the two groups. Conclusions TAP block following local infiltration had a clinical advantage only in the recovery room.
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Affiliation(s)
- Mun Gyu Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Soon Im Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Si Young Ok
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sang Ho Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Se-Jin Lee
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sun Young Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jae-Hwa Yoo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ana Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Kyung Yul Hur
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Myung Jin Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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