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Bourgeois C, Oyaert L, Van de Velde M, Pogatzki-Zahn E, Freys SM, Sauter AR, Joshi GP, Dewinter G. Pain management after laparoscopic cholecystectomy: A systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations. Eur J Anaesthesiol 2024:00003643-990000000-00210. [PMID: 39129451 DOI: 10.1097/eja.0000000000002047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Laparoscopic cholecystectomy can be associated with significant postoperative pain that is difficult to treat. We aimed to evaluate the available literature and develop updated recommendations for optimal pain management after laparoscopic cholecystectomy. A systematic review was performed using the procedure-specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials and systematic reviews published in the English language from August 2017 to December 2022 assessing postoperative pain after laparoscopic cholecystectomy using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. From 589 full text articles, 157 randomised controlled trials and 31 systematic reviews met the inclusion criteria. Paracetamol combined with NSAIDs or cyclo-oxygenase-2 inhibitors should be given either pre-operatively or intra-operatively, unless contraindicated. In addition, intra-operative intravenous (i.v.) dexamethasone, port-site wound infiltration or intraperitoneal local anaesthetic instillation are recommended, with opioids used for rescue analgesia. As a second-line regional technique, the erector spinae plane block or transversus abdominis plane block may be reserved for patients with a heightened risk of postoperative pain. Three-port laparoscopy, a low-pressure pneumoperitoneum, umbilical port extraction, active aspiration of the pneumoperitoneum and saline irrigation are recommended technical aspects of the operative procedure. The following interventions are not recommended due to limited or no evidence on improved pain scores: single port or mini-port techniques, routine drainage, low flow insufflation, natural orifice transluminal endoscopic surgery (NOTES), infra-umbilical incision, i.v. clonidine, nefopam and regional techniques such as quadratus lumborum block or rectus sheath block. Several interventions provided better pain scores but are not recommended due to risk of side effects: spinal or epidural anaesthesia, gabapentinoids, i.v. lidocaine, i.v. ketamine and i.v. dexmedetomidine.
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Affiliation(s)
- Camille Bourgeois
- From the Department of Cardiovascular Sciences, Section Anaesthesiology, KU Leuven and University Hospital Leuven, Belgium (CB, LO, MvdV, GD), Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Hospital Münster, Münster (EP-Z), Department of Surgery, DIAKO Ev. Diakonie-Krankenhaus, Bremen, Germany (SMF), Division of Emergencies and Critical Care, Department of Anaesthesiology and Department of Research and Development, Oslo University Hospital, Oslo, Norway (ARS), Department of Anaesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA (GPJ)
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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; 31:381-388. [PMID: 38780355 PMCID: PMC11264529 DOI: 10.1177/15533506241256529] [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] [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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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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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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Paneque T, Richey J, Abdelrazek A, Morgan K, Fitz-Gerald J, Swinney S, Connelly ZM, Khater N. Current advances in pain regimens for percutaneous nephrolithotomy A comprehensive review. Can Urol Assoc J 2023; 17:E388-E394. [PMID: 37549344 PMCID: PMC10657229 DOI: 10.5489/cuaj.8333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) causes pain and discomfort after surgery. The primary causes of immediate postoperative pain after PCNL are visceral pain from the ureters and kidneys, and body surface discomfort from incisions. Acute, untreated pain has the potential to develop into chronic pain, which remains a considerable burden for the rehabilitation of patients. The goal of this review was to describe the current options for treating pain post-PCNL. METHODS We conducted a literature review of all published manuscripts on pain protocols for patients undergoing PCNL and related topics; 50 published manuscripts were identified and reviewed. RESULTS PCNL morbidity must be reduced by an appropriate management of postoperative pain. Opioids, multimodal therapy, tubeless PCNL, reduced size of nephrostomy tube, and regional anesthesia are currently available for reducing postoperative pain. CONCLUSIONS Implementing successful treatment strategies for postoperative pain after PCNL is key in reducing the morbidity and mortality of PCNL.
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Affiliation(s)
- Tomas Paneque
- Department of Urology, LSU Health Shreveport, Shreveport, LA, United States
| | - John Richey
- LSU Health Shreveport School of Medicine, Shreveport, LA, United States
| | | | - Kevin Morgan
- Department of Urology, LSU Health Shreveport, Shreveport, LA, United States
| | - Joseph Fitz-Gerald
- Department of Urology, LSU Health Shreveport, Shreveport, LA, United States
| | - Seth Swinney
- Department of Urology, LSU Health Shreveport, Shreveport, LA, United States
| | | | - Nazih Khater
- Department of Urology, LSU Health Shreveport, Shreveport, LA, United States
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Bilge A, Başaran B, Altıparmak B, Et T, Korkusuz M, Yarımoğlu R. Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomized, controlled trial. BMC Anesthesiol 2023; 23:139. [PMID: 37106319 PMCID: PMC10134575 DOI: 10.1186/s12871-023-02106-z] [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: 10/27/2022] [Accepted: 04/23/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy(LC) causes significant postoperative pain. Oblique subcostal transversus abdominis plane(OSTAP) block was described for postoperative analgesia, especially for upper abdominal surgeries. Modified thoracoabdominal nerves block through perichondrial approach(M-TAPA) block is a new technique defined by the modification of the thoracoabdominal nerves through perichondrial approach (TAPA) block, in which local anesthetics are delivered only to the underside of the perichondral surface. The primary aim of this study was to evaluate the effect of M-TAPA and OSTAP blocks as part of multimodal analgesia on postoperative opioid consumption in patients undergoing LC. METHOD The present study was designed as a randomized, controlled, prospective study. Seventy-six adult patients undergoing LC were randomly assigned to receive either bilaterally M-TAPA or OSTAP block after the induction of anesthesia and before surgery using bupivacaine 0.25%, 25 ml. The primary outcome was assessed as postoperative 24 h opioid consumption, between groups were compared. Secondary outcomes were Numerical Rational scale(NRS) scores, time to first opioid analgesia, patient recovery, using the Quality of Recovery-15 (QoR-15) scale, nausea and vomiting, sedation score, metoclopramide consumption, and evaluating the analgesic range of dermatome. RESULTS The mean tramadol consumption at the postoperative 24th hour was higher in the group OSTAP than in group M-TAPA (P = 0.047). NRS movement score at 12th hour was statistically significantly lower in group M-TAPA than in group OSTAP (P = 0.044). Dermatomes showed intense sensory analgesia between T7-11 in both groups, and it was determined that there was proportionally more involvement in the group M-TAPA. There were no differences between the groups in terms of other results. CONCLUSIONS After the LC surgery, ultrasound-guided M-TAPA block effectively reduced opioid consumption, postoperative pain, and QoR-15 scores similar to OSTAP block. CLINICAL TRIAL REGISTRATION The study was registered prospectively at clinicaltrials.gov (trial ID: NCT05108129 on 4/11/2021).
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Affiliation(s)
- Ayşegül Bilge
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey.
| | - Betül Başaran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey
| | - Başak Altıparmak
- Department of Anesthesiology and Reanimation, Muğla Sıtkı Koçman University, Menteşe Muğla, Turkey
| | - Tayfun Et
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey
| | - Muhammet Korkusuz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoğlu Mehmetbey University, Üniversite Mh. Şehit Ömer Halis Demir Caddesi Blok No:7, Karaman, Turkey
| | - Rafet Yarımoğlu
- Department of Anesthesiology and Reanimation, Karaman Training and Research Hospital, Karaman, Turkey
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De Cassai A, Sella N, Geraldini F, Tulgar S, Ahiskalioglu A, Dost B, Manfrin S, Karapinar YE, Paganini G, Beldagli M, Luoni V, Ordulu BBK, Boscolo A, Navalesi P. Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis. Korean J Anesthesiol 2023; 76:34-46. [PMID: 36345156 PMCID: PMC9902189 DOI: 10.4097/kja.22366] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/05/2022] [Accepted: 11/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Different regional anesthesia (RA) techniques have been used for laparoscopic cholecystectomy (LC), but there is no consensus on their comparative effectiveness. Our objective was to evaluate the effect of RA techniques on patients undergoing LC using a network meta-analysis approach. METHODS We conducted a systematic review and network meta-analysis. We searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (Science and Social Science Citation Index) using the following PICOS criteria: (P) adult patients undergoing LC; (I) any RA single-shot technique with injection of local anesthetics; (C) placebo or no intervention; (O) postoperative opioid consumption expressed as morphine milligram equivalents (MME), rest pain at 12 h and 24 h post-operation, postoperative nausea and vomiting (PONV), length of stay; and (S) randomized controlled trials. RESULTS A total of 84 studies were included. With the exception of the rectus sheath block (P = 0.301), the RA techniques were superior to placebo at reducing opioid consumption. Regarding postoperative pain, the transversus abdominis plane (TAP) block (-1.80 on an 11-point pain scale) and erector spinae plane (ESP) block (-1.33 on an 11-point pain scale) were the most effective at 12 and 24 h. The TAP block was also associated with the greatest reduction in PONV. CONCLUSIONS RA techniques are effective at reducing intraoperative opioid use, postoperative pain, and PONV in patients undergoing LC. Patients benefit the most from the bilateral paravertebral, ESP, quadratus lumborum, and TAP blocks.
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Affiliation(s)
- Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Nicolò Sella
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Federico Geraldini
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - 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
| | - Burhan Dost
- Department of Anesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Silvia Manfrin
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Yunus Emre Karapinar
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Greta Paganini
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Muzeyyen Beldagli
- Department of Anesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Vittoria Luoni
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Busra Burcu Kucuk Ordulu
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun, Turkey
| | - Annalisa Boscolo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
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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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Bilge A, Başaran B, Et T, Korkusuz M, Yarımoğlu R, Toprak H, Kumru N. Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: a randomized double-blind controlled trial. BMC Anesthesiol 2022; 22:329. [PMID: 36307755 PMCID: PMC9615166 DOI: 10.1186/s12871-022-01866-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) is a new technique that provides effective analgesia of the anterior and lateral thoracoabdominal walls by administering local anesthesia only to the underside of the perichondral surface. The primary purpose of the present study was to investigate the postoperative analgesic efficacy of M-TAPA block performed before surgery in patients undergoing laparoscopic cholecystectomy (LC). Method The present study was designed as a double-blind, randomized, controlled, prospective study. A total of 68 patients were included in the study. In group M-TAPA, M-TAPA block was performed bilaterally after the induction of general anesthesia. No block was performed on the group control. The postoperative pain scores, analgesic use in the first 24 h, antiemetic consumption, sedation, postoperative nausea and vomiting (PONV), and Quality of Recovery-40 (QoR-40) scores were recorded. Results Pain scores were significantly lower in group M-TAPA than in the group control, both during resting and motion at all times (p < 0.001 at each time point). The total amount of tramadol consumed in the first 24 h was lower in group M-TAPA [median 100 mg, min-max (0-200)] than in the group control (P < 0.001). Postoperative median QoR-40 scores were higher in group M-TAPA compared with the group control (P < 0.001). There were no differences between the groups in terms of other results. Conclusion After the LC surgery, ultrasound-guided M-TAPA block reduced postoperative pain scores and tramadol consumption effectively. It was observed that the quality of recovery was also higher because QoR-40 scores were higher.
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Rahimzadeh P, Faiz SHR, Latifi-Naibin K, Alimian M. A Comparison of effect of preemptive versus postoperative use of ultrasound-guided bilateral transversus abdominis plane (TAP) block on pain relief after laparoscopic cholecystectomy. Sci Rep 2022; 12:623. [PMID: 35022459 PMCID: PMC8755749 DOI: 10.1038/s41598-021-04552-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022] Open
Abstract
Nowadays, there are various methods to manage pain after laparoscopic cholecystectomy. The aim of this study was to compare the effectof preemptive versus postoperative use of ultrasound-guided transversus abdominis plane (USG-TAP) block on pain relief after laparoscopic cholecystectomy. In this single-blinded randomized clinical trial, the patients who were candidates for laparoscopic cholecystectomy were randomly divided into the two groups (n = 38 per group). In the preemptive group (PG) after the induction of anesthesia and in the postoperative group (POG) after the end of surgery and before the extubation, bilateral ultrasound-guided transversus abdominis plane (TAP) block was performed on patients using 20 cc of ropivacaine 0.25%. Both groups received patient controlled IV analgesia (PCIA) containing Acetaminophen (20 mg/ml) plus ketorolac (0.6 mg/ml) as a standard postoperative analgesia and meperidine 20 mg q 4 h PRN for rescue analgesia. Using the numerical rating scales (NSR), the patients' pain intensity was assessed at time of arrival to the PACU and in 2th, 4th, 8th, 12th, 24th h. Primary outcome of interest is NSR at rest and coughing in the PACU and in 2th, 4th, 8th, 12th, 24th h. Secondary outcomes of interests were the time to first post-surgical rescue analgesic and level of patients' pain control satisfaction in the first 24 h. The USG-TAP block significantly decreased pain score in the POG compared to the PG, and also the pain was relieved at rest especially in 8 and 12 h (p value ≤ 0.05) after the surgery. Pain score after coughing during recovery at 2, 8 and 12 h after the operation were significantly decreased. (p value ≤ 0.05) The patient satisfaction scores in the POG were significantly higher in all times. There was a statistically significant difference between the two groups in terms of rate of postoperative nausea and vomiting (PONV), indicating that patients in the POG had significantly lower incidences of the PONV compared tothe PG. The time to first analgesic request was significantly shorterin the POG, which was statistically significant (p value = 0.089). There was no statistically significant difference between the two groups in terms of consumption of analgesics. The postoperative TAP block could offer better postoperative analgesia than preepmtive TAP block.
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Affiliation(s)
- Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Reza Faiz
- Minimally Invasive Surgery Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Kaveh Latifi-Naibin
- Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahzad Alimian
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Mehdiratta L, Kumar N, Bajwa SJS. Advancing, strengthening and reshaping obstetric critical care with Point-of-Care Ultrasound (POCUS). Indian J Anaesth 2021; 65:711-715. [PMID: 34898697 PMCID: PMC8607862 DOI: 10.4103/ija.ija_924_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
- Lalit Mehdiratta
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Centre, Bhopal, Madhya Pradesh, India
| | - Nishant Kumar
- Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
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Bajwa SJS, Jain D, Anand S, Palta S. Neural blocks at the helm of a paradigm shift in enhanced recovery after surgery (ERAS). Indian J Anaesth 2021; 65:S99-S103. [PMID: 34703053 PMCID: PMC8500195 DOI: 10.4103/ija.ija_807_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
| | - Divya Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Smriti Anand
- Department of Anaesthesia, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India
| | - Sanjeev Palta
- Department of Anaesthesiology and Intensive Care, Govenment Medical College and Hospital, Chandigarh, India
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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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Afshan G, Khan RI, Ahmed A, Siddiqui AS, Rehman A, Raza SA, Kerai R, Mustafa K. Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review. BMC Anesthesiol 2021; 21:160. [PMID: 34034672 PMCID: PMC8152022 DOI: 10.1186/s12871-021-01375-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. METHODS A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. RESULTS Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. CONCLUSION We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review.
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Affiliation(s)
- Gauhar Afshan
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
| | - Robyna Irshad Khan
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
| | - Aliya Ahmed
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
| | - Ali Sarfraz Siddiqui
- Faculty of Health Sciences, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| | - Azhar Rehman
- Faculty of Health Sciences, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| | - Syed Amir Raza
- Faculty of Health Sciences, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| | - Rozina Kerai
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
| | - Khawaja Mustafa
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
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Swati S, Shagufta N, Erum O, Adil A, Urvashi Y. Ultrasound-Guided Intercostal Nerve Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Posted for Open Cholecystectomy: A Randomized Controlled Trial. Anesth Essays Res 2021; 14:376-383. [PMID: 34092845 PMCID: PMC8159063 DOI: 10.4103/aer.aer_100_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/30/2020] [Accepted: 12/22/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Effective postoperative analgesia leads to early mobilization, fewer pulmonary complications, and shorter hospital stay. Aims: We compared the analgesic effects of ultrasound-guided intercostal nerve (ICN) blocks, subcostal transversus abdominis plane (SCTAP) block, and a control group in open cholecystectomy. Settings and Design: This was a prospective, randomized controlled, double-blind, multi-arm and parallel study. Materials and Methods: The study was conducted on patients of American Society of Anaesthesiology Physical Status Classes I and II, either sex, 18–60 years of age, and body mass index 18–30 kg.m−2. Exclusion criteria were infection at the injection site, coagulopathy, thrombocytopenia, and allergy to the drugs used. Group I (n = 41) received ICN blocks, Group T (n = 41) SCTAP block, and Group C (n = 41) no postoperative block. The duration of analgesia was the primary outcome, and the analgesic consumption, the pain intensity, adverse events, and patient satisfaction were the secondary outcomes. Statistical Analysis: For the continuous data, analysis of variance was used for multiple group comparison and intergroup data were analyzed by Student's t-test. Kruskal-Wallis and Mann-Whitney U tests were applied for ordinal data. P = 0.05 or less was considered statistically significant. Results: The duration of postoperative analgesia was significantly longer in the ICN (mean = 441.6 min; 95% confidence interval [CI], 407.71, 475.49) and SCTAP block (mean = 417.6 min; 95% CI, 390.94, 444.26) as compared to control (mean = 33.98 min; 95% CI, 26.64, 41.32) (P = 0.00) with no significant intergroup difference between the two intervention groups (P = 0.278). The cumulative analgesic consumption was not significantly different between the intervention groups but was significantly reduced in the study groups when compared with the control group (P < 0.001). No notable adverse events were observed. Patients with both the techniques were very satisfied in comparison with the control group (P = 0.00). Conclusion: Both the ICN and SCTAP blocks have similar results in terms of analgesia and patient satisfaction for cholecystectomy.
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Affiliation(s)
- Srivastava Swati
- Department of Cardiac Anaesthesia, LPS Institute of Cardiology, GSVM Medical College, Kanpur, Uttar Pradesh, India
| | - Naaz Shagufta
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
| | - Ozair Erum
- Department of Anaesthesiology, SKMCH, Muzaffarpur, Bihar, India
| | - Asghar Adil
- Department of Anatomy, AIIMS, Patna, Bihar, India
| | - Yadav Urvashi
- Department of Anesthesiology, UPUMS Saifai, Etawah, Uttar Pradesh, India
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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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Comparison of ultrasound guided Erector Spinae Plane Block and quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy patients; a prospective randomized study. J Clin Anesth 2020; 62:109696. [DOI: 10.1016/j.jclinane.2019.109696] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/07/2019] [Accepted: 12/14/2019] [Indexed: 11/22/2022]
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Özdilek A, Beyoğlu ÇA, Demirdağ Ç, Şen Ö, Erbabacan ŞE, Ekici B, Altindaş F, Köksal GM. Perioperative Analgesic Effects of Preemptive Ultrasound-Guided Subcostal Transversus Abdominis Plane Block for Percutaneous Nephrolithotomy: A Prospective, Randomized Trial. J Endourol 2020; 34:434-440. [DOI: 10.1089/end.2019.0766] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Aylin Özdilek
- Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Çiğdem Akyol Beyoğlu
- Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Çetin Demirdağ
- Department of Urology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Öznur Şen
- Department of Anesthesiology and Reanimation, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Şafak Emre Erbabacan
- Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Birsel Ekici
- Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatiş Altindaş
- Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Güniz Meyanci Köksal
- Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Verma R, Srivastava D, Saxena R, Singh TK, Gupta D, Agarwal A, Mishra P. Ultrasound-guided Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Trial. Anesth Essays Res 2020; 14:226-232. [PMID: 33487820 PMCID: PMC7819425 DOI: 10.4103/aer.aer_41_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is associated with moderate-to-severe pain in immediate postoperative period. Some patients even suffer from prolonged pain long after surgery. AIMS The aim of present study is to determine the efficacy of ultrasound-guided bilateral erector spinae plane block (ESPB) in patients undergoing LC, time to ambulation after surgery, and incidence of prolonged pain up to 6 months later. SETTINGS AND DESIGN This was a double-blinded prospective randomized controlled trial. MATERIALS AND METHODS Eighty-five adults posted for elective LC were randomized to receive bilateral ESPB at T7 level with either 20 mL of 0.375% ropivacaine or 20 mL normal saline. Postoperative static and dynamic pain score as per the visual analog scale (VAS), intraoperative requirement of fentanyl, postoperative use of diclofenac, time to ambulation after surgery, and presence of any pain after surgery were noted. STATISTICAL ANALYSIS Independent t-test and Mann-Whitney U-test were used for quantitative data, while Chi-square test was used for comparing qualitative data. RESULTS Static and dynamic VAS scores were significantly lower in ESPB group (P < 0.05). Intraoperative fentanyl requirement (165 ± 30.72 - ESPB, 180.95 ± 29.12 - controls, P = 0.020) and number of patients requiring diclofenac (28/42 - ESPB, 37/42 - controls, P = 0.019) were lower, while number of patients ambulating by 4 hours (20/42 - ESPB, 9/42 - control, P = 0.012) were higher in ESPB group. Patients suffering from pain at 1 week (22/42 - ESPB and 34/42 - control, P = 0.005) and 1 month (9/42 - ESPB and 13/42 - control, P = 0.207) were lower in ESPB group. CONCLUSION ESPB provides effective analgesia and early ambulation after LC. The benefit extends to 1 week thereafter.
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Affiliation(s)
- Ruchi Verma
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Divya Srivastava
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Ruchi Saxena
- Department of Anaesthesiology, Super Speciality Cancer Institute and Hospital, Lucknow, Uttar Pradesh, India
| | - Tapas K. Singh
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Devendra Gupta
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Anil Agarwal
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, SGPGIMS, Lucknow, Uttar Pradesh, India
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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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Rajanbabu A, Puthenveettil N, Appukuttan A, Asok A. Efficacy of laparoscopic-guided transversus abdominis plane block for patients undergoing robotic-assisted gynaecologic surgery: A randomised control trial. Indian J Anaesth 2019; 63:841-846. [PMID: 31649397 PMCID: PMC6798625 DOI: 10.4103/ija.ija_471_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 01/17/2023] Open
Abstract
Background and Aims: Transverse abdominis plane (TAP) block has been used regularly as part of multimodal analgesia for caesarean sections and other lower abdominal surgeries. Adequate postoperative analgesia provided with regional blocks allows faster postoperative recovery and better patient satisfaction. In our study, we are comparing the analgesic efficacy of laparoscopic-guided TAP block with port infiltration using a local anaesthetic in patients undergoing gynaecologic robotic surgeries. Methods: After obtaining approval from the hospital ethics committee, Central Trial Registry of India (CTRI) clearance and written informed consent from patients, this prospective double-blinded randomised control trial was conducted on patients undergoing robotic-assisted gynaecologic surgery under general anaesthesia. Group B patients received bilateral TAP block under direct laparoscopic vision with 15 ml of 0.1% ropivacaine on each side and Group C patients received routine port site infiltration with 30 ml of 0.1% ropivacaine. Postoperative pain score was measured till 24 hours, need for rescue analgesics, complications associated were noted. Independent two sample 't' test, Mann Whitney u test, Chi-square and Fisher's exact test were used for statistical analysis. Results: Pain score was significantly lower in Group B patients up to 24h (P < 0.001). The use of rescue analgesic was also significantly less in group B compared to Group C (P < 0.001). No adverse events were noted in both groups. Conclusion: Laparoscopic-guided TAP block is effective and superior to port site infiltration in providing postoperative analgesia in patients undergoing robotic-assisted gynaecologic surgery.
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Affiliation(s)
- Anupama Rajanbabu
- Departments of Gynaecological Oncology, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Nitu Puthenveettil
- Departments of Anaesthesia and Critical Care, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Akhila Appukuttan
- Departments of Gynaecological Oncology, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Anjitha Asok
- Departments of Gynaecological Oncology, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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The Impact of Parecoxib on Pain Management for Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Trials. Surg Laparosc Endosc Percutan Tech 2019; 29:69-74. [DOI: 10.1097/sle.0000000000000626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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