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Yu S, Wen Y, Lin J, Yang J, He Y, Zuo Y. Combined rectus sheath block with transverse abdominis plane block by one puncture for analgesia after laparoscopic upper abdominal surgery: a randomized controlled prospective study. BMC Anesthesiol 2024; 24:58. [PMID: 38336613 PMCID: PMC10854179 DOI: 10.1186/s12871-024-02444-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Rectus sheath block (RSB) and transversus abdominis plane block (TAPB) have been shown to reduce opioid consumption and decrease postoperative pain scores in abdominal surgeries. However, there are no reports about the one-puncture technique of RSB combined with TAPB for perioperative pain management during laparoscopic upper abdominal surgery. METHODS A total of 58 patients were randomly assigned to the control group (C), the TAP group (T), and the one-puncture technique of RSB combined with TAPB group (RT). The patients in group C did not receive any regional block. The patients in group T received ultrasound-guided subcostal TAPB with 30 mL of 0.33% ropivacaine on each side. The patients in the RT group received a combination of RSB and TAPB with 15 mL of 0.33% ropivacaine in each plane by one puncture technique. All patients received postoperative patient-controlled intravenous analgesia (PCIA) after surgeries. The range of blocks was recorded 20 min after the completion of the regional block. The postoperative opioid consumption, pain scores, and recovery data were recorded, including the incidence of emergence agitation (EA), the times of first exhaust and off-bed activity, the incidence of postoperative nausea and vomiting, dizziness. RESULTS The range of the one-puncture technique in group RT covered all areas of surgical incisions. The visual analogue scale (VAS) score of the RT group is significantly lower at rest and during coughing compared to groups T and C at 4, 8, 12, and 24 h after surgery, respectively (P < 0.05). The consumption of sufentanil and the number of postoperative compressions of the analgesic pumps at 24 and 48 h in the RT group are significantly lower than those in groups T and C (P < 0.05). The incidence of EA in the RT group is significantly lower than that in groups T and C (P < 0.05). CONCLUSION The one-puncture technique of RSB combined with TAPB provides effective postoperative analgesia for laparoscopic upper abdominal surgery, reduces the incidence of EA during PACU, and promotes early recovery. TRIAL REGISTRATION ChiCTR, ChiCTR2300067271. Registered 3 Jan 2023, http://www.chictr.org.cn .
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Affiliation(s)
- Shan Yu
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
- Department of Anesthesiology, Armed Police Forces Hospital of Sichuan, Leshan, 614000, China
| | - Yaling Wen
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Jing Lin
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Jinghao Yang
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Yihang He
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Youbo Zuo
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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Alterisio MC, Micieli F, Valle GD, Chiavaccini L, Vesce G, Ciaramella P, Guccione J. Cardiovascular changes, laboratory findings and pain scores in calves undergoing ultrasonography-guided bilateral rectus sheath block before herniorrhaphy: a prospective randomized clinical trial. BMC Vet Res 2023; 19:191. [PMID: 37798785 PMCID: PMC10552199 DOI: 10.1186/s12917-023-03754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The study aimed to assess the clinical utility of a multiparametric approach to measure the impact of bilateral ultrasound-guided rectus sheath blocks (RSB) on heart rate, serum cortisol concentrations, and pain in calves undergoing herniorraphy. Fourteen calves were randomly assigned to receive either the RSB (RSB group, n = 7, injected with 0.3 mL/kg of bupivacaine 0.25% and 0.15 µg/kg of dexmedetomidine per side) or a sham injection (CG group, n = 7, injected with an equivalent volume of sterile saline solution). Monitoring included (i) continuous Holter recording from 120 min pre-surgery to 120 min post-surgery; (ii) serum cortisol concentration (SC) at -150 min pre-surgery (baseline), induction time, skin incision, end of surgical procedure (EP-t), and then 30 min, 45 min, 60 min, 120 min, 360 min after recovery; (iii) UNESP-Botucatu pain evaluation at -150 min pre-surgery and 30 min, 45 min, 60 min, 120 min, 240 min, 360 min after recovery. RESULTS A significant difference in the heart rate was observed within the RSB group, in the time frame between 120 min to induction compared to the time frame between induction to EP-t period. The SC concentration was significantly higher in the CG at the skin incision. Calves in the RSB group recorded significantly lower pain scores at 45 min, 60 min, 120 and 240 min after recovery. CONCLUSIONS The study demonstrated that monitoring heart rate and serum cortisol concentrations effectively quantified the effects of RSB during surgery. At the same time, the UNESP-Botucatu pain scale identified effects post-surgery when the calves regained consciousness. Overall, ultrasound-guided RSB appeared to enhance the well-being of calves undergoing herniorrhaphy.
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Affiliation(s)
- Maria Chiara Alterisio
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Via Delpino 1, Napoli, 80137, Italy
| | - Fabiana Micieli
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Via Delpino 1, Napoli, 80137, Italy
| | - Giovanni Della Valle
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Via Delpino 1, Napoli, 80137, Italy
| | - Ludovica Chiavaccini
- Department of Comparative, Anesthesiology and Pain Management, Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, Gainesville, 32608, FL, USA
| | - Giancarlo Vesce
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Via Delpino 1, Napoli, 80137, Italy
| | - Paolo Ciaramella
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Via Delpino 1, Napoli, 80137, Italy.
| | - Jacopo Guccione
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Via Delpino 1, Napoli, 80137, Italy
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Morrell DJ, Chau MH, Winder JS, Stredny ES, Alli VV, Sinz EH, Hazard SW, Simmons Z, Pauli EM. Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: outcomes of a dedicated anesthesia and surgery protocol. Surg Endosc 2023. [PMID: 36735049 DOI: 10.1007/s00464-023-09896-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients requiring percutaneous endoscopic gastrostomy (PEG) for amyotrophic lateral sclerosis (ALS) related dysphagia represent a clinical challenge. Diminished pulmonary function and aspiration risks can lead to anesthesia-related complications, and gastric displacement from hemidiaphragm elevation may preclude safe gastric access. This study reports the efficacy and outcomes of a dedicated anesthesia/surgery management protocol for ALS patients undergoing PEG. METHODS In 2013, a PEG placement protocol for ALS patients was developed emphasizing efficient pre-operative evaluation, rapidly metabolized anesthetic agents, and minimization of opioid use. Outcomes were analyzed retrospectively. Preoperative weight loss, pulmonary function tests, total analgesia, procedural time, and 90-day morbidity and mortality were recorded. RESULTS From 2013-2019, 67 ALS patients (mean age 65.3 years, 52.2% female) received a PEG under the protocol. Mean percentage weight loss 6 months before PEG was 9.3 ± 5.1% with 38.8% of patients meeting criteria for severe malnutrition. Mean anesthesia time (propofol induction to anesthesia emergence) was 34.5 ± 10.8 min and mean operative time (endoscope insertion to dressing placement) was 16.4 ± 8.2 min. Regional anesthesia with liposomal bupivacaine was performed in 76.1%. All attempts at PEG placement were successful. With a mean follow-up of 6.1 ± 6.8 months, all PEGs were functional and there were no surgical site complications. Thirty-day readmission rate was 7.0% and 90-day mortality was 22.4% (46.7% occurring within 30 days). Mean time from surgery to death was 8.8 ± 7.8 months. CONCLUSIONS Protocols for optimizing PEG may help overcome challenges present in the ALS patient population. Despite patient comorbidities, protocol implementation and dedicated team members resulted in a high procedural success rate and low complication rate. Further study is warranted to optimize the timing of PEG placement in relation to ALS disease progression and determine the utility of regional anesthesia during PEG placement.
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Sawada R, Watanabe K, Tokumine J, Lefor AK, Ando T, Yorozu T. Ultrasound-guided rectus sheath block for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery: A case report. World J Clin Cases 2022; 10:2357-2362. [PMID: 35321172 PMCID: PMC8895180 DOI: 10.12998/wjcc.v10.i7.2357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/18/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anterior cutaneous nerve entrapment syndrome is defined as abdominal pain due to entrapped intercostal nerves. This is the first report of a patient successfully treated for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery with an ultrasound-guided rectus sheath block. The rectus sheath block physically lysed adhesions and relieved pain from anterior cutaneous nerve entrapment syndrome.
CASE SUMMARY The patient is a 44-year-old man who presented with severe left upper abdominal pain at an operative scar one month after laparoscopic ulcer repair. Diagnosis and treatment were performed using an ultrasound-guided rectus sheath block with 0.1% lidocaine 20 mL. The pain was relieved after the block. The diagnosis was anterior cutaneous nerve entrapment syndrome. Rectus sheath block may be effective for patients with anterior cutaneous nerve entrapment syndrome.
CONCLUSION Ultrasound-guided rectus sheath block is a promising treatment modality for patients with postoperative anterior cutaneous nerve entrapment syndrome due to adhesions.
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Affiliation(s)
- Ryuji Sawada
- Department of Pain Clinic, NTT Medical Center Tokyo, Higashigotanda 141-8625, Tokyo, Japan
| | - Kunitaro Watanabe
- Department of Anesthesiology, Hino Municipal Hospital, Tamadaira 191-0062, Tokyo, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka 181-8611, Tokyo, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke 329-0498, Tochigi, Japan
| | - Tadao Ando
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka 181-8611, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka 181-8611, Tokyo, Japan
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Kase Y, Kuniyoshi H, Terui T. Reply to the letter titled "Difficulty in evaluating the effect of CEA or CRSB". J Anesth 2021; 36:164-165. [PMID: 34811593 DOI: 10.1007/s00540-021-03022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Yoichi Kase
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan.
- Department of Anesthesiology, Jikei Kashiwa Hospital, 163-1, Kashiwashita, Kashiwa, Chiba, Japan.
| | - Hideki Kuniyoshi
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Anesthesiology, Jikei Kashiwa Hospital, 163-1, Kashiwashita, Kashiwa, Chiba, Japan
| | - Takako Terui
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
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Shim JW, Jung S, Moon HW, Lee JY, Park J, Lee HM, Kim YS, Hong SH, Chae MS. Rectus sheath block for acute pain management after robot-assisted laparoscopic prostatectomy. Asian J Surg 2021; 45:1843-1848. [PMID: 34801360 DOI: 10.1016/j.asjsur.2021.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Robot-assisted laparoscopic prostatectomy (RALP) is a favored surgical approach for treating prostate cancer. However, RALP does not decrease postoperative pain significantly despite its minimal invasiveness. The pain associated with robot-assisted surgery is most severe during the immediate postoperative period. We aimed to demonstrate that preoperative rectus sheath block (RSB) can reduce acute pain after RALP. METHODS A prospective non-randomized study with two parallel groups was performed from June 2020 to August 2020. A total of 100 patients undergoing RALP were divided into two groups: the RSB group (n = 50) and the non-RSB group (n = 50). Ultrasound-guided RSB was performed preoperatively only in the RSB group. The primary outcome of the study was the visual analog scale (VAS) pain score during coughing (VAS-C) 1 h after surgery. In addition, the VAS pain score at rest (VAS-R) and the VAS-C were assessed up to 24 h after surgery. The doses of postoperative opioids consumed were also recorded. RESULTS The RSB group had a significantly lower VAS-C 1 h after RALP (58 [47-73] vs. 74 [63-83] mm, p = 0.001). In addition, the RSB group had significantly lower VAS-R and VAS-C scores, and postoperative opioid requirement, up to 6 h after surgery compared to the non-RSB group. Moreover, the VAS-R was significantly lower in the RSB group than in the non-RSB group 24 h after surgery. CONCLUSION Preoperative RSB significantly improved analgesia during the early period after RALP. The long-term analgesic efficacy of RSB needs further study.
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Affiliation(s)
- Jung-Woo Shim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sangmin Jung
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyong Woo Moon
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaesik Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Mook Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Suk Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Yang H, Yang G, Zhang Y. Difficulty in evaluating the effect of CEA or CRSB. J Anesth 2021; 36:162-163. [PMID: 34727248 DOI: 10.1007/s00540-021-03018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Hao Yang
- Department of Imaging, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan, China
| | - GuangLi Yang
- Department of Medical Administration, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yixian Zhang
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, Sichuan, China.
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Teshome D, Hunie M, Essa K, Girma S, Fenta E. Rectus sheath block and emergency midline laparotomy at a hospital in Ethiopia: A prospective observational study. Ann Med Surg (Lond) 2021; 68:102572. [PMID: 34336198 PMCID: PMC8318980 DOI: 10.1016/j.amsu.2021.102572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Midline laparotomy is associated with severe postoperative pain. Literature showed controversial results regarding the efficacy of the rectus sheath block. METHODS This is a prospective cohort study that recruits 30 patients in the rectus sheath block (RSB) group and 30 patients in the multimodal analgesia (MMA) group who underwent emergency midline laparotomy. The RSB was performed by an experienced anesthetist using a land-mark technique. Independent t-test and Mann-Whitney-U test were used for numeric data while Chi-Square or Fisher exact test was used for categorical variables. P-values < 0.05 were considered as statistically significant. RESULTS The numeric rating scale score at the recovery was significantly reduced in an RSB group with a p-value of 0.039. Postoperative numeric rating scale scores at 3rd, 6th, 12th, and 24th hours were statistically significantly lower in the RSB group. Postoperative tramadol consumption in 24 h was significantly lower with a p-value of 0.0001 for the rectus sheath group. CONCLUSIONS For midline laparotomy, adding a bilateral rectus sheath block at the end of the operation might be an effective postoperative analgesia option.
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Affiliation(s)
- Diriba Teshome
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Metages Hunie
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Keder Essa
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sossina Girma
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Efrem Fenta
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Kuniyoshi H, Yamamoto Y, Kimura S, Hiroe T, Terui T, Kase Y. Comparison of the analgesic effects continuous epidural anesthesia and continuous rectus sheath block in patients undergoing gynecological cancer surgery: a non-inferiority randomized control trial. J Anesth 2021; 35:663-670. [PMID: 34268624 DOI: 10.1007/s00540-021-02973-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/09/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We investigated the non-inferiority of continuous rectus sheath block to continuous epidural anesthesia for postoperative analgesia of gynecological cancer patients. METHODS One hundred ASA-PS 1-2 patients via a median incision up to 5 cm above the navel were randomized into a continuous epidural anesthesia (CEA) group and a continuous rectus sheath block (CRSB) group. Following surgery, they have controlled with intravenous patient-controlled analgesia (IV-PCA) as basal postoperative analgesia. For patients in the CEA group were administered 0.25% levobupivacaine at 5 mg/h. Patients in the CRSB group, catheters were inserted on both sides of the posterior rectus sheath after surgery. They received 0.25% levobupivacaine on both sides at 7.5 mg/h. To determine whether CRSB is non-inferior to CEA in postoperative treatment, pain at rest and movement was assessed using the Numerical Rating Scale (NRS). The non-inferiority margin of NRS difference between CRSB and CEA was set at 1.3 difference in means. The primary outcome was non-inferiority comparisons of NRS at rest/at movement after surgery, while the secondary outcome included the frequency of requesting IV-PCA and rescue drugs. RESULTS NRS at rest in the CRSB group was not inferior to that in the CEA group. On the other hand, the NRS at movement at 4, 6, 8, 12 h following surgery in the CRSB group was inferior to CEA. There was no difference in the frequency of requesting IV-PCA and rescue drugs. CONCLUSIONS CRSB showed the non-inferiority to CEA for postoperative analgesia at rest, while CRSB was not non-inferior to CEA at movement in gynecological cancer patients. CRSB would be a substitute when CEA is contraindicated as a component of postoperative multimodal analgesia.
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Affiliation(s)
- Hideki Kuniyoshi
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yu Yamamoto
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shohei Kimura
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takanori Hiroe
- Department of Biostatistics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takako Terui
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoichi Kase
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan.
- Department of Anesthesiology, Jikei Kashiwa Hospital, 163-1, Kashiwashita, Kashiwa, Chiba, Japan.
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Hamid HKS, Ahmed AY, Alhamo MA, Davis GN. Efficacy and Safety Profile of Rectus Sheath Block in Adult Laparoscopic Surgery: A Meta-analysis. J Surg Res 2021; 261:10-17. [PMID: 33387729 DOI: 10.1016/j.jss.2020.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rectus sheath block (RSB) has been increasingly used for pain management after laparoscopic procedures but with a conflicting data on its analgesic efficacy. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of RSB in adults undergoing laparoscopic surgery. METHODS A systematic literature search of the PubMed, Embase, CINAHL, and Cochrane Library databases was conducted from inception through October 1, 2020, to identify trials comparing RSB with a control group in laparoscopic surgery. The primary outcome was rest pain scores at 0-2 h postoperatively. Secondary outcomes included pain scores at rest at 10-12 and 24 h postoperatively, pain scores on movement at 0-2, 10-12, and 24 h postoperatively, 24- and 48-h opioid consumption, opioid-related side effects, and RSB-associated adverse events. RESULTS Nine trials with 698 patients were included. RSB was associated with significantly lower rest pain scores at 0-2 h postoperatively (standardized mean difference -1.83, 95% confidence interval [-2.70, -0.96], P < 0.001, I2 = 95%) than control. Furthermore, RSB significantly reduced pain scores at rest at 10-12 h postoperatively and on movement at 0-2 h postoperatively, 24-h opioid consumption, and opioid-related side effects. Other secondary outcomes were similar between groups. Preoperative RSB provided better pain control compared with postoperative block administration. None of the studies reported local or systemic complications related to RSB. CONCLUSIONS In the setting of laparoscopic surgery, RSB improves pain control for up to 12 h postoperatively and reduces opioid consumption, without major reported adverse events.
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Affiliation(s)
- Hytham K S Hamid
- Department of Surgery, Soba University Hospital, Khartoum, Sudan.
| | - Amjed Y Ahmed
- Department of Surgery, Soba University Hospital, Khartoum, Sudan
| | - Manhl A Alhamo
- Department of Nursing, Alexandria University, Alexandria, Egypt
| | - George N Davis
- Department of Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
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Wang S, Liu P, Gao T, Guan L, Li T. The impact of ultrasound-guided bilateral rectus sheath block in patients undergoing cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy - a retrospective study. BMC Anesthesiol 2020; 20:197. [PMID: 32781985 PMCID: PMC7418388 DOI: 10.1186/s12871-020-01099-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Rectus sheath block (RSB) is known to attenuate postoperative pain and reduce perioperative opioid consumption. Thus, a retrospective study was performed to examine the effects of bilateral rectus sheath block (BRSB) in cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Methods A total of 178 patients undergoing CRS/HIPEC at our hospital were included. Patient information and anaesthesia-related indicators were collected from the electronic medical record (EMR) system. All subjects were divided into the following two groups: the G group (general anaesthesia) and the GR group (RSB combined with general anaesthesia). Patients in the GR group received 0.375% ropivacaine for BRSB before surgery. The primary outcomes included the total amount of remifentanil and rocuronium, the total consumption of dezocine after surgery, the visual analogue scale (VAS) score and the patient-controlled intravenous analgesia (PCIA) input dose at 1 h (T6), 6 h (T7), 12 h (T8), 24 h (T9) and 48 h (T10) after surgery. Other outcomes were also recorded, such as patient demographic data, the intraoperative heart rate (HR) and mean arterial pressure (MAP), and postoperative complications. Results Compared with the G group, the GR group showed a shorter time to tracheal extubation (P < 0.05), a decreased total amount of remifentanil and rocuronium (P < 0.05), and a reduced VAS score, PCIA input dose and number of PCIA boluses at 1 h, 6 h and 12 h after surgery (P < 0.05). However, at 24 h and 48 h after surgery, there were no differences in the VAS score of pain at rest or during motion between the two groups (P > 0.05). Moreover, the incidence of hypertension, emergence agitation, delayed recovery, hypercapnia, and nausea and vomiting was lower in the GR group than in the G group (P < 0.05). There were no differences in the changes in MAP and HR during the surgery between the two groups (P > 0.05). No complications associated with nerve block occurred. Conclusion BRSB could provide short-term postoperative analgesia, reduce perioperative opioid consumption and reduce the incidence of postoperative complications. It is an effective and safe procedure in CRS/HIPEC.
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Affiliation(s)
- Shaoheng Wang
- Department of Anesthesiology, Beijing Shijitan Hospital Capital Medical University, Beijing, 10038, China
| | - Pengfei Liu
- Department of Anesthesiology, Beijing Shijitan Hospital Capital Medical University, Beijing, 10038, China
| | - Teng Gao
- Department of Anesthesiology, Beijing Shijitan Hospital Capital Medical University, Beijing, 10038, China
| | - Lei Guan
- Department of Anesthesiology, Beijing Shijitan Hospital Capital Medical University, Beijing, 10038, China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital Capital Medical University, Beijing, 10038, China.
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Li Y, Jiang X, Wang J, Yang L, Chen W, Miao X, Yuan H. Intravenous Dexmedetomidine Combined with Ultrasound-Guided Rectus Sheath Block for Open Gastrectomy: a Prospective Randomized Trial. J Gastrointest Surg 2020; 24:1290-1297. [PMID: 31147972 DOI: 10.1007/s11605-019-04249-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 04/24/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE To compare the incidences of positive hemodynamic response (HR > 100 beats min-1 or SBP > 160 mmHg) during abdominal exploration and moderate pain after surgery, when using dexmedetomidine infusion and rectus sheath block. METHODS One hundred patients undergoing open gastrectomy were randomized to receive rectus sheath block with ropivacaine (Group B, n = 25), initial loading dose of 0.6 μg kg-1 dexmedetomidine, followed by a continuous infusion of 0.2 μg kg-1 h-1 throughout surgery (Group D, n = 25), both rectus sheath block and dexmedetomidine (Group BD, n = 25), or neither rectus sheath block nor dexmedetomidine (Group C, n = 25). General anesthesia techniques were standardized. HR, SBP, and positive hemodynamic response at peritoneum incision (TPI), 5 min (TAE-5), 10 min (TAE-10), and 15 min (TAE-15) after the start of abdominal exploration, and incidences of moderate postoperative pain were recorded. RESULTS Positive hemodynamic responses during abdominal exploration were more common in Groups B (82%) and C (74%) than in Groups D (14%) and BD (9%) (all P = 0.000). HR and SBP were lower in Groups D and BD, compared with those in Groups C and B (all P < 0.05). Compared with TPI, HR and SBP increased significantly in Groups B and C during abdominal exploration (all P < 0.05), but not in Group BD (except HR at TAE-15). The incidences of moderate pain in Groups B and BD were noticeably lower than in Groups C and D at 1 h, 2 h, and 6 h after surgery (all P < 0.0083). CONCLUSION Dexmedetomidine infusion combined with rectus sheath block provided more hemodynamic stability during abdominal exploration and better analgesia after surgery.
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Affiliation(s)
- Yonghua Li
- Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Xin Jiang
- Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Jiafeng Wang
- Department of Anesthesiology, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Liye Yang
- Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Wei Chen
- Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Xuerong Miao
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No.225 Changhai Road, Shanghai, 200433, China.
| | - Hongbin Yuan
- Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China.
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Zhu JL, Wang XT, Gong J, Sun HB, Zhao XQ, Gao W. The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy: a randomized trial. BMC Anesthesiol 2020; 20:22. [PMID: 31973700 PMCID: PMC6979058 DOI: 10.1186/s12871-020-0941-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background Splenectomy performed with a curved incision results in severe postoperative pain. The aim of this study was to evaluate the effect of transversus abdominis plane block and rectus sheath block on postoperative pain relief and recovery. Methods A total of 150 patients were randomized into the control (C), levobupivacaine (L) and levobupivacaine/morphine (LM) groups. The patients in the C group received only patient-controlled analgesia. The patients in the L and LM groups received transversus abdominis plane block and rectus sheath block with levobupivacaine or levobupivacaine plus morphine. The intraoperative opioid consumption; postoperative pain score; time to first analgesic use; postoperative recovery data, including the times of first exhaust, defecation, oral intake and off-bed activity; the incidence of postoperative nausea and vomiting and antiemetics use; and the satisfaction score were recorded. Results Transversus abdominis plane block and rectus sheath block reduced intraoperative opioid consumption. The patients in the LM group showed lower postoperative pain scores, opioid consumption, postoperative nausea and vomiting incidence and antiemetic use and presented shorter recovery times and higher satisfaction scores. Conclusions The combination of transversus abdominis plane block and rectus sheath block with levobupivacaine and morphine can improve postoperative pain relief, reduce the consumption of analgesics, and partly accelerate postoperative recovery. Trial registration Chinese Clinical Trial Registry, ChiCTR 1,800,015,141, 10 March 2018.
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Affiliation(s)
- Jing-Li Zhu
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xue-Ting Wang
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jing Gong
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hai-Bin Sun
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiao-Qing Zhao
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wei Gao
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, China.
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Lee KH, Kim DH, Kim YH, Ro SH, Lee J. Neurolytic abdominal wall blocks with alcohol for intractable gastrostomy site pain in a cancer patient -a case report. Korean J Anesthesiol 2019; 73:247-251. [PMID: 31048655 PMCID: PMC7280887 DOI: 10.4097/kja.19041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been reports of neurolytic transversus abdominis plane (TAP) block using different agents such as alcohol or phenol for the treatment of chronic abdominal pain caused by malignant abdominal wall invasion. However, to date, there have been no reports on neurolytic abdominal wall blocks for pain with non-cancer-related origin in cancer patients. CASE We performed subcostal TAP neurolysis using ethanol in a patient with esophageal cancer with constant pain at the site of gastrostomy. After neurolysis, the patient's overall pain decreased, with the exception of pain in the medial part of the gastrostomy site. We performed additional rectus sheath neurolysis using ethanol for the treatment of continuous pain at the medial site, and the effect of neurolysis has persisted for over 4 months. CONCLUSIONS Alcohol-based TAP neurolysis and rectus sheath neurolysis provide effective pain control in a cancer patient with chronic treatment-related pain involving the abdominal wall.
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Affiliation(s)
- Ki Hoon Lee
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea
| | - Dae Hyun Kim
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea
| | - Yang Hyun Kim
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea
| | - Soo Han Ro
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea
| | - Jun Lee
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea
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Dai W, Lu Y, Liu J, Tang L, Mei B, Liu X. Ultrasound-guided left lateral transversus abdominis plane block combined with rectus sheath block in peritoneal dialysis catheter placement. J Anesth 2018; 32:645-648. [PMID: 29978298 DOI: 10.1007/s00540-018-2528-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/28/2018] [Indexed: 11/25/2022]
Abstract
This study assessed the utility of ultrasound-guided lateral transversus abdominis plane (TAP) block combined with rectus sheath (RS) block for peritoneal dialysis catheter placement surgery. Thirty consecutive patients with end-stage renal disease scheduled to have peritoneal dialysis catheter placement received a left lateral TAP block combined with RS block performed under ultrasound guidance. The TAP and RS blocks were, respectively, conducted with 15 ml of 0.5% ropivacaine and 10 ml of 0.5% ropivacaine. Pain intensity was evaluated by verbal rating scale during operation, and the degree of patient and surgeon satisfaction was qualified by a categorical scale. Twenty-nine patients received successful blocks without any other adjuvant anesthetic drugs. One patient required rescue analgesia with lidocaine infiltration. No complications related to regional anesthesia were noted. Ultrasound-guided left lateral TAP block combined with RS block can serve as the primary anesthetic modality for peritoneal dialysis catheter placement surgery.
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Affiliation(s)
- Wei Dai
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui Province, People's Republic of China
| | - Yao Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui Province, People's Republic of China
| | - Jia Liu
- Department of Anesthesiology, The First College of Clinical Medicine, Anhui Medical University, Hefei, 230022, Anhui Province, People's Republic of China
| | - Lili Tang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui Province, People's Republic of China
| | - Bin Mei
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui Province, People's Republic of China
| | - Xuesheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui Province, People's Republic of China.
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Maloney C, Kallis M, El-Shafy IA, Lipskar AM, Hagen J, Kars M. Ultrasound-guided bilateral rectus sheath block vs. conventional local analgesia in single port laparoscopic appendectomy for children with nonperforated appendicitis. J Pediatr Surg 2018; 53:431-436. [PMID: 28610706 DOI: 10.1016/j.jpedsurg.2017.05.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/15/2017] [Accepted: 05/28/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite its minimally invasive approach, laparoscopic surgery can cause considerable pain. Regional analgesic techniques such as the rectus sheath block (RSB) offer improved pain management following elective umbilical hernia repair in the pediatric population. This effect has not been examined in laparoscopic single-incision surgery in children. We sought to compare the efficacy of bilateral ultrasound-guided RSB versus local anesthetic infiltration (LAI) in providing postoperative pain relief in pediatric single-incision transumbilical laparoscopic assisted appendectomy (TULA) with same-day discharge. METHODS We retrospectively reviewed 275 children, ages 4 to 17 years old, who underwent TULA for uncomplicated appendicitis in a single institution from August 2014 to July 2015. We compared those that received preincision bilateral RSB (n=136) with those who received LAI (n=139). The primary outcome was narcotic administration. Secondary outcomes included initial and mean scores, time from anesthesia induction to release, operative time, time to rescue dose of analgesic in the PACU and time to PACU discharge. RESULTS Total narcotic administration was significantly reduced in patients that underwent preincision RSB compared to those that received conventional LAI, with a mean of 0.112 mg/kg of morphine versus 0.290 mg/kg morphine (p<0.0001). Patients undergoing RSB reported lower initial (0.38 vs. 2.38; p<0.0001) and mean pain scores (1.26 vs. 1.77; p<0.015). Time to rescue analgesia was prolonged in patients undergoing RSB compared to LAI (58.93min vs. 41.56min; p=0.047). CONCLUSION Preincision RSB for TULA in uncomplicated appendicitis in children is associated with decreased opioid consumption and lower pain scores compared with LAI. As the addition of this procedure only added 6.67min to time under anesthesia, we feel that it is a viable option for postoperative pain control in pediatric single-incision laparoscopic surgery. RETROSPECTIVE COMPARATIVE STUDY LEVEL III EVIDENCE.
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Affiliation(s)
- Caroline Maloney
- Department of Surgery, Hofstra Northwell School of Medicine, 300 Community Drive Manhasset, New York 11030
| | - Michelle Kallis
- Department of Surgery, Hofstra Northwell School of Medicine, 300 Community Drive Manhasset, New York 11030
| | - Ibrahim Abd El-Shafy
- Department of Surgery, Hofstra Northwell School of Medicine, 300 Community Drive Manhasset, New York 11030
| | - Aaron M Lipskar
- Department of Surgery, Hofstra Northwell School of Medicine, 300 Community Drive Manhasset, New York 11030; Department of Pediatric Surgery, Northwell Cohen Children's Medical Center, 269-01 76th Ave, New Hyde Park, NY 11040
| | - John Hagen
- Department of Anesthesia, Northwell Cohen Children's Medical Center, 269-01 76th Ave, New Hyde Park, NY 11040
| | - Michelle Kars
- Department of Anesthesia, Northwell Cohen Children's Medical Center, 269-01 76th Ave, New Hyde Park, NY 11040.
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Jin F, Li Z, Tan WF, Ma H, Li XQ, Lu HW. Preoperative versus postoperative ultrasound-guided rectus sheath block for improving pain, sleep quality and cytokine levels in patients with open midline incisions undergoing transabdominal gynecological surgery: a randomized-controlled trial. BMC Anesthesiol 2018; 18:19. [PMID: 29426287 PMCID: PMC5807824 DOI: 10.1186/s12871-018-0485-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/31/2018] [Indexed: 01/30/2023] Open
Abstract
Background Nerve block is usually performed before surgery because it inhibits reflection of the skin incision and reduces the amount of intraoperative anesthetic used. We hypothesized that performing rectus sheath block (RSB) after surgery would result in a longer duration of the analgesic effects and have a subtle influence on sleep time after surgery but that it would not decrease the perioperative cytokine levels of patients undergoing gynecological surgery. Methods A randomized, double-blinded, controlled trial was conducted from October 2015 to June 2016. Seventy-seven patients undergoing elective transabdominal gynecological surgery were randomly assigned to the following two groups: a general anesthesia group who received 0.5% ropivacaine hydrochloride RSB preoperatively and saline RSB postoperatively, and another group who received the opposite sequence. The objective of the trial was to evaluate the postoperative pain, sleep and changes in cytokine levels of patients during the postoperative 48 h. Results A total of 61 female patients (mean age: 50 years; range: 24–65 years) were included in the final study sample. There was no significant difference in the pain, consumption of oxycodone, or time to first administration of patient-controlled intravenous analgesia between the two groups. The postoperative sleep stages N2 and N3 were increased by 52.9 and 29.1 min per patient, respectively, in the preoperative RSB group compared with those in the postoperative group. The preoperative IL-6 concentration in the preoperative RSB group was lower than that in the same group at the end of surgery and 24 h postoperatively. Conclusions We concluded that preoperative RSB might preserve postoperative sleep by inhibiting the increase of IL-6 without shortening the analgesia time compared with postoperative RSB in female patients undergoing elective midline incision transabdominal gynecological surgery. Trial registration ClinicalTrials.gov, NCT02477098, registered on 15 June 2015.
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Affiliation(s)
- Feng Jin
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Zhe Li
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Wen-Fei Tan
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China.
| | - Hong Ma
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Xiao-Qian Li
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Huang-Wei Lu
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China
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Iwata M, Kuzumoto N, Akasaki Y, Morioka M, Nakayama K, Matsuzawa N, Kimoto K, Shimomura T. The ultrasound-guided nerve blocks of abdominal wall contributed to anesthetic management of cholecystectomy in a patient with Becker muscular dystrophy without using muscle relaxants. JA Clin Rep 2017; 3:64. [PMID: 29457107 PMCID: PMC5804660 DOI: 10.1186/s40981-017-0134-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 11/28/2017] [Indexed: 12/12/2022] Open
Abstract
Becker muscular dystrophy (BMD) is a progressive neuromuscular disorder caused by mutations in the dystrophin gene. The sensitivity to non-depolarizing muscle relaxant in a patient with muscle dystrophy is reportedly higher than that in normal individuals, and the duration of the effect is known to be prolonged. In this report, we present the case of a 58-year-old man with BMD who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis under total intravenous anesthesia without the use of muscle-relaxant drugs and supplemented with regional anesthesia. Anesthesia was induced and maintained with propofol, remifentanil, and fentanyl; ultrasound-guided bilateral rectus sheath block (RSB) and right-sided subcostal transversus abdominis plane block (TAP) were performed. The procedure required conversion to open surgery because of hard conglutination; intraoperative and postoperative periods were uneventful. Adequate analgesia was maintained after extubation because of the effect of RSB and TAP.
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Affiliation(s)
- Masato Iwata
- Department of Anesthesiology, Nara Prefecture general Medical Center, 30-1, Hiramatsu 1-chome, Nara city, Nara 631-0846 Japan
| | - Naoya Kuzumoto
- Department of Anesthesiology, Nara Prefecture general Medical Center, 30-1, Hiramatsu 1-chome, Nara city, Nara 631-0846 Japan
| | - Yuka Akasaki
- Department of Anesthesiology, Nara Prefecture general Medical Center, 30-1, Hiramatsu 1-chome, Nara city, Nara 631-0846 Japan
| | - Masayo Morioka
- Department of Anesthesiology, Nara Prefecture general Medical Center, 30-1, Hiramatsu 1-chome, Nara city, Nara 631-0846 Japan
| | - Kana Nakayama
- Department of Anesthesiology, Nara Prefecture general Medical Center, 30-1, Hiramatsu 1-chome, Nara city, Nara 631-0846 Japan
| | - Nobuyoshi Matsuzawa
- Department of Anesthesiology, Nara Prefecture general Medical Center, 30-1, Hiramatsu 1-chome, Nara city, Nara 631-0846 Japan
| | - Katsuhiro Kimoto
- 2Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Toshiyuki Shimomura
- Perioperative Care Center, Nara Prefecture General Medical Center, Nara, Japan
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Nagata J, Watanabe J, Sawatsubashi Y, Akiyama M, Arase K, Minagawa N, Torigoe T, Hamada K, Nakayama Y, Hirata K. Novel technique of abdominal wall nerve block for laparoscopic colostomy: Rectus sheath block with transperitoneal approach. World J Gastrointest Surg 2017; 9:182-185. [PMID: 28932352 PMCID: PMC5583526 DOI: 10.4240/wjgs.v9.i8.182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/20/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023] Open
Abstract
A 62-year-old man who had acute rectal obstruction due to a large rectal cancer is presented. He underwent emergency laparoscopic colostomy. We used the laparoscopic puncture needle to inject analgesia with the novel transperitoneal approach. In this procedure, both ultrasound and laparoscopic images assisted with the accurate injection of analgesic to the correct layer. The combination of laparoscopic visualization and ultrasound imaging ensured infiltration of analgesic into the correct layer without causing damage to the bowel. Twenty-four hours postoperatively, the patient’s pain intensity as assessed by the numeric rating scale was 0-1 during coughing, and a continuous intravenous analgesic was not needed. Colostomy is often necessary in colon obstruction. Epidural anesthesia for postoperative pain cannot be used in patients with a coagulation disorder. We report the use of a novel laparoscopic rectus sheath block for colostomy. There has been no literature described about the nerve block with transperitoneal approach. The laparoscopic rectus sheath block was performed safely and had enough analgesic efficacy for postoperative pain. This technique could be considered as an optional anesthetic regimen in acute situations.
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Affiliation(s)
- Jun Nagata
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Fukuoka 808-0024, Japan
| | - Jun Watanabe
- Department of Surgery, Yokosuka Kyosai Hospital, Kanagawa 238-0011, Japan
| | - Yusuke Sawatsubashi
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Fukuoka 808-0024, Japan
| | - Masaki Akiyama
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Fukuoka 808-0024, Japan
| | - Koichi Arase
- Department of Surgery, University of Occupational and Environmental Health, Fukuoka 808-0024, Japan
| | - Noritaka Minagawa
- Department of Surgery, University of Occupational and Environmental Health, Fukuoka 808-0024, Japan
| | - Takayuki Torigoe
- Department of Surgery, University of Occupational and Environmental Health, Fukuoka 808-0024, Japan
| | - Kotaro Hamada
- Department of Anesthesiology, Wakamatsu Hospital, University of Occupational and Environmental Health, Fukuoka 808-0024, Japan
| | - Yoshifumi Nakayama
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Fukuoka 808-0024, Japan
| | - Keiji Hirata
- Department of Surgery, University of Occupational and Environmental Health, Fukuoka 808-0024, Japan
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Landmann A, Visoiu M, Malek MM. Development of a novel technique for bilateral rectus sheath nerve blocks under laparoscopic-guidance. J Pediatr Surg 2017; 52:966-969. [PMID: 28343663 DOI: 10.1016/j.jpedsurg.2017.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bilateral rectus sheath blocks have proven to be superior to local anesthetic infiltration for umbilical incisions and have been gaining popularity for the treatment of perioperative pain in children. We aim to develop a technique of surgeon performed rectus sheath blocks under laparoscopic-guidance alone. METHODS In phase I, we observed the laparoscopic appearance of a rectus sheath block. The pain management team performed an ultrasound-guided rectus sheath nerve block as we visualized the posterior rectus sheath with the laparoscope. In phase II, after completion of the laparoscopic procedure, we performed a rectus sheath nerve block. Ultrasound was used to identify where the local anesthetic had been injected. RESULTS Nineteen patients were included in this study, accounting for 38 rectus sheath blocks. In phase I, we observed with the laparoscope the delivery of ten ultrasound-guided rectus sheath blocks. In phase II, 28 laparoscopic-guided rectus sheath blocks were completed with immediate ultrasound confirmation of correct placement. CONCLUSIONS We have demonstrated that the rectus sheath nerve block can be performed reliably under laparoscopic-guidance alone. The efficacy of the laparoscopic-guided nerve block compared to the ultrasound-guided approach will need further study in a prospective, randomized trial. TYPE OF STUDY Retrospective review. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Alessandra Landmann
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Mihaela Visoiu
- Department of Pediatric Anesthesiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
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Litz CN, Farach SM, Fernandez AM, Elliott R, Dolan J, Patel N, Zamora L, Colombani PM, Walford NE, Amankwah EK, Snyder CW, Danielson PD, Chandler NM. Percutaneous ultrasound-guided vs. intraoperative rectus sheath block for pediatric umbilical hernia repair: A randomized clinical trial. J Pediatr Surg 2017; 52:901-906. [PMID: 28377023 DOI: 10.1016/j.jpedsurg.2017.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/09/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Regional anesthesia is commonly used in children. Our hypothesis was that percutaneous ultrasound-guided (PERC) rectus sheath blocks would result in lower postoperative pain scores compared to intraoperative (IO) rectus sheath blocks following umbilical hernia repair. METHODS A single-institution randomized blinded trial was conducted in pediatric patients undergoing elective umbilical hernia repair. The primary outcome was mean postoperative Wong-Baker pain score. Secondary outcomes included narcotic requirements and length of postoperative stay. RESULTS Fifty-eight patients were included: 28 PERC and 30 IO. Operating room time was significantly longer in the PERC group (41 vs. 35min, p<0.01). Mean postoperative pain scores (PERC-2.6 vs. IO-3.3, p=0.11), morphine equivalents intraoperatively (PERC-0 vs. IO-0.04mg/kg, p=0.29) and postoperatively (PERC-0.04 vs. IO-0.09mg/kg, p=0.17), time to first postoperative narcotic dose (PERC-30 vs. IO-22min, p=0.33, log-rank test), and postoperative length of stay (PERC-76 vs. IO-80min, p=0.44) were similar. CONCLUSION Following umbilical hernia repair in children, percutaneous ultrasound-guided and intraoperative rectus sheath blocks resulted in similar mean postoperative pain scores. There were no differences in secondary outcomes such as time to first narcotic, narcotic requirements, and length of stay. The additional resources required to complete a percutaneous ultrasound-guided rectus sheath block may not be warranted. TYPE OF STUDY Randomized controlled trial. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Cristen N Litz
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Sandra M Farach
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Allison M Fernandez
- Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Richard Elliott
- Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Jenny Dolan
- Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Nikhil Patel
- Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Lillian Zamora
- Division of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Paul M Colombani
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Nebbie E Walford
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Ernest K Amankwah
- Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Christopher W Snyder
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL.
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Imajo Y, Komasawa N, Fujiwara S, Minami T. Transversus abdominal plane and rectus sheath block combination for intractable anterior cutaneous nerve entrapment syndrome after severe cholecystitis. J Clin Anesth 2016; 31:119. [PMID: 27185691 DOI: 10.1016/j.jclinane.2016.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Yukihiro Imajo
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Nobuyasu Komasawa
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.
| | - Shunsuke Fujiwara
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Toshiaki Minami
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
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Manassero A, Bossolasco M, Meineri M, Ugues S, Liarou C, Bertolaccini L. Spread patterns and effectiveness for surgery after ultrasound-guided rectus sheath block in adult day-case patients scheduled for umbilical hernia repair. J Anaesthesiol Clin Pharmacol 2015; 31:349-53. [PMID: 26330714 PMCID: PMC4541182 DOI: 10.4103/0970-9185.161671] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS We conducted a prospective study to examine the local anesthetic (LA) spread and the effectiveness for surgical anesthesia of ultrasound (US)-guided rectus sheath block (RSB) in adult patients undergoing umbilical hernia repair. MATERIAL AND METHODS Thirty patients received at T-10 level a bilateral US-guided injection of 20 mL levobupivacaine 0.375% + epinephrine 5 μg/mL behind the rectus muscle to detach it from its sheath. Anesthetic spread into the rectus sheath was evaluated ultrasonographically at T-9 and T-11 levels and scored from 0 to 4. The RSB was defined effective for surgical anesthesia if it was able to guarantee an anesthetic level sufficient for surgery without any mepivacaine supplementation. RESULTS Overall, the block was effective for surgical anesthesia in 53.3% of patients (95% confidence interval, ±17.8). In the remaining patients, anesthesia supplementation was needed at cutaneous incision, whereas manipulation of the muscle and fascial planes was painless. No patients required general anesthesia. LA spreads as advocated (to T-9 and to T-11 bilaterally = spread score 4) in 8/30 patients (26.6%); in these cases, the block was 75% effective for surgery. The anesthetic spread was most negatively influenced by increased body mass index. Postoperative analgesia was excellent in 97% of patients. CONCLUSION Use of RSB as an anesthetic management of umbilical herniorrhaphy is recommended only with anesthetic supplementation at the incision site.
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Affiliation(s)
- Alberto Manassero
- Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Matteo Bossolasco
- Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Maurizio Meineri
- Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Susanna Ugues
- Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Chrysoula Liarou
- Department of Anesthesiology and Intensive Care, S. Croce e Carle Hospital, Cuneo, Italy
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