ABSTRACT
Background: Ultrasound (US)-guided transmuscular quadratus lumborum (TQL) block and oblique subcostal transversus abdominis plane (OSTAP) block are components of multimodal analgesia for abdominal surgeries.The aim of the study is to compare the analgesic efficacy of US-guided TQL block versus US-guided OSTAP block after upper abdominal surgeries.Methods: This prospective randomized study was conducted on 40 patients scheduled for elective open upper abdominal surgery under general anesthesia. Patients were randomly allocated into2groups; OSTAPGroup (20 patients) received US-guided OSTAP block, and TQL Group (20 patients) received US-guided TQL block. At the end of surgical procedure, while patients were still under general anesthesia, each group received 30 mL bupivacaine 0.25%. Postoperative measurements included pain scores, time to first opioid analgesic request, postoperative total opioid consumption, patient satisfaction, and complications.Results: Patients of TQL group had statistically significant lower 24 h postoperative total morphine consumption than patients of OSTAP group (13.25±2.88 mg and 20.10±3.21 mg, respectively,P < 0.001), and longer time to first opioid analgesic request (373.25±18.76 min. and 245.75±11.50 min., respectively,P < 0.001). Patients received TQL block had also statistically significant lower postoperative pain scores, less frequent morphine doses, and more patient satisfaction.Conclusion: US-guided TQL block is more effective postoperative analgesic modality than US-guided OSTAP block in patients undergoing elective open upper abdominal surgery under general anesthesia
Subject(s)
Abdominal Oblique Muscles , Retroperitoneal Space , Surgical Procedures, OperativeABSTRACT
Background: Retroperitoneal hematoma (RH) can present as an acute life-threatening condition, report on RH in low-income countries are lacking. Objective: We present the severity, pattern, challenges, and outcome of RH in a low-resource country such as Nigeria. Methods: This was a retrospective observational study of all patients with blunt or penetrating abdominal injury needing surgery, patients with RH among them were analyzed. Results: In the last one decade spanning 2005-2015, our operation database record showed that 247 patients had exploratory laparotomy for blunt and penetrating abdominal trauma. Out of the 115 patients with complete record available, only 43 had RH. The median age of the patients was 30 years, and the most affected age group was 20-29 years. Female to male ratio was 1:13. Only eight patients (18.6%) reached the hospital from the accident site within the first "Golden Hour" of accident, which is the first 1 h postrauma during which treatment intervention believed to have the best outcome. Only two patients (4.7%) got to operating theater within 1 h of reaching hospital. None of our patients had preoperative diagnosis of RH; overall, mortality was two patients (4.7%). Conclusion: Logistical infrastructural inadequacies such as lack of sterile theater bundle and drapes/nonavailability or busy theater space caused delay for patients between presentation in the Accident and Emergency Center and operating theater. None of our patients had a preoperative diagnosis of RH because of lack of access to computerized tomography scan dedicated to trauma in Accident and Emergency Center. The overall mortality of 4.7% in this study, which is on the low side, tends to suggest that mostly mild and stable cases which can make it to the operating table were eventually operated upon
Subject(s)
Developing Countries , Emergency Medical Services , Hematoma , Nigeria , Retroperitoneal Space/diagnosis , Tertiary Care Centers , Wounds and InjuriesABSTRACT
L'hematome retroperitoneal est habituellement secondaire a un traumatisme. La forme spontanee idiopathique est rare surtout quand il survient chez la femme enceinte. Nous rapportons le cas d'une femme de 29 ans enceinte de 20 semaines d'amenorrhee; qui a presente une douleur abdominale aigue avec instabilite hemodynamique et deglobulisation. La difficulte est d'affirmer le diagnostic de cet hematome afin d'evaluer le retentissement foto-maternel et d'adapter la prise en charge therapeutique
Subject(s)
Hematoma , Laparoscopy , Pregnant Women , Retroperitoneal SpaceABSTRACT
Objectives To evaluate retroperitoneal laparoscopic ureterolithotomy as an alternative line of treatment for ureteral stones not amenable for other less invasive procedures. Patients and Methods Retroperitoneal laparoscopic ureterolithotomy was tried in 34 patients with impacted upper ureteral stones (27 patients) and middle ureteral stones (7 patients). Mean stone size was 16 mm. Twenty-six patients were males and 8 were females with a mean age of 36 years (range 18 - 54 years). Results The procedure was successful in 29 cases (85.3); while 5 cases (14.7) required open surgery. The mean operative time was 55 minutes (range 25 - 90 minutes). No major intraoperative complications were encountered. No blood transfusion was required. Mean hospital stay was 6 days. Postoperative complications in the form of prolonged urinary leakage and high-grade fever occurred in 2 patients (5.9) and 1 patient (2.9); respectively. Conclusion Retroperitoneal laparoscopic ureterolithotomy is a good minimally invasive alternative line of treatment for ureteral stones in cases not amenable for ESWL or endoscopy. However; it takes a long learning curve. Moreover; a careful case selection and good working instruments are necessary for success