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Objective:To observe the effects of ultrasound guided transversus abdominis plane block (TAPB) on pain, rehabilitation indexes and immune function of postoperative in patients undergoing laparoscopic colorectal cancer surgery.Methods:A total of 100 patients undergoing laparoscopic colorectal cancer surgery admitted to Jiading Branch of Shanghai First People′s Hospital/Jiangqiao Hospital of Jiading District and Shanghai First People′s Hospital from February 2020 to February 2021 were selected as the study subjects, including 43 patients performed epidural block (control group) and 57 patients performed TAPB (observation group). The clinical indicators, vital signs parameters, pain degree, immune function in the two groups were compared.Results:The exhausting time, defecation time, getting out of bed time and hospitalization time in observation group were shorter than those in control group: (2.71 ± 0.54) d vs. (2.99 ± 0.66) d, (3.02 ± 0.49) d vs. (3.49 ± 0.56) d, (3.20 ± 0.89) d vs. (3.85 ± 1.08) d, (6.81 ± 0.98) d vs. (7.71 ± 1.08) d, there were statistical differences ( P<0.05). The diastolic blood pressure, systolic blood pressure and heart rate at pre-anesthesia, immediate incision of the skin, end of the surgery between two groups had no significant differences ( P>0.05). The scores of visual analogue scale at 4, 24, 48 and 72 h after surgery in the observation group were significantly lower than those in the control group ( P<0.05). The levels of CD 3+, CD 4+, CD 4+/CD 8+ and IgM after surgery for 3 d in the observation group were higher than those in the control group: 0.512 ± 0.054 vs. 0.487 ± 0.051, 0.280 ± 0.036 vs. 0.222 ± 0.032, 1.36 ± 0.29 vs. 1.17 ± 0.26, (152.53 ± 34.3) kU/L vs. (138.86 ± 31.18) kU/L, there were statistical differences ( P<0.05). Conclusions:TAPB can effectively reduce the degree of postoperative pain and immunosuppression after laparoscopic colorectal cancer surgery, so as to promote postoperative rehabilitation of patients.
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Abstract Objective To summarize the available evidence of TAP Block in efficacy in laparoscopic or robotic hysterectomy. Data Sources We searched databases and gray literature for randomized controlled trials in which transversus abdominis plane (TAP) block was compared with placebo or with no treatment in patients who underwent laparoscopic or robot-assisted hysterectomy. Method of Study Selection Two researchers independently evaluated the eligibility of the selected articles. Tabulation, Integration, and Results Seven studies were selected, involving 518 patients. Early postoperative pain showed a difference in the mean mean difference (MD): - 1.17 (95% confidence interval [CI]: - 1.87-0.46) in pain scale scores (I2=68%), which was statistically significant in favor of using TAP block, but without clinical relevance; late postoperative pain: DM 0.001 (95%CI: - 0.43-0.44; I2=69%); opioid requirement: DM 0.36 (95%CI: - 0.94-1.68; I2=80%); and incidence of nausea and vomiting with a difference of 95%CI=- 0.11 (- 0.215-0.006) in favor of TAP. Conclusion With moderate strength of evidence, due to the high heterogeneity and imbalance in baseline characteristics among studies, the results indicate that TAP block should not be considered as a clinically relevant analgesic technique to improve postoperative pain in laparoscopic or robotic hysterectomy, despite statistical significance in early postoperative pain scale scores. Clinical Trial Number and Registry: PROSPERO ID - CRD42018103573.
Resumo Objetivo Resumir as evidências disponíveis sobre a eficácia do bloqueio TAP em histerectomia laparoscópica ou robótica. Fontes de Dados Pesquisamos bancos de dados e literatura cinza por ensaios clínicos randomizados nos quais o bloqueio do plano transverso do abdome (TAP na sigla em inglês) foi comparado com placebo ou com nenhum tratamento em pacientes que foram submetidos a histerectomia laparoscópica ou assistida por robô. Métodos de Seleção de Estudos Dois pesquisadores avaliaram independentemente a elegibilidade dos artigos selecionados. Tabulação, Integração e Resultados Sete estudos foram selecionados envolvendo 518 pacientes. A dor pós-operatória precoce apresentou diferença nasmédias (DM) de: -1 17 (intervalo de confiança [IC] de 95%: - 1 87-0 46) nos escores da escala de dor (I2=68%) o que foi estatisticamente significativo a favor do uso do bloqueio TAP mas sem relevância clínica; dor pós-operatória tardia: DM 0001 (IC95%: - 043-044; I2=69%); necessidade de opioides: DM0 36 (95%CI: - 0 94-168; I2=80%); e incidência de náuseas e vômitos com diferença de 95% CI=- 011 (- 0215-0006) a favor do TAP. Conclusão Com moderada força de evidência devido à alta heterogeneidade e ao desequilíbrio nas características basais entre os estudos os resultados indicam que o bloqueio do TAP não deve ser considerado como uma técnica analgésica clinicamente relevante para melhorar a dor pós-operatória em histerectomia laparoscópica ou robótica apesar da significância estatística nas pontuações da escala de dor pósoperatória inicial. Número e Registro do Ensaio Clínico: PROSPERO ID - CRD42018103573.
Subject(s)
Pain, Postoperative/prevention & control , Laparoscopy/methods , Robotic Surgical Procedures/methods , Analgesics, Opioid/therapeutic use , Pain, Postoperative/drug therapy , Robotics , Abdominal Muscles , Hysterectomy/methodsABSTRACT
Objective:To investigate the safety and efficacy of ultrasound-guided transversus abdominis plane (TAP) combined with paracervical block in percutaneous microwave ablation(PMWA) of uterine fibroids.Methods:Twenty-four patients with uterine fibroids who underwent PMWA after ultrasound-guided TAP combined with paracervical block in Sichuan Cancer Hospital from October 2021 to January 2022 were retrospectively analyzed. The success rate and adverse reactions of TAP combined with paracervical block were recorded, and the types and doses of rescue analgesics used during and after operation were recorded. The pain degree of patients was recorded by NRS(numeric rating scales) during and 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 12 hours and 24 hours after operation, and the satisfaction of patients was recorded.Results:The success rate of TAP combined with paracervical block was 100%, and there were no adverse reactions during and after operation. During the operation, 5 patients(20.83%) had mild pain, which was tolerable and did not need intervention, 4 patients(16.67%) presented with moderate pain, and the NRS scores were 4, 4, 5 and 6 respectively, the symptoms were relieved after rescue analgesia. All patients completed one ablation, no ablation failure or secondary ablation. Some patients had mild pain after operation, which could be tolerated without intervention, and all were relieved naturally within 6 hours. All patients returned home on the day of ablation and were 100% satisfied with the analgesic effect.Conclusions:Ultrasound-guided TAP combined with paracervical block in PMWA of uterine fibroids is safe and effective, which is worthy of clinical promotion.
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Abstract Morbid obesity is associated with various pathophysiological changes which affect the outcome of anaesthesia and surgery. So it's challenging to give anaesthesia to such patients. We present a 59-year-old adult morbidly obese, hypertensive, diabetic female with hypothyroidism operated for proximal humerus fracture and now presented with non-union of fracture, requiring percutaneous injection of bone marrow aspirate from the iliac crest to the site of non-union. The patient was extremely anxious and refused to undergo the procedure under local anaesthesia or sedation and demanded anaesthesia. Given her comorbidities general anaesthesia (GA) was avoided and the procedure was accomplished using Ultrasound (USG) guided Transversus abdominis plane (TAP) block and Lateral Femoral Cutaneous Nerve (LFCN) block for the bone marrow aspirate from the iliac crest and Intercostobrachial nerve block (T2) was given to prevent pain while injecting the aspirate into the non-union site. Dexmedetomidine and ketamine were given for deep level sedation and analgesia. TAP block and LFCN block is generally used for post-op analgesia but can be also used for surgical anaesthesia instead of General anaesthesia in specific scenarios. Its perioperative application and its potential use instead of GA have been discussed.
Resumo A obesidade mórbida se associa a várias alterações fisiopatológicas que afetam o desfecho da anestesia e cirurgia. É, portanto, um desafio anestesiar tais pacientes. Apresentamos uma mulher adulta de 59 anos, obesa mórbida, hipertensa, diabética, com hipotiroidismo, submetida a cirurgia devido a fratura proximal do úmero e que compareceu ao serviço com fratura não consolidada, e com indicação de injeção percutânea de aspirado de medula óssea da crista ilíaca na fratura não consolidada. A paciente estava extremamente ansiosa e recusou o procedimento sob anestesia local ou sedação e exigiu anestesia. Em função de suas comorbidades, Anestesia Geral (AG) foi evitada e o procedimento foi realizado usando bloqueio do Plano Transverso Abdominal (PTA) guiado por Ultrassonografia (USG) e bloqueio do Nervo Cutâneo Femoral Lateral (NCFL) para aspiração de medula óssea da crista ilíaca. O bloqueio do nervo Intercostobraqueal (T2) foi realizado para evitar dor durante a injeção do aspirado. Dexmedetomidina e ketamina foram dadas para sedação profunda e analgesia. O Bloqueio PTA e bloqueio NCFL geralmente são usados para analgesia pós-operatória, mas também podem ser usados para anestesia cirúrgica substituindo a anestesia geral em condições clínicas específicas. O emprego desses bloqueios no perioperatório e seu uso potencial no lugar de AG têm sido discutidos.
Subject(s)
Humans , Female , Shoulder Fractures/surgery , Bone Marrow Transplantation , Ultrasonography, Interventional , Fractures, Ununited/surgery , Nerve Block/methods , Peripheral Nerves , Shoulder Fractures/complications , Obesity, Morbid/complications , Fractures, Ununited/complications , Anesthesia , Middle AgedABSTRACT
Background: Caesarean section is most frequently performed surgery worldwide. Patients experience moderate to severe pain in the first 48 hours post-operatively. Aim of this study was to evaluate the efficacy of dexmedetomidine and dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block for postoperative analgesia in patients of caesarean section.Methods: A total 120 ASA I and II patients undergoing elective and emergency caesarean section under subarachnoid block were randomly divided into three groups B, BDM, BDX to receive bupivacaine alone or dexmedetomidine or dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block. Postoperatively, the patients were evaluated for pain level at rest and on movement with a 10 cm visual analog scale (VAS) pain score (0 = no pain and 10 = worst pain), time to demand of first analgesic request, number of analgesic requirements, nausea or vomiting, sedation and patient satisfaction at 0 hours and at 2, 4, 6, 12, 18, and 24 hours.Results: VAS score was significantly higher in group B in comparison to BDM and BDX, and higher in BDX in comparison to group BDM. Mean duration of analgesia was significantly higher in group BDM in comparison to group B and BDX. Total number of rescue analgesic demands were significantly lower in group BDM in comparison to group B and BDX. Sedation score and satisfaction score was higher in group BDM as compared to group B and BDX.Conclusions: Addition of dexmedetomidine and dexamethasone as an adjunct to bupivacaine reduces postoperative pain, prolongs analgesia, decreases demand for additional analgesics and provides better maternal satisfaction as compared to plain bupivacaine group in TAP block in patients undergoing caesarean section under subarachnoid block. Among dexmedetomidine and dexamethasone, dexmedetomidine had prolonged analgesia as compared to dexamethasone group.
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Background: Ultrasound guided TAP block is safe, simple and effective method of providing postoperative analgesia in surgeries involving abdominal wall incision by blocking anterior branches of thoracolumbar nerves originating from T6-L1. Our aim to study the efficacy of dexmedetomidine and clonidine as an adjunct to levobupivacaine in ultrasound guided TAP block for postoperative analgesia in patients undergoing TAH.Methods: Prospective, double blind randomized control study. Ninety ASA I and II patients scheduled for TAH were randomly assigned in a double blinded study and divided into three groups. Group L received 18ml of 0.25% levobupivacaine+2ml of NS to make total volume of 20ml on each side. Group LC and Group LD received 18ml of 0.25% levobupivacaine + 1 mcg/kg of clonidine or dexmedetomidine diluted in NS to make total volume of 20ml on each side. USG guided TAP block was given when subarachnoid block level regressed to T10 level. Postoperatively patients were assessed for pain scores, HR, SBP, DBP, nausea vomiting, sedation and satisfaction scores at 0, 2, 4, 6 and 12 and 24 hours. Statistical analysis was performed using SPSS software 17. p value<0.05 was considered significant.Results: Pain scores were significantly lower in LD and LC groups as compared to L group and demand for first rescue analgesic was delayed in LD group (491.50±73.29min) and group LC (268.00±35.47min) as compared to group L (129.17±10.67min). The total number of demand doses in 24 hours were significantly less in group LD (1.00±0.00) followed by group LC (2.03±0.18) and group L (2.77±0.57) respectively. Incidence of hypotension, bradycardia and sedation was more in LD group as compared to LC and L groups.Conclusions: TAP block with dexmetomidine as an adjunct to levobupivacaine provides prolonged postoperative analgesia as compared to clonidine as an adjunct and plain levobupivacaine.
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Abstract Objective and background: Erector spinae plane block is a novel analgesic truncal block that has been popularized due to its ease of performance and perceived safety. Erector spinae plane block has been postulated to target the ventral rami and rami communicates of spinal nerves, thus providing somatic and visceral analgesia. In this case series, we describe our experience of bilateral erector spinae plane block placed at the low thoracic level in open gynecologic oncology surgery in three patients. Method: Under ultrasound guidance, erector spinae plane blocks were done, preoperatively, at the 8th thoracic transverse process bilaterally. Numeric rating scale for pain and opioid consumption of the first 48 postoperative hours were recorded. Results: Pain scores ranged from 0 to 4 among the three patients and 48 h opioid consumption in oral morphine equivalents of 4, 6 and 18 mg. No adverse events were recorded up to patient discharge from the hospital. Conclusions: Erector spinae plane block provided effective analgesia in our case series. While its true mechanism of action remains obscure, the available case reports show encouraging analgesic results with no adverse events recorded. Formal prospective randomized trials are underway to provide further evidence on its efficacy, failure rate and safety.
Resumo Justificativa e objetivo: O bloqueio do plano do músculo eretor da espinha é um novo bloqueio troncular analgésico popularizado devido à sua facilidade de aplicação e segurança percebida. O bloqueio do plano do músculo eretor da espinha foi postulado para atingir os ramos ventrais e os ramos comunicantes dos nervos espinhais, proporcionando analgesia somática e visceral. Nesta casuística, descrevemos nossa experiência com o bloqueio do plano do músculo eretor da espinha bilateral depositado no nível torácico inferior em cirurgia oncológica ginecológica aberta em três pacientes. Método: Os bloqueios do plano do músculo eretor da espinha guiados por ultrassom foram administrados no pré-operatório, entre o 8° e o 10° processo transverso do tórax bilateralmente. Os valores de uma escala de classificação numérica para dor e consumo de opioides nas primeiras 48 horas de pós-operatório foram registrados. Resultados: Os escores de dor variaram de 0-4 entre as três pacientes e o consumo de opioide em 48 horas equivaleu à morfina oral (4, 6 e 18 mg). Nenhum evento adverso foi registrado até a alta hospitalar das pacientes. Conclusões: O bloqueio do plano do músculo eretor da espinha proporcionou analgesia efetiva em nossa casuística. Embora o mecanismo de ação verdadeiro permaneça obscuro, os relatos de casos disponíveis mostram resultados analgésicos encorajadores, sem eventos adversos registrados. Ensaios prospectivos randômicos formais estão em andamento para fornecer mais evidências sobre sua eficácia, taxa de falha e segurança.
Subject(s)
Humans , Female , Aged , Salpingo-oophorectomy , Hysterectomy , Nerve Block/methods , Paraspinal MusclesABSTRACT
Background: The ultrasound guided transversus abdominis plane (TAP) block which provides effective analgesia after lower abdominal surgeries including caesarean section. It is a simple and reliable technique. In this prospective, randomized double-blind study, we determined the efficacy of TAP block using 0.25% Bupivacaine and 0.9N Saline with respect to VAS for pain, postoperative Tramadol consumption and post-operative ondansetron usage.Methods: This study was conducted on 100 adult patients of ASA physical status I and II in the age group of 18 to 40 years undergoing elective lower segment cesarean section under spinal anaesthesia. Study group received TAP block with 0.25% Bupivacaine and control group received 10 ml of 0.9N saline on each side. Patients were analyzed for postoperative pain by pain score (at rest, on movement, on cough) using VAS was recorded at 0, ½, 1, 2, 4, 6, 12 and 24 hours postoperatively. Need for rescue analgesia was assessed by time to first dose of Tramadol requirement and total dose of Tramadol over 24 hours of postoperative period. Ondansetron (4 mg i.v.) was administered whenever nausea score was more than 2 or the patient vomited. All the data was noted using uniform performs.Results: Patients received TAP block with 0.25% Bupivacaine had better pain scores at first hour of postoperative period during rest, cough and movement which was statistically significant (p<0.0010) in comparison to group B. There was a statistically significant difference (p <0.001) in the requirement of total dose of Tramadol as a rescue analgesia in patients who received transversus abdominis block with 0.25% Bupivacaine (138.77 mg) in comparison with other group(240 mg).The mean time to first request for Tramadol was significantly longer in group A (5.8 hrs) in comparison to group B (1.93 hrs) with p value <0.001. Patients received TAP block with 0.9N saline needed more dose of Ondansetron, however, the difference was not statistically significant (p >0.001).Conclusions: TAP block using ultrasound provides substantial reduction in Tramadol consumption, time to first dose of rescue tramadol when compared with control group. This study reinforces the recommendation for TAP as a part of multimodal post-operative analgesic regimen.
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BACKGROUND: The transversus abdominis plane (TAP) block is an effective technique to block the thoracolumbar nerves innervating the anterolateral abdominal wall. This study was conducted to evaluate the analgesic efficacy and opioid consumption with the use of perineural buprenorphine or dexamethasone in TAP blocks after unilateral inguinal hernioplasties. METHODS: This prospective, randomized, double-blinded, placebo-controlled study enrolled 93 patients scheduled for unilateral inguinal hernioplasty, followed by an ultrasound-guided TAP block. The participants were randomized into 3 groups (31 patients each). Group L received 20 ml 0.25% levobupivacaine + 1 ml normal saline (NS); group LB, 20 ml 0.25% levobupivacaine + 0.3 mg (1 ml) buprenorphine; and group LD, 20 ml 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone. The patients were observed postoperatively for 24 h for first rescue analgesic requirement, total rescue analgesic consumption, and pain scores on the numeric rating scale (NRS). RESULTS: The time to first rescue analgesic requirement was significantly longer in Group LB than in groups LD and L (688.87 ± 36.11 min, 601.45 ± 39.85 min, and 383.06 ± 36.21 min, respectively; P < 0.001). The mean total tramadol consumption in the first 24 h was the lowest in group LB (P < 0.001, L vs. LB / LD). Groups LB and LD displayed significantly lower NRS scores than group L (P < 0.001 both). CONCLUSIONS: Levobupivacaine with perineural buprenorphine in a TAP block after unilateral open inguinal hernioplasty facilitates prolonged analgesia and reduced requirement for rescue analgesics compared to perineural dexamethasone, without significant side effects.
Subject(s)
Humans , Abdominal Wall , Analgesia , Analgesics , Buprenorphine , Dexamethasone , Hernia, Inguinal , Herniorrhaphy , Prospective Studies , Tramadol , UltrasonographyABSTRACT
OBJECTIVE@#To compare the efficacy and safety of postoperative analgesia with low-dose sufentanil combined with transversus abdominis plane (TAP) block and with sufentanil alone in promoting patients'recovery following laparoscopic hysterectomy.@*METHODS@#Sixty patients undergoing laparoscopic hysterectomy in our hospital between September, 2016 and August, 2017 were randomly allocated into two equal groups. In group A, the patients were given postoperative analgesia with 1 μg/kg sufentanil, 9.96 mg tropisetronmesylate, and 200 mg flurbiprofen axetil (diluted with 0.9% NaCl solution to 100 mL, pumped at the rate of 2 mL/h) combined with TAP block; in group B, the patients received similar postoperative analgesia but at a higher dose of sufentanil (2 μg/kg) without TAP block. Visual analogue scale (VAS) was used to evaluate pain at 15 min and at 4, 8, 12, 24 and 48 h postoperatively, and the first off-bed time, the length of postoperative hospital stay and the incidence of postoperative nausea and vomiting (PONV) were recorded in all the patients.@*RESULTS@#Compared with those in group B, the patients in group A had significantly lower VAS scores at 15 min, 4 h, 8 h, and 12 h postoperatively ( < 0.01) with also statistically shorter first off-bed time and postoperative hospital stay ( < 0.01). Two (6.7%) patients in group A had mild PONV, and 6 (20.0%) in group B had PONV (including 4 with mild and 2 with moderate PONV).@*CONCLUSIONS@#Lowdose sufentanil combined with TAP block is effective for postoperative analgesia after laparoscopic hysterectomy and helps to reduce the incidence of PONV and shorten the first off-bed time and postoperative hospital stay to promote the recovery of the patients.
Subject(s)
Female , Humans , Abdominal Muscles , Analgesics, Opioid , Hysterectomy , Laparoscopy , Pain Measurement , Pain, Postoperative , SufentanilABSTRACT
Objective To investigate the effects of different doses of dexmedetomidine (Dex) combined with ropivacaine continuous transverse abdominal plane (TAP) block on analgesia and immune function in patients with laparoscopic colon cancer surgery. Methods Fifty colon cancer patients who had underwent laparoscopic radical resection from January 2017 to May 2018 in Wenzhou People′s Hospital were selected. The patients were divided into group A and group B according to random digits table method with 25 cases each. Group A was treated with 0.75 μg/kg Dex before operation; group B was treated with 1.00 μg/kg Dex before operation, then 2.00 μg/kg Dex continuous analgesia 48 h after operation. Both groups were given 0.375% ropivacaine 40 ml before operation for TAP block, and 0.2% ropivacaine 5 ml/h continuous analgesia 48 h after operation. The visual analogue score (VAS), interferon γ (IFN-γ), interleukin 10 (IL-10), T lymphocyte subsets (CD4+and CD8+) 12, 24 and 48 h after operation and adverse reactions were observed. Results The VAS 12, 24 and 48 h after operation in group B was significantly lower than that in group A: (2.2 ± 0.6) scores vs. (3.1 ± 0.9) scores, (1.6 ± 0.4) scores vs. (2.3 ± 0.8) scores and (1.1 ± 0.3) scores vs. (1.9 ± 0.6) scores, and there was statistical difference (P＜0.05). The IFN-γ and CD4+12, 24 and 48 h after operation in group B were significantly higher than those in group A, IFN-γ: (281.6 ± 42.1) ng/L vs. (213.5 ± 37.4) ng/L, (335.7 ± 42.5) ng/L vs. (244.2 ± 36.3) ng/L and (362.4 ± 42.8) ng/L vs. (258.6 ± 36.8) ng/L; CD4 +: 0.186 ± 0.047 vs. 0.163 ± 0.045, 0.265 ± 0.058 vs. 0.215 ± 0.052 and 0.314 ± 0.062 vs. 0.226 ± 0.053. The IL-10 and CD8+were significantly lower than those in group A, IL-10: (263.5 ± 28.7) ng/L vs. (314.2 ± 35.6) ng/L, (225.4 ± 26.9) ng/L vs. (279.5 ± 29.8) ng/L and (206.3 ± 26.1) ng/L vs. (272.1 ± 29.2) ng/L; CD8 +:0.268 ± 0.062 vs. 0.295 ± 0.064, 0.217 ± 0.048 vs. 0.266 ± 0.061 and 0.164 ± 0.036 vs. 0.243 ± 0.055. There were statistical differences (P＜0.05). There was no statistical difference in the incidence of adverse reactions between 2 groups (P＞0.05). Conclusions Different doses of Dex combined with ropivacaine continuous TAP block has good analgesic effect on colon cancer patients who had underwent laparoscopic radical resection. However, high first dose load and continuous combination is better and has less effect on immune function.
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Abstract Background and objectives: A transversus abdominis plane block is a peripheral block method that has been used successfully for pain relief after total abdominal hysterectomy. However, the effects of the combination of the transversus abdominis plane block and general anesthesia on analgesic and anesthetic requirements remain unclear. This randomized placebo-controlled study is aimed to evaluate the effects of transversus abdominis plane block on analgesic and anesthetic consumption during total abdominal hysterectomy under general anesthesia. Methods: Sixty-six women undergoing total abdominal hysterectomy were randomized into two groups to receive general anesthesia alone (control group) or with transversus abdominis plane block using 20 mL of 0.25% bupivacaine (transversus abdominis plane group). Intraoperative remifentanil and sevoflurane consumption were recorded. We also evaluated the postoperative pain, nausea, quality of recovery scores and rescue analgesic requirement during postoperative 24 hours. Results: The total remifentanil and sevoflurane consumption is significantly lower in transversus abdominis plane group; respectively mean (SD) 0.130 (0.25) vs. 0.094 (0.02) mcg.kg-1.min-1; p < 0.01 and 0.295 (0.05) vs. 0.243 (0.06) mL.min-1; p < 0.01. In the postoperative period, pain scores were significantly reduced in transversus abdominis plane group soon after surgery; median (range) 6 (2-10) vs. 3 (0-5); p < 0.001, at 2 h (5 [3-9] vs. 2.5 [0-6]; p < 0.001), at 6 h (4 [2-7] vs. 3[0-6], p < 0.001), at 12 h (3.5 [1-6] vs. 2 [1-5]; p = 0.003). The patients in the transversus abdominis plane group had significantly higher QoR-40 scores 190.5 (175-197) vs. 176.5 (141-187); p < 0.001). Conclusion: Combining transversus abdominis plane block with general anesthesia can provide reduced opioid and anesthetic consumption and can improve postoperative pain and quality of recovery scores in patients undergoing total abdominal hysterectomy.
Resumo Justificativa e objetivos: O bloqueio do plano transverso abdominal é um método de bloqueio periférico que tem sido usado com sucesso para alívio da dor após histerectomia abdominal total. No entanto, os efeitos da combinação do bloqueio do plano transverso abdominal e da anestesia geral sobre a necessidade de analgésico e anestésico ainda não estão claros. Este estudo randômico e controlado com placebo tem como objetivo avaliar os efeitos do bloqueio do plano transverso abdominal sobre o consumo de analgésico e anestésico durante histerectomia abdominal total sob anestesia geral. Métodos: Foram randomizadas em dois grupos 66 mulheres submetidas à histerectomia abdominal total para receber apenas anestesia geral (grupo controle) ou associada a bloqueio do plano transverso abdominal com 20 mL de bupivacaína a 0,25% (grupo plano transverso abdominal). O consumo de remifentanil e sevoflurano no período intraoperatório foi registrado. Também avaliamos a dor pós-cirurgia, náusea, qualidade dos escores de recuperação e necessidade de analgésico de resgate durante as 24 horas de pós-operatório. Resultados: O consumo total de remifentanil e sevoflurano foi significativamente menor no grupo plano transverso abdominal, respectivamente, média (DP): 0,130 (0,25) vs. 0,094 (0,02) mcg.kg-1.min-1; p < 0,01 e 0,295 (0,05) vs. 0,243 (0,06) mL.min-1; p < 0,01. No pós-operatório, os escores de dor foram significativamente reduzidos no grupo plano transverso abdominal logo após a cirurgia; mediana (intervalo): 6 (2-10) vs. 3 (0-5); p < 0,001, em 2 h (5 [3-9] vs. 2,5 [0-6]; p < 0,001), em 6 h (4 [2-7] vs. 3 [0-6], p < 0,001), em 12 h (3,5 [1-6] vs. 2 [1-5]; p = 0,003). As pacientes do grupo plano transverso abdominal apresentaram escores QoR-40 significativamente maiores: 190,5 (175-197) vs. 176,5 (141-187); p < 0,001). Conclusão: A combinação de bloqueio do plano transverso abdominal e anestesia geral pode proporcionar um consumo reduzido de opioides e anestésicos e melhorar a dor pós-cirúrgica e a qualidade dos escores de recuperação em pacientes submetidas à histerectomia abdominal total.
Subject(s)
Humans , Hysterectomy/instrumentation , Anesthesia, General/instrumentation , Nerve Block/methods , Bupivacaine/administration & dosage , Double-Blind Method , Controlled Clinical Trial , Sevoflurane/administration & dosage , Remifentanil/administration & dosage , Anesthesia, ConductionABSTRACT
This paper pretends to demonstrate the effect of the combination of transversus abdominis plane block (TAP block) and Serratus plane block (SP block) techniques in analgesia of 4 dogs undergoing total unilateral mastectomy. Dogs were premedicated with methadone (0.5mg.kg-1) intramuscularly. Anesthesia was induced with propofol (6mg.kg-1) and midazolam (0.3mg.kg-1) and maintained with isoflurane. SP and TAP block were performed unilaterally using ultrasound by the injection of bupivacaine 0.25% (0.3mL kg-1) diluted with NaCl solution 1:1. Heart rate (HR), respiratory rate (f), non-invasive arterial pressure, esophageal temperature (T), oxygen saturation (SpO2) and electrocardiogram were monitored continuously. Animals were monitored for two and four hours after extubation for pain by using the Canine Acute Pain Scale from Colorado State University. Two hours after extubation, tramadol (4mg.kg-1) and dipyrone (25mg.kg-1) was administered to all dogs. It was not observed any alteration on cardiac rhythm. HR, f, T and mean arterial pressure remained below the preincisional values for all dogs. No dog required intraoperative rescue analgesia. Recovery from anesthesia was without any complication. All animals scored 0 (0/5) at pain scale, two and four hours after extubation and none of them expressed concern over the surgical wound. Dogs were able to walk before two hours after extubation. The combination of both techniques is effective in anesthetic blocking the thoracic and abdominal walls and it is suggested both may be included in the multimodal analgesia protocols for this type of surgery.(AU)
Este trabalho pretende demonstrar o efeito analgésico da combinação das técnicas de bloqueio do plano transverso abdominal (TAP block) e bloqueio do plano serrátil (SP block) em 4 cadelas submetidas à mastectomia unilateral total. Os animais foram pré-medicados com metadona (0,5mg.kg-1) por via intramuscular. A anestesia foi induzida com propofol (6mg.kg-1) e midazolam (0,3mg.kg-1) e mantida com isoflurano. Os bloqueios SP e TAP foram realizados unilateralmente, utilizando ultrassonografia, pela injeção de bupivacaína a 0,25% (0,3mL.kg-1), diluída com solução de NaCl a 1:1. A frequência cardíaca (FC), frequência respiratória (f), pressão arterial não invasiva, temperatura esofágica (T), saturação de oxigênio (SpO2) e eletrocardiograma foram monitorados continuamente. Os animais foram monitorizados durante duras e quatro horas após a extubação para a dor usando a Escala de Dor Aguda Canina da Universidade Estadual do Colorado. Duas horas após a extubação, tramadol (4mg.kg-1) e dipirona (25mg.kg-1) foram administrados a todos os cães. Não foi observada qualquer alteração no ritmo cardíaco. HR, f, T e pressão arterial média permaneceram abaixo dos valores basais para todos os cães. Nenhum cão requereu resgate analgésico intra-operatório. Não houve complicações na recuperação anestésica. Todos os animais apresentaram escore 0 (0/5) na escala de dor, duras e 4 quatro horas após a extubação e nenhum expressou desconforto com a ferida cirúrgica. Todos os cães foram capazes de caminhar antes de duas horas após extubação. A combinação de ambas as técnicas é eficaz no bloqueio anestésico das paredes torácica e abdominal e sugere-se que ambos podem ser incluídos nos protocolos de analgesia multimodal para este tipo de cirurgia.(AU)
Subject(s)
Animals , Female , Dogs , Abdominal Muscles/drug effects , Anesthesia, Conduction/veterinary , Anesthetics, Local/analysis , Isoflurane/therapeutic use , Mastectomy/veterinary , Midazolam/therapeutic use , Propofol/therapeutic useABSTRACT
Abstract Background and objectives We aimed to evaluate the effect of bupivacaine and dexmedetomidine added to bupivacaine used in tranversus abdominis plane (TAP) block on postoperative pain and patient satisfaction in patients undergoing lower abdominal surgery. Methods Patients submitted to lower abdominal surgery were enrolled in the study. After anesthesia induction, ultrasound guided TAP block was performed. TAP block was obtained with 21 mL 0.9% saline in Group C (n = 31), 20 mL 0.5% bupivacaine + 1 mL saline in Group B (n = 31), and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 µg) in Group BD (n = 31). Results Visual analog scale scores were lower in Group BD compared to Group C, at all time points (p < 0.05); it was lower in group BD than in group B at 10-24 h. In Group B, it was lower than Group C at 2-8 h (p < 0.05). Total morphine consumption was lower in Group BD compared to other groups and lower in group B than in the controls (p < 0.001). Patient satisfaction was higher in Group BD than in other groups and was higher in both study groups than in the controls (p < 0.001). Nausea-vomiting scores, antiemetic requirement, or additional analgesic administration were not significant among groups (p > 0.05). Conclusions The addition of dexmedetomidine to bupivacaine on TAP block decreased postoperative pain scores and morphine consumption; it also increased patient satisfaction in patients undergoing lower abdominal surgery. Dexmedetomidine did not have any effect on nausea and vomiting score and antiemetic requirement.
Resumo Justificativa e objetivos O objetivo do estudo foi avaliar o efeito de bupivacaína e dexmedetomidina adicionada à bupivacaína para bloqueio do plano transverso abdominal (TAP) no controle da dor e satisfação do paciente após cirurgia abdominal inferior. Métodos Pacientes submetidos à cirurgia abdominal inferior foram incluídos no estudo. Após a indução da anestesia, o bloqueio TAP guiado por ultrassom foi feito com 21 mL de solução salina a 0,9% no Grupo C (n = 31), 20 mL de bupivacaína a 0,5% + 1 mL de solução salina no Grupo B (n = 31) e 20 mL de bupivacaína a 0,5% + 1 mL de dexmedetomidina (100 µg) no grupo BD (n = 31). Resultados Os escores da escala visual analógica foram menores no Grupo BD comparado com o Grupo C em todos os tempos mensurados (p < 0,05); foi menor no Grupo BD do que no Grupo B em 10-24 horas. No Grupo B, os escores VAS foram menores do que no Grupo C em 2-8 horas (p < 0,05). O consumo total de morfina foi menor no Grupo BD em comparação com outros grupos e menor no Grupo B do que nos controles (p < 0,001). A satisfação do paciente foi maior no Grupo BD do que nos outros grupos e maior em ambos os grupos de estudo do que nos controles (p < 0,001). Os escores de náusea e vômito, necessidade de antiemético ou de analgésicos adicionais não foram significativos entre os grupos (p > 0,05). Conclusões A adição de dexmedetomidina à bupivacaína em bloqueio TAP reduziu os escores de dor e o consumo de morfina no pós-operatório, além de aumentar a satisfação em pacientes submetidos à cirurgia abdominal inferior. Dexmedetomidina não apresentou efeito sobre os escores de náusea e vômito e a necessidade de antiemético.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Pain, Postoperative/drug therapy , Appendectomy , Bupivacaine/administration & dosage , Dexmedetomidine/administration & dosage , Adrenergic alpha-2 Receptor Agonists/administration & dosage , Herniorrhaphy , Anesthetics, Local/administration & dosage , Nerve Block/methods , Double-Blind Method , Prospective Studies , Treatment Outcome , Abdominal Muscles , Ultrasonography, Interventional , Drug Therapy, Combination , Middle AgedABSTRACT
Objective To evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block for preventive analgesia in patients undergoing gynecological laparoscopy. Methods 60 ASA physical status I ~ II, aged 30 ~ 50 yr, weighting 50 ~ 65 kg patients scheduled for elective gynecological laparoscopy were randomly divided into 3 groups using a random number table (n = 20 each): control group (group I), preoperative TAP block group (group II) and postoperative TAP block group (group III). Ultrasound-guided bilateral TAP block was performed before induction of anesthesia or at the end of surgery in II and III groups, respectively. Patient-controlled intravenous analgesia (PCIA) with 1μg/ml sufentanil (background infusion 2 ml/h, bolus dose 2 ml, lockout interval 15 min) was used until 2 days after surgery and VAS score was maintained ≤ 3. When VAS score > 3, flurbiprofen axetil 50 mg was injected intravenously as rescue medication. The consumption of sufentanil per hour, requirement for rescue medication, and development of adverse reactions were recorded within 24 h after surgery. Sufentanil-sparing degree was calculated. Results Compared with group I, the consumption of sufentanil per hour, requirement for rescue medication and the incidence of nausea and vomiting were significantly lower within 24 h after surgery in II and III groups (P < 0.05). The consumption of sufentanil per hour, requirement for rescue medication and the incidence of nausea and vomiting were significantly lower in group II than in group III (P < 0.05). The consumption of sufentanil was decreased by 35.0% in group II as compared with group I, and decreased by 16.0% in group II as compared with group III. Conclusion Ultrasound-guided TAP block can provide good postoperative analgesia in patients undergoing gynecological laparoscopy, and effect of preoperative nerve block is better than that of postoperative nerve block.
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Objective To evaluate the median effective anesthetic dose of ropivacaine in ultrasound-guided transversus abdominis plane ( TAP ) block for analgesia in patients undergoing appendectomy. Methods Twenty-eight cases of appendectomy under general anesthesia were analyzed.After standardized general anaesthesia,a bilateral ultrasound-guided TAP block was performed on patients undergoing appendectomy using ropivacaine. Sequential method was applied. The initial dose of ropivacaine in first patient was 1.6 mg·kg-1,the dose adjustment interval was 0.2 mg·kg-1.Numerical Rating Scale was used to estimate the level of pain postoperatively. If NRS≤3, dosage of ropivacaine was decreased by 0. 2 mg·kg-1. The transversus abdominis plane block analgesia duration and incidences of postoperative adverse reactions were analyzed. Results Median effective dose (ED50) of ropivacaine in ultrasound-guided transversus abdominis plane block was 2.73 mg·kg-1.95%CI (1.94, 3.84) mg·kg-1. Conclusion The determination of ED50of ropivacaine in ultrasound-guided transversus abdominis plane block improved the anesthesia efficacy and safety.
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Objective To observe the effect of ultrasound-guided transversus abdominis plane blockon median effective dose of sufentanil in pediatric postoperative analgesia. Methods Forty-fivepediatric patients under-going elective hernia repairsurgery were randomly divided into two groups:group Rop and group Sal. Ultrasound-guided transversus abdominis plane blocks were performed on both groups after general anesthesia induction before the start of surgery. Group Rop received 0.3 mL/kg of 0.25%ropivacaine,and group Sal received 0.3 mL/kg of 0.9%saline. Patient controlled intravenous analgesia pump within sufentanil was used in both groups after operation. Used the sequential method to determine the median effective dose of sufentanil ,recorded the times of the pressing self-control analgesia within 6h after operation,the use of sufentanil,postoperative pediatric pain(FLACC)score and adverse reactions. Results 1. The median effective dose of sufentanil in group Rop was lower than group Sal (0.0259 μg/(kg · h)vs 0.0379 μg/(kg · h)). 2.The times of the pressing self-control analgesia within 6 h after operation and the use of sufentanil in group Rop were less than in group Sal. 3.The postoperative FLACC score at different points in group Rop was lower than in group Sal(P < 0.05). 4.There were no significant difference(P >0.05)in incidence of adverse reactions in both groups. Conclusion The ultrasound-guided transversus abdominis plane block in pediatric lower abdominal surgery can effectively reduce the median effective dose of sufentanil.
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Objective To investigate the effect of ultrasound-guided oblique subcostal trans versus abdominis plane (OSTAP) block with different concentration of ropivacaine in combined anesthesia for upper abdominal surgery.Methods One hundred forty-seven patients underwent upper abdominal surgery,85 males and 62 females,aged 18-80 years,ASA physical status Ⅰ or Ⅱ,were recruited and randomly divided into four groups.Bilateral ultrasound-guided OSTAP block were performed in each group.Ropivacaine hydrochloride injection of 2.5 mg/kg were performed in each of group A (n =41),B (n =55),C (n =37) while concentration was 0.375％,0.5％,0.75％,respectively.Group D (n =14) was received 20 ml of saline solution for each side.Intravenous-inhalation combined anesthesia was conducted during the surgery,with sevoflurane 0.8-1.0 MAC,dexmedetomidine 0.5 μg/kg iv,remifentanil 0.1μg·kg-1 ·min-1 iv.Each group was received patient-controlled intravenous analgesia (PCIA) after surgery which contained butorphanol tartrate and flurbiprofen axetil.The consumption of opioids and vasoactive drugs,hemodynamic parameters in operation were recorded.The visual analogue scale (VAS) scores were evaluated at 12 and 24 h after operation,the location and degree of abdominal pain,fentanyl used for acute pain during the first 12 h after operation,the postoperative intestinal exhaust time and hospitalization time were also recorded.Results There was no difference in basic states,duration of operation or blood loss in each group.The consumption of sufentanil in operation in groups A,B and C was (30.5±9.4)μg,(27.4±7.4) μg,(30.9±8.8) μg,respectively,which were significantly lower than that in group D [(47.1±9.3) μg] (P＜0.05).There was no difference in vasoactive drugs between the four groups.There was no difference in hemodynamic indexes in the TAP block groups.There was no significant difference in intraoperative blood loss between the four groups the VAS scores.There was no difference in the location and degree of abdominal pain,fentanyl used for acute pain,the postoperative intestinal exhaust time and hospitalization time.Conclusion Intraoperative opioids consumption in combined general anesthesia was reduced by ultrasound-guided OSTAP block.There is no difference between the effect of OSTAP block with different concentration of ropivacaine in combined anesthesia for upper abdominal surgery.
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OBJECTIVE: To explore the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with transversus abdominis plane (TAP) block in the enhanced recovery after surgery (ERAS) in patients undergoing laparoscopic colorectal cancer resection (LCCR). METHODS: A total of 101 patients undergoing LCCR were randomly divided into three groups: control (n＝34), TAP (n＝35) and TEAS＋TAP (n＝32). Conventional perioperative anesthesia management of the 3 groups was performed according to the ERAS guidelines. All the patients experienced patient controlled epidural analgesia (PCEA), and those of the TAP and TEAS＋TAP groups received TAP block by injection of 0.3% Roperca hydrochloride (15 mL) into the space between the internal oblique and the transverse abdominis after induction of anesthesia. For patients of the TEAS＋TAP group, TEAS (2 Hz/10 Hz, an endurable stimulation strength) was applied to bilateral Zusanli (ST 36) from 30 min before anesthesia to the end of the surgery. The blood glucose value and dosage of Remifentanil used were recorded. The pain severity was assessed at 4, 12, 24 and 48 h after surgery by using visual analogue scale (VAS). Moreover, postoperative anal exhaust time, postoperative oral feeding time, postoperative first ambulation time and postoperative hospital stay length were recorded. RESULTS: The total dosages of Remifentanil used during surgery, and the blood glucose levels were significantly lower in the TAP and TEAS＋TAP groups than in the control group (P0.05). The VAS scores of the TAP and TEAS＋TAP groups were considerably lower than those of the control group at 4, 12, 24 and 48 h after surgery (P0.05). CONCLUSION: TEAS combined with TAP block analgesia is superior to simple TAP block analgesia in relieving postoperative pain, shortening the recovery time of gastrointestinal function and promoting postoperative rehabilitation in patients undergoing LCCR.
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Abstract Anti-N-methyl-D-aspartate receptor encephalitis is a recently described neurological disorder and an increasingly recognized cause of psychosis, movement disorders and autonomic dysfunction. We report 20-year-old Chinese female who presented with generalized tonic-clonic seizures, recent memory loss, visual hallucinations and abnormal behavior. Anti-N-methyl-D-aspartate receptor encephalitis was diagnosed and a computed tomography scan of abdomen reviewed a left adnexal tumor. We describe the first such case report of a patient with anti-N-methyl-D-aspartate receptor encephalitis who was given a bilateral transversus abdominis plane block as the sole anesthetic for removal of ovarian tumor. We also discuss the anesthetic issues associated with anti-N-methyl-D-aspartate receptor encephalitis. As discovery of tumor and its removal is the focus of initial treatment in this group of patients, anesthetists will encounter more such cases in the near future.
Resumo A encefalite antirreceptor de N-metil-D-aspartato (NMDA) é um distúrbio neurológico recentemente descrito e uma causa cada vez mais reconhecida de psicose, distúrbios do movimento e disfunção autonômica. Relatamos o caso de uma paciente de origem chinesa, de 20 anos, que se apresentou com crises tônico-clônicas generalizadas, perda de memória recente, alucinações visuais e comportamento anormal. Encefalite antirreceptor de NMDA foi diagnosticada e uma tomografia computadorizada de abdome revelou um tumor anexial à esquerda. Descrevemos o primeiro relato de caso de paciente com encefalite antirreceptor de NMDA submetida ao bloqueio de plano transverso abdominal (PTA) bilateral como única anestesia para remoção de tumor ovariano. Também discutimos as questões anestésicas associadas à encefalite antirreceptor de NMDA. Como a descoberta e a remoção do tumor são o foco do tratamento inicial nesse grupo de pacientes, os anestesiologistas encontrarão mais desses casos no futuro próximo.