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Background : Transversus Abdominis Plane (TAP) block is recently being used for effective pain relief following Total Abdominal Hysterectomy (TAH). Ultrasound guided block helps in correct localization of the plane and proper deposition of drugs. This study was done to compare the efficacy of Levobupivacaine and Bupivacaine in TAP block in TAH. Materials and Method : Seventy patients (ASA 1 and 2) prepared for TAH under General Anesthesia were randomly allocated into two groups. Ultrasound guided TAP block was performed bilaterally with 20ml of Levobupivacaine (0.25%) in Group A (n=35) and Bupivacaine (0.25%) in Group B (n=35) on each side of abdomen after skin closure at the end of operation. Intensity of pain was evaluated by 10cm Visual Analogue Scale (VAS) score at 0, 2, 6, 12,24 hours. If VAS >3, 1gram paracetamol infusion was given as rescue analgesic. Duration of analgesia, total rescue analgesic requirement and hemodynamic changes by measuring MAP and PR were noted. Results : VAS at 12 hours was significantly lower in Group A (mean 3.2±1) than Group B (mean 4.1±0.7, p<0.0001). Time of first rescue analgesic requirement was longer in Group A (mean 12.0±1.1h) compared to Group B (mean 11.2±1.1h, p=0.0059). Total analgesic requirement( paracetamol) in 24 hours was lower in Group A (mean 1.7±0.7g) compared to Group B (mean 2.2±0.7g, p=0.007). Hemodynamic changes were comparable in both groups. Conclusion : Levobupivacaine provided better postoperative analgesia than Bupivacaine with stable hemodynamic condition in TAP block.
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Dengue fever is endemic India and the prevalence of dengue is on the rise owing to various social and economic factors. Prevalence of asymptomatic dengue infection varies widely from less than 1 % to 80 % in India. Transfusion transmissible dengue has been reported in different parts of the word. Prevalence of subclinical dengue among blood donor poses a threat to the blood supply leading to transfusion transmissible dengue. We wanted to estimate the prevalence of IgG antibodies for Dengue in the blood donor population. METHODSSix hundred and eight whole blood donors were included in the study during the period January 2017 to October 2018. Donor registration and education was done as per the national guidelines. Donors who gave a history of previous dengue or symptoms consistent with dengue were excluded from the study. Serum samples from whole blood donors were tested for IgG antibodies using ELISA technology. RESULTSOf the total of 608 donors, 602 were male donors and 55 % of the donors were in the age group 21 - 30 years. Majority (69 %) of the donors were from urban locations. Anti IgG antibodies for dengue were present in 4.14 % of donors of which 38 % of donors were in the age group 31 - 40 years. Three hundred and eighty-four donors revealed history of fever, myalgia and headache in the past one year. No statistical significance was found between fever, myalgia and the presence of IgG anti-dengue antibodies. CONCLUSIONSThe subclinical or asymptomatic prevalence of dengue infection is low when compared to other studies in other parts of the country. Enquiring into donor history for history of dengue or symptoms of dengue and deferring such donors for a recommended period will prevent transfusion transmissible dengue.
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@#【Objective】To evaluate the efficacy of three different methods of subcostal transversus abdominis plane（TAP）block for patients undergoing open liver carcinoma resection.【Methods】A total of 60 adult patients，undergoing elective open liver carcinoma resection through a“reverse L”incision below the rib bow，were enrolled. The subjects were randomly divided into three groups（20 cases in each），including Group A，B and C，according to the position of local anesthetic injection. All patients underwent ultrasound- guided bilateral subcostal TAP block under local anesthesia. The TAP injection was injected at the middle line of the clavicle in Group A；Two separate injections were at the parasternal line and at the anterior axillary line in Group B；Multiple injections were proformed between the anterior median line and the middle axillary line in Group C. After completion of TAP block，the onset time，duration，blocking extent，hemodynamics and abdominal muscle thickness were evaluated. The operating time of TAP block and incidence of complications were recorded.【Results】The blocking extent of Group B or Group C was greater than that of Group A（P < 0.05），with no significant difference between Group B and Group C. The duration of TAP block in Group B or Group C was longer than that of Group A，while the onset time was not significantly different between the three groups. The mean arterial pressure and heart rate during laparotomy were higher than the base value in Group A，while there were no evident changes in Group B and Group C. The rectus abdominis became thinner after TAP block in all patients，but there was no significant difference in muscle thickness change among the three groups. The operating time of TAP block in the three groups was （8.4±1.9），（13.8±3.1），（23.3±4.2）min，respectively，with significant difference between any two groups（P < 0.05）. None of the patients enrolled showed such complications as local anesthetic poisoning，abdominal wall hematoma，nerve injury， abdominal viscera injury，and puncture point infection.【Conclusion】The outcome of subcostal TAP block for patients undergoing open liver surgery is related to injecting position of anesthetics. Two- point-injection method is superior to one- point-injection method or multiple-point-injection method，for adequate analgesic extent as well as less operating time.
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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)
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Animales , Femenino , Perros , Músculos Abdominales/efectos de los fármacos , Anestesia de Conducción/veterinaria , Anestésicos Locales/análisis , Isoflurano/uso terapéutico , Mastectomía/veterinaria , Midazolam/uso terapéutico , Propofol/uso terapéuticoRESUMEN
Objective To evaluate the adjuvant analgesia effect of the addition of dexamethasone to ropiva-caine in a transversus abdominis plane(TAP)block after inguinal herniorrhaphy. Methods 100 adult male pa-tients who underwent open tension-free inguinal herniorrhaphy from August 2015 to June 2017,randomized into two groups equally. TAP block with ropivacaine with additional dexamethasone was experiment group(group D) and with ropivacaine was control group(group C). Before the operation,all the patients were performed TAP block by the same group of surgeons. Celecoxib(200mg,Q12h,po)was prescribed to all patients in 48 hours after oper-ation. VAS and clinical symptoms were recorded. The sum and time of celecoxib consumption were also recorded af-ter 72 hours postoperatively. The surveys about the Carolinas comfort scale(CCS)of all the patients one week after operation were collected. Results The averaged pain score in 48 hours after operation has no statistical signifi-cance. The occurrence of postoperative nausea and vomiting of group D is lower than group C,neither of them were statistically significant. The averaged CCS of group D was lower than group C;the difference was significant. Con-clusions Compared to single usage of ropivacaine in the single-shot TAP as a preemptive analgesia method for in-guinal herniorrhaphy,adding dexamethasone to ropivacaine didn′t show significance in analgesic intensity after in-guinal herniorrhaphy,though the adjuvant usage of dexamethasone reduced the sum and duration of other analgesic medications and enhanced the comfort of the patients after mesh-used herniorrhaphy.
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Introduction: Pain is one of the most important factors that is responsible for many adverse outcomes during surgery and in postoperative period. Effective pain control can also facilitate rehabilitation and accelerate recovery from surgery. Aim: To compare ultrasound-guided TAP block versus patients receiving no Transverse abdominis plane (TAP) block as regards the degree of pain relief in patients undergoing laparoscopic appendectomy. Materials and methods: Prospective single blinded randomized control study. Patients were randomly allocated (computer coded sealed envelopes) to receive either TAP block or no TAP block with regular analgesia. Patient will be observed for 24 hours post operatively. 60 patients divided equally into 2 groups cases were TAP (transverse abdominis plane block) group (n =30), Control group (n= 30). Results: The age between the two groups was analysed using student-t-test , the average age group in control group was found to be 32.64 years and TAP group 29.4 years. There was no significant difference in age between the two groups. The percentage of Males in TAP group was more when compare with Control, whereas in Control group the females were more but the difference was not PSV Rama Rao, M. Vijayakanth, Mohammad Feroz. A prospective single blinded randomized study to assess post operative analgesia using ultrasound guided transverse abdominis plane block for laparoscopic appendectomy. IAIM, 2016; 3(11): 103-111. Page 104 statistically differ. Pain score between two groups was analysed using Maan-Whintney U test. The pvalues of the Mann-Whitney U-test for the 2nd, 6th and 12th hours showed significant (p value – 0.000), which revealed that the mean rank for the pain scores of Control group was significant greater than the TAP group. Whereas for the 24th hour the mean rank for the pain score for both the groups were almost similar. Conclusions: Ultrasound guided TAP block with 0.375% ropivacaine bilaterally can be used effectively for post operative analgesia for patients undergoing laparoscopic appendectomy.
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The transverse abdominal plan blockade is a block of abdominal wall that has diffused rapidly in the clinical practice as part of a multimodal analgesia for abdominal surgery. The performance of the ultrasound-guided technique has allowed the lowering of potential complications, as well as new approaches that were carried out according to the descriptions, and the prospective studies would make it possible to utilize the transverse abdominal plan blockade in different surgical interventions; however, the results obtained in randomized clinical trials are inconsistent. To prepare a systematic review aiming to determine the efficacy of the ultrasound-guided transverse abdominal plan blockade for different surgical interventions, as well as the indications according to the approaches and their influences. Two research approaches, one manual, and the other in Pubmed returned 28 randomized clinical trials where intervention with ultrasound-guided transverse abdominal plan blockades was performed to compare the analgesic efficacy in contrast to another technique in adults, published between 2007 and October 2013, in English or Spanish, with Jadad score > 1, according to the inclusion criteria for this review. The authors analyzed independently all the randomized clinical trials. The transverse abdominal plan blockades have been shown to be an effective technique in colorectal surgery, cesarean section, cholecystectomy, hysterectomy, appendectomy, donor nephrectomy, retropubic prostatectomy, and bariatric surgery. However, the data found in randomized clinical trial are not conclusive, and as a result, it is necessary to develop new and well designed randomized clinical trial, with enough statistical power to compare different approaches, drugs, doses, and volumes for the same ...
O bloqueio do plano transverso abdominal (TAP) é um bloqueio da parede abdominal que se difundiu rapidamente na prática clínica como parte de analgesia multimodal em cirurgia abdominal. A técnica ecoguiada permitiu reduzir as possíveis complicações, assim como as novas abordagens, que, de acordo com as descrições feitas e os estudos prospectivos, permitiram usar o TAP em vários procedimentos cirúrgicos; no entanto, os resultados obtidos em ensaios clínicos randomizados (ECR) são inconsistentes. Revisão sistemática para determinar a eficácia analgésica do TAP ecoguiado em diversos procedimentos cirúrgicos, assim como determinar as indicações de acordo com abordagens e sua influência. Foi feita uma pesquisa no PubMed e outra livre, ou manual, e foram encontrados 28 ECR em que uma intervenção com o TAP ecoguiado era feita e se comparava sua eficácia analgésica com outra técnica em humanos adultos, publicados entre 2007 e outubro de 2013 com escore de Jadad > 1, em inglês ou espanhol, de acordo com os critérios de inclusão para esta revisão. Todos os ECR foram analisados de forma independente pelos autores. O TAP mostrou ser uma técnica eficaz em cirurgia colorretal, cesárea, colecistectomia, histerectomia, apendicectomia, nefrectomia em doador, prostatectomia retropúbica e cirurgia bariátrica. No entanto, os dados encontrados nos ECR são inconclusivos, de modo que mais ECR bem desenhados são necessários e com poder estatístico suficiente na comparação de diferentes abordagens, drogas, doses e volumes para uma mesma intervenção, a fim de resolver os temas da atualidade e seu impacto na prática clínica habitual.
El bloqueo del plano transverso del abdomen (TAP) es un bloqueo de pared abdominal que se ha extendido rápidamente en la práctica clínica como parte de analgesia multimodal en cirugía abdominal. La realización de la técnica ecoguiada ha permitido disminuir las potenciales complicaciones, así como nuevos abordajes que según las descripciones realizadas y los estudios de extensión permitirían utilizar el TAP en distintas intervenciones quirúrgicas; sin embargo, los resultados obtenidos en ensayos clínicos aleatorizados (ECA) son inconsistentes. Revisión sistemática para determinar la eficacia analgésica del TAP ecoguiado en las distintas intervenciones quirúrgicas en las que se ha realizado, así como determinar las indicaciones según los abordajes y la influencia de estos. Se realizó una búsqueda en Pubmed y otra manual, encontrando 28 ECA en los que se realiza una intervención con TAP ecoguiado que comparan la eficacia analgésica respecto a otra técnica en humanos adultos, publicados entre 2007 y octubre de 2013 con puntuación Jadad > 1, publicados en inglés o en castellano, según los criterios de inclusión para esta revisión. Todos los ECA fueron analizados de forma independiente por los autores. El TAP demostró ser una técnica eficaz en cirugía colorrectal, cesárea, colecistectomía, histerectomía, apendicectomía, nefrectomía de donante, prostatectomía retropúbica y cirugía bariátrica; sin embargo, los datos hallados en ECA no son concluyentes, por lo que se requieren nuevos ECA bien diseñados y con suficiente potencia estadística en los que se comparen los distintos abordajes, fármacos, dosis y volúmenes para una misma intervención con el fin de resolver los actuales interrogantes y su repercusión en la práctica clínica habitual.
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Humanos , Dolor Postoperatorio/prevención & control , Ultrasonografía Intervencional/métodos , Bloqueo Nervioso/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Pared Abdominal , Abdomen/cirugíaRESUMEN
Aim: Transversus abdominis plane (TAP) block is mainly used as part of multimodal postoperative analgesia regimens in a wide variety of abdominal operations. Our purpose was to evaluate feasibility and safety of TAP block as anesthesia method for inguinal hernia repair. Methodology: Twenty patients scheduled to undergo ambulatory inguinal hernia repair were selected and consented to ultrasound-guided TAP block anesthesia plus conscious sedation. Twenty to 25 ml of ropivacaine 0.5% were administered into the TAP and sensory blockade of T11-L1 dermatomes was examined 30 minutes later. Data on intraoperative tolerance, postoperative pain levels, rescue analgesia requirements, ambulation and complications were recorded. Results: Nineteen blocks (95%) were successful. One patient (5%) required conversion to general anesthesia. One patient (5%) needed further local anesthetic infiltration before mesh fixation. Postoperative pain levels were excellent, with only one patient (5%) requiring rescue analgesia at home. No complications were observed and all patients were discharged on the evening of surgery. Conclusion: Inguinal hernias can be safely repaired under ultrasound-guided TAP block anesthesia. Preliminary data are encouraging, in terms of intraoperative anesthesia adequacy, postoperative pain levels and rescue analgesia requirements. The role of TAP block as anesthetic modality for abdominal wall operations should be further investigated.