Transversus abdominis plane block under laparoscopic guide versus port-site local anaesthetic infiltration in laparoscopic excision of endometriosis: a double-blind randomised placebo-controlled trial.

OBJECTIVE: To compare the efficiency of laparoscopically guided transversus abdominis plane block (LTAP) versus port-site local anaesthetic infiltration (LAI) in reducing postoperative pain following laparoscopic excision of endometriosis. DESIGN: A prospective, double-blind randomised controlled trial. SETTING: A tertiary referral centre for endometriosis and minimally invasive gynaecological surgery. POPULATION: Women undergoing laparoscopic excision of endometriosis from December 2015 through July 2016. METHODS: Participants were randomised to receive: port-site infiltration with bupivacaine and placebo LTAP (LAI group, n = 21); placebo port-site infiltration and LTAP with bupivacaine (LTAP group, n = 24); placebo port-site infiltration and placebo LTAP (placebo group, n = 25). MAIN OUTCOME MEASURES: Post-operative pain at 2-4, 6-8, 10-12 and 24 hours, analgesic requirements, TAP block-related complications and opioid-related adverse effects. RESULTS: There were no differences in patient characteristics between the groups. In comparison with placebo, both LTAP and LAI groups had significantly less pain at 2-4, 6-8, and 10-12 hours (median 3, 3, 3.5 versus 3, 6, 4 versus 8, 8, 7 for LTAP, LAI, and placebo, respectively, P < 0.05). Median differences (and 95% confidence intervals) were as follows; LTAP versus placebo -5 (-6 to -4), -4 (-5 to -3), -3 (-4 to -0.5); LAI versus placebo -4 (-5 to -2), -2 (-3 to -0.5), -1 (-4 to -0.5) at 2-4, 6-8 and 10-12 hours, respectively. There were no statistically significant differences between the LTAP and LAI groups. CONCLUSIONS: Laparoscopically guided transversus abdominis plane block and LAI both reduce postoperative pain in patients undergoing laparoscopic excision of endometriosis, compared with placebo. We found no differences in effect between LTAP and LAI. TWEETABLE ABSTRACT: TAP block and port-site local infiltration are both effective in reducing postoperative pain in major gynaecological laparoscopic surgery.

Antibacterial effect of tramadol against Staphylococcus aureus and Pseudomonas aeruginosa: an in vivo study.

Some important adverse effects of local and regional anaesthesia including injection-site infection, epidural abscess and meningitis, are usually caused by bacteria such as Staphylococcus aureus and Pseudomonas aeruginosa. These infections can even cause the patient's death in severe cases. In the present study, the antimicrobial activity of tramadol was investigated on S. aureus and P. aeruginosa in BALB/c-sensitive mice. This experimental multigroup research study evaluated the effect of two different concentrations of injectable tramadol (12.5 and 25 mg/mL) on local infections caused by S. aureus and P. aeruginosa in BALB/c mice within 24 and 48 hours. The results showed that tramadol injection in the specified doses did not have a significant impact on the diameter of lesions caused by local infections due to these organisms. However, the diameter of inflammation resulting from local infection with P. aeruginosa had statistically increased in the two doses after 48 hours (p 0.019). Subcutaneous injection of tramadol reduced the growth of S. aureus through enhancing phagocytes and tissue inflammation; however, it did not help eliminate P. aeruginosa, and at a dose of 25 mg/mL it also increased the growth and spread of the bacteria. It seems that the observed difference was due to the different characteristics of these two bacteria.