RESUMO
Background: Laparoscopic surgery in recent times has noteworthy advantages over conventional surgery, yet recovery is prolonged due to debilitating shoulder tip pain (STP) and operated site pain. Various studies have compared the effect of trocar site, intraperitoneal instillation of local anesthetic (LA) for pain relief while only a few studies have tested the combination of these two techniques. Hence, this study was undertaken to compare the combination of these two techniques versus trocar site alone for STP particularly. Subjects and Methods: This prospective, randomized, comparative study was conducted on 52 patients who were undergoing laparoscopic abdominal surgery. The patients were allocated into either of the two groups. Group I (n = 26): trocar site infiltration (20 mL) and intraperitoneal instillation (20 mL) of 0.25% levobupivacaine and Group II (n = 26): trocar site infiltration (20 mL) of 0.25% levobupivacaine and saline (20 mL) intraperitoneally. Postoperative STP was the primary outcome while surgical site pain, nausea, and vomiting were secondary outcomes. Results: There were no statistically significant differences between the groups with regard to shoulder pain, surgical site pain, total rescue analgesics, and incidence of nausea and vomiting (P > 0.05). Conclusion: Trocar site infiltration with intraperitoneal instillation of LA or trocar site infiltration alone was found to be equally effective. However, we suggest that it is better to provide a combination of trocar site infiltration plus intraperitoneal instillation of LA if we have to restrict opioid usage such as in day-care surgeries.
RESUMO
CONTEXT: Traditional truncal blocks are devoid of visceral analgesia. Quadratus lumborum (QL) block has shown greater efficacy in providing the same. AIMS: This study was done to compare the efficacy of transversus abdominal plane (TAP) block versus QL block in providing postoperative analgesia for lower abdominal surgeries. SETTINGS AND DESIGN: This was a prospective, randomized, double-blinded study. SUBJECTS AND METHODS: Seventy adult patients were randomly allocated into two groups, where Group A received TAP block with 20 ml of 0.25% ropivacaine on each side (n = 35) and Group B received QL block with 20 ml of 0.25% ropivacaine on each side (n = 35). The time of block, duration of surgery, Numerical Pain Intensity Scale (NPIS) score at the 1st, 2nd, 4th, 8th, 12th, 16th, and 24th postoperative hours, and the total analgesic drug requirements were noted and compared between the two groups. STATISTICAL ANALYSIS USED: Data were analyzed with SPSS version 23 (IBM corporation, Armonk, NY, USA) with independent t-test and Chi-square test as appropriate. P < 0.05 was considered statistically significant. RESULTS: The time for first analgesic requirement was 243.00 ± 97.36 min and 447.00 ± 62.52 min and the total analgesic consumption (morphine in mg) was 5.65 ± 1.55 and 3.25 ± 0.78 in Group A and Group B, respectively, both of which were statistically significant (P < 0.01). There was a significant difference in postoperative pain scores (NPIS scale 0-10) at rest, between the two groups, up to 16 h. CONCLUSIONS: Patients who received QL block had a significant improvement in postoperative pain relief with reduced consumption of opioids.
RESUMO
CONTEXT: Dexamethasone as an adjunct to ropivacaine has shown promising results in prolonging the duration of analgesia in transverse abdominis plane (TAP) block. Only limited studies evaluated the effects of dexamethasone with ropivacaine in TAP block in specific population. AIMS: The effects of adding dexamethasone to ropivacaine on the quality and duration of TAP block in lower abdominal surgeries in multiple specialties were studied. SETTINGS AND DESIGN: This was a prospective, randomized, double-blinded study. SUBJECTS AND METHODS: Seventy adult patients undergoing lower abdominal surgeries were allocated into two groups to receive general anesthesia with TAP block with 20 ml 0.25% ropivacaine with 8 mg dexamethasone (2 ml) (Group A, n = 35) or 20 mL 0.25% ropivacaine with 2 ml saline (Group B, n = 35) each side. The analgesic efficacy in terms of pain scores, morphine consumption, and occurrence of nausea and vomiting was compared between two groups. STATISTICAL ANALYSIS USED: Data were analyzed with SPSS 23 with independent t-test and Chi-square test as applicable. P < 0.05 was considered statistically significant. RESULTS: The duration of analgesia was significantly prolonged in Group A (P = 0.000). The total morphine consumption was significantly lesser in Group A (P = 0.000). The pain scores (numerical pain intensity scale) were significantly lesser in Group A till the 8th postoperative hours. The occurrence of nausea and vomiting was comparable between the groups (P = 0.3821). CONCLUSIONS: Addition of dexamethasone to ropivacaine significantly improved the quality of analgesia with reduced consumption of opioids as compared to plain ropivacaine in TAP block.
