The analgesic efficacy of ultrasound-guided transversus abdominis plane block with mid-axillary approach after gynecologic laparoscopic surgery: A randomized controlled trial.

BACKGROUND AND AIMS: The transversus abdominis plane (TAP) block is widely used in clinical practice as a part of the multimodal analgesic regimen after abdominal surgery. The analgesic efficacy of ultrasound (US)-guided TAP block with the mid-axillary approach was investigated in patients undergoing laparoscopic gynecologic surgery in a randomized controlled clinical trial. MATERIALS AND METHODS: Adult patients (n = 119) undergoing laparoscopic gynecologic surgery were randomized to undergo either TAP block with ropivacaine (Group A, n = 60) or that with saline (Group B, n = 59), in a blinded manner. Following general anesthesia, TAP block was performed bilaterally by infusion of either 20-mL 0.375% ropivacaine/one side in Group A or 20-mL saline/one side in Group B, under US guidance with a mid-axillary approach. Patient-controlled analgesia (PCA) was performed postoperatively with tramadol. The analgesic effect was postoperatively evaluated using a four-grade pain score and the prince Henry pain scale (PHS) at 0, 6, 12, and 24 h. Postoperative tramadol PCA consumption and vomiting/nausea were recorded. Statistical analyses were performed using the Mann-Whitney U-test or Fisher's exact probability test. A P < 0.05 was considered significant. RESULTS: There was no statistically significant difference in background characteristics. The dose of remifentanil was significantly higher in Group B (P = 0.01). The pain score (P = 0.02) and PHS (P = 0.01) were significantly lower in Group A at 0 h. Tramadol PCA consumption in the period of 0-6 h (P = 0.01) and postoperative nausea (P = 0.04) were significantly less in Group A. CONCLUSION: Postoperative pain/nausea and PCA consumption were significantly lower in patients with TAP block in the early postoperative stage. TAP block with a mid-axillary approach holds considerable promise as a part of a balanced postoperative analgesic regimen following laparoscopic gynecologic surgery.

[Influence of general anesthesia in pregnant patients for gynecologic surgery].

BACKGROUND: Surgery during pregnancy is suspected to have various harmful influences to pregnant patients and fetuses. Although laparoscopic surgery has been recently reported to have some advantages over open surgery in this condition, it often requires general anesthesia. METHODS: The influence of general anesthesia was retrospectively investigated in 12 patients having undergone gynecologic surgery during pregnancy in comparison with 18 with surgery under lumbar and epidural anesthesia. RESULTS: Patients receiving general anesthesia required less pain relief compared with those receiving lumbar and epidural anesthesia. Pregnancy was adequately maintained after surgery in all patients. No abortions or preterm deliveries occurred. There was no significant difference in influence on mother and babies between these two patient groups. CONCLUSIONS: General anesthesia during pregnancy is not necessarily associated with harmful influences on mother and babies compared with lumbar and epidural anesthesia if selected appropriately.

[Comparative study of anesthesia with remifentanil VS fentanyl in terms of postoperative pain and shivering].

BACKGROUND: Remifentanil is reported to be cleared rapidly more than other any opioids. It is considered that this characteristic may lead to an increase in postoperative pain and shivering after general anesthesia with remifentanil. This study was aimed to examine the influence of remifentanil to these adverse symptoms in comparison with fentanyl. METHODS: The subjects consisted of 41 female patients having undergone a total intravenous anesthesia with remifentanil or/and fentanyl for gynecological laparoscopic surgery. RESULTS: There was no significant difference in the occurrence of postoperative pain. Shivering occurred significantly more frequently in patients who had received remifentanil anesthesia, associated with a significant lower body temperature after general anesthesia. CONCLUSIONS: Careful management of intraoperative body temperature is important to prevent the occurrence of shivering after total intravenous general anesthesia with remifentanil.

[Effects of rikkunshito on the postoperative nausea and vomiting (PONV) after laparoscopic gynecological surgery].

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of unignorable complications after general anesthesia. The aim of this study was to examine prophylactic effects of TSUMURA rikkunshito (TJ-43), a herbal medicine consisting of eight herbs, on PONV after laparoscopic surgery. METHODS: One hundred and forty-two female patients undergoing gynecological laparoscopic surgery (ASA-PS1-2) were randomly allocated to one of two groups receiving rikkunshito (n = 91) and control (n = 51). The oral administration of 2.5 g of TJ-43 was commenced the night before surgery and was continued for 3 days after surgery. The suppository form containing 1.5 g of TJ-43 was used during surgery. RESULTS: There were no significant differences of the incidence of PONV between the two groups. The patterns of change in the degree of PONV were similar between the two groups, although TJ-43 group showed slightly earlier reduction in symptom scores. The patients with TJ-43 showed earlier postoperative recovery of oral meal intake. CONCLUSIONS: Perioperative administration of TJ-43 showed a possible effectiveness to reduce the severity of PONV and to promote earlier recovery of oral meal intake after gynecological laparoscopic surgery.