RESUMO
The study objective of this prospective, double-blind randomised controlled study was to evaluate the efficacy of ultrasound guided transversus abdominis plane (TAP) block and bupivacaine infiltration of the skin and subcutaneous tissue of the wound in patients undergoing hysterectomy. Patients were randomly allocated to three groups: a control group (n = 18) and TAP block group (n = 18) received bilateral TAP blocks with saline and bupivacaine respectively, and an infiltration group (n = 19) received skin and subcutaneous wound tissue infiltration with bupivacaine at the end of surgery. After surgery patients received patient-controlled intravenous tramadol and were assessed for pain and tramadol consumption at 1, 2, 4, 6 and 24 hours. Both the TAP and infiltration groups had lower movement and rest pain scores than the control group, with lower scores in the TAP group than the infiltration group at 6 and 24 hours. Total tramadol consumption was significantly lower in the TAP group than in the other groups at all time points. We concluded that ultrasound-guided TAP block reduced rest and movement pain after total abdominal hysterectomy and was more effective than superficial wound infiltration for postoperative pain management.
Assuntos
Abdome/diagnóstico por imagem , Histerectomia/métodos , Bloqueio Nervoso/métodos , Adulto , Idoso , Analgesia Controlada pelo Paciente , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestesia Local , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Bupivacaína/administração & dosagem , Bupivacaína/uso terapêutico , Método Duplo-Cego , Eletrocardiografia , Determinação de Ponto Final , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Tramadol/administração & dosagem , Tramadol/uso terapêutico , UltrassonografiaRESUMO
Burn scars in early childhood often impairs normal development of the structures of the face. Multiple reconstructive interventions contribute to airway deformity with excessive scar and contracture band formation. Such patients are the most difficult group because of the risk of difficult ventilation and intubation in anesthesiology practice. Although developments in complex airway management techniques are increased, solutions may be achieved with simple approaches. For this purpose, we report about a patient with an anticipated difficult airway who has rejected awake fiberoptic intubation. The patient was managed successfully using classical laryngeal mask airway and nasogastric tube with the guidance of fiberoptic bronchoscope under deep sedation.
