THE ROLE OF BILATERAL CONTINUOUS TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN MAJOR ABDOMINAL SURGERY: A CASE SERIES PDF Download

Author: Danilo Canzio
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Languages : en
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BACKGROUND The use of loco-regional anesthesia aims at providing an adequate intra- and/or post-operative pain management for a broad spectrum of surgical interventions which historically have relayed on the use of opiod drugs. On this fashion, the aim of our study is to prove that the use of bilateral continuous subcostal TAP block, in a multimodal opiod-sparing analgesic approach, provides a successful post-operative pain management for major abdominal surgical interventions. We adopted the NRS score as a reference and u2264 6 as an acceptable response. METHODS We enrolled (16) patients undergoing major abdominal surgery. A primer infusion of 1gr paracetamol + 30 mg ketoralac was administered 30 minutes prior to the end of the intervention. Moreover, in the immediate post-operative period, via US guidance, a 20 ml bolus of 0.5% levobupivacaine was administered bilaterally. Then, a permanent catheter was placed on both sides with a 2ml/h infusion of 0.5% levobupivacaine (20 ml in 28 ml of 0.9% NaCl). RESULTS In the 30-minutes post-operative period, the NRS score was u2264 4 for all of our patients. Then u2264 3 in the 6, 12 and 24-hour post-operative period. None of our patients requested any supplementary analgesics. CONCLUSIONS The major drawback of this study is the small size of our sample. Further studies might encourage the spread of this procedure as a new gold-standard for laparoscopic interventions (e.g. right hemicolectomy and laparocele) and its non-inferiority to epidural analgesia, the current gold-standard for laparotomic surgeries (especially left hemicolectomy).

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Languages : en
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Background and Goal of Study: Patients scheduled for abdominal aortic aneurysm (AAA) surgery carry a high risk of cardiac, renal or respiratory comorbidities. The post-operative pain control is essential in this population. Transversus abdominis plane (TAP) block has been described as an effective technique to reduce postoperative pain and morphine consumption after gynecologic and lower abdominal surgery but not in open AAA surgery.The aim of this study was to demonstrate the postoperative analgesic efficacy of bilateral dual TAP block by reducing the amount of morphine consumption during the first 24 hours postoperative.Materials and Methods: This randomized, double-blind, controlled, prospective trial approved by the local ethics committee enrolled 60 adult patients with AAA or Leriche syndrome scheduled for an aortic surgery through midline laparotomy. Patients were randomized to receive bilateral dual TAP block using 4 x 10 mL of 0.375% ropivacaine (= 150 mg) (TAP group = 30 patients) or not (CONTROL group = 30 patients). Anaesthetic technique (Remifentanil, Sevoflurane) and postoperative analgesia were standardized. All patients received IV morphine via a morphine patient-controlled analgesia device and IV paracetamol every 6 hours for postoperative analgesia. Postoperative assessments were conducted every hour for the first 48 hours after surgery. Postoperatively pain scores at rest and with movement, total morphine consumption and opioid related side effects were recorded. The primary outcome of the study was total morphine (mg) consumption at 24 hours postoperatively.Results and Discussion: Both groups were comparable as to gender, age, body mass index (BMI), creatinine clearance and ASA physical status. Nine patients (64,3%) in the TAP group had a BMI > 30 kg/m2 and 5 (35,7%) in the CONTROL group. Total morphine consumption at 24 hours was 35,5 mg (+/- 24,2) in the TAP group and 33,3 mg (+/- 19,5) in the CONTROL group (P=0,71). Total morphine consumption at 48 hours was also similar in both groups (58,4 +/- 39 mg vs 60 +/- 35 mg, P=0,85). This non-significant result could be explained by the fact that the dose of ropivacaine wasnu2019t sufficient.Conclusion(s): In our study, bilateral dual TAP block performed in open AAA surgery doesnu2019t show a reduction of morphine consumption during the first 24 hours postoperative. A study with different doses of ropivacaine in this type of surgery could be interesting and refine this work.

Author: Teal Hickey
Publisher:
ISBN:
Category : Analgesics
Languages : en
Pages : 59

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"Introduction: Perioperative pain management and attenuation of the sympathetic stress response is important in achieving positive patient outcomes. Opioids have been at the frontlines of analgesia plans. The untoward side effects of opioids lead practitioners to explore alternative analgesia methods with strategies including use of multimodal pain management, NSAIDs, and peripheral and neuraxial nerve blockade. While single injection bilateral transversus abdominis plane (TAP) blocks prove efficacious in pain management and opioid reduction, there is little evidence on the use of continuous TAP blocks. The purpose of this study is to explore the effects of continuous bilateral TAP blocks on opioid consumption after laparoscopic colorectal surgery. Methods: IRB approval was obtained for a retrospective chart analysis of elective laparoscopic colorectal procedures in a single medical center. All cases received intrathecal narcotics preoperatively. The experimental group received continuous bilateral TAP blocks placed before emergence and continued through postoperative day (POD) 2 while the control group did not. Thirty-four charts were reviewed. Demographics including age, sex, BMI, and ASA classification were collected and analyzed. The dependent variable, perioperative opioid consumption, was collected and analyzed. Secondary outcome measures, including length of stay, readmission, and complications (ileus and respiratory depression), were collected and analyzed. Results: Using a one-tailed t-test, statistical analysis was conducted to establish the significance of the data. Demographic analysis yielded no statistical significance between the control and experimental groups. No statistical significance was found in total morphine equivalents consumed during POD 1 or POD 2. There was no statistical difference in the length of stay, readmission rate, or rate of complications. There was significantly less opioid consumption in the experimental group in the post anesthesia care unit (p = 0.049), during POD zero (p = 0.006), and when comparing total opioid use from surgery through POD two (p = 0.031). Discussion: The use of continuous bilateral TAP blocks has been demonstrated to be an opioid reducing analgesic tool that is effective in patients recovering from laparoscopic colorectal surgery. When added to an enhanced recovery after surgery protocol, we believe that continuous bilateral TAP blocks will serve as an opioid sparing technique that will provide analgesia while allowing patients to return to normal physiological function as quickly as possible. We project that this will translate to fewer complications, a shorter length of stay, greater patient satisfaction, and fewer readmissions. Several theories warrant exploration as to why this study failed to show a significant decrease in opioid use during POD 1 and POD 2 despite the overall decrease in opioid consumption"--Page i.

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Languages : en
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TITLE: EFFICACY OF ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK FOR REDUCING POST-OPERATIVE PAIN AND PERI-OPERATIVE ANALGESIC REQUIREMENT IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERY.ABSTRACT -BACKGROUND AND AIMS: Ultrasound-guided TAP block helps deposit local anaesthetic between the internal oblique and transversus abdominis muscles . Its role as a part of multimodal analgesic technique for gynaecological abdominal surgeries needs to be clearly defined. The objective of this study was to assess TAP block for post-operative analgesia and peri-operative fentanyl requirement.METHODS: After ethics committee approval and obtaining written informed consent, 30 ASA 1 and 2 patients scheduled for Total abdominal hysterectomy and bilateral salpino-oopherectomy using infraumbilical midline vertical incision were recruited. They were randomly divided to receive bilateral pre-incisional TAP block with ropicavaine (group R) or normal saline (group S) using ultrasound guidance. RESULTS: The VAS scores both at rest and movement were less in group R at 0, 4, 8, 12 and until 24 hours post-surgery (p

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Languages : en
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Background and Aims:Patients who undergo major abdominal surgery are at risk of developing acute post-operative pain and it is vital to ensure that they receive adequate post-operative analgesia. Continuous TAP blockade has been shown to be non-inferior to epidural analgesia as part of multimodal pain management for these patients.1 Since 2013, our department has initiated the practice of continuous TAP blockade for patients who undergo abdominal surgery to address the issue of opioid-sparing post-operative pain control. Compared to epidurals, the continuous TAP blockade under ultrasound guidance has a less acute learning curve which residents/registrars would be able to perform with greater confidence. This study objective is to review the trend of continuous TAP and Thoracic Epidural Analgesia (TEA) insertion for abdominal surgery performed by residents.Methods:A retrospective data collection was performed on surgical patients who received either continuous TAP blockade or TEA for major abdominal surgery from 01 Jan 2014 to 1 Jan 2016.Results112 TEA and 84 continuous TAP blockade were performed in 2014 whilst 68 TEA and 144 continuous TAP blockade were performed in 2015 for major abdominal surgery. 27% and 33.8% of TEA were performed by junior anaesthesiologists (residents, registrars or fellows) whilst 77.7% (103) and 75.4% (126) continuous TAP blockade were performed by the junior staff in 2014 and 2015 respectively.Conclusions:With the introduction of TAP catheters, the number of epidurals for abdominal surgery is on the downward trend. Continuous TAP blockade is relatively easier to perform but also offer opioid-sparing analgesia.

Author: Ion Chesov
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Category :
Languages : en
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Background and Goals of the StudyTransversus abdominis plane (TAP) block has been described as effective technique for pain management after abdominal surgery. So far, it is little known about quantitative sensory changes induces by TAP block.The goal of this study was to assess the quantitative sensory changes induced by TAP block in ventral hernia repair.Materials and MethodsThe Research Ethics Committee, Nicolae Tetsemitanu State University of Medicine and Pharmacy reviewed and approved the study protocol. Seventy (23 male, 47 female) consecutive adult (>18 years) patients, without cognitive impairment were enrolled in this study. Subjects (ASA 1-3) were scheduled for elective ventral hernia repair with general anesthesia (induction thiopental or propofol and opioids, maintained with endotracheal tube fentanyl and a mixture of air/O2/sevoflurane, NMBA u2013atracurium).Patients were randomly allocated to receive TAP block (case group u2013 35 subjects) or systemic analgesic drugs (control group - subjects) for postoperative pain treatment. Case group subjects received bilateral USG-guided TAP block with bupivacaine (1 mg/kg per each site). TAP block was performed after the induction of anesthesia before surgery. Control group subjects received morphine and AINS according to institutional pain management protocol.The end points:- preoperative qualitative sensory testing: pain threshold and tolerance; intensity of pain at 48u00b0 C at site of future incision;- postoperative (day 0, day 1) quantitative sensory testing: area and width of hyper- and hypoalgesia; presence of allodynia, hyperpathia, pain intensity at 48u00b0 C, abnormal sensitive sensations around the wound.- postoperative visual analogue scale (VAS) pain score (0, 3, 6, 12, 24 hours) during rest and movement.For comparison of parametric variable T-student test was used and for categorial variables X2 was was applied.ResultsData sets from all 70 subjects were included in final analysis. There was no differences in demographic characteristics and results of preoperative qualitative sensory testing.VAS score was lower in case vs control group:at rest 0h, 3h, 6h, 12h, 24h u2013 10.7 (95%CI, 5.6 - 15.8), 12.82 (95%CI, 8.8 - 16.8), 12.3 (95%CI, 8.3 - 16.3), 12.3 (95%CI, 8.45 - 16.2), 12.5 (95%CI, 8.5 u2013 16.5) vs 44.0 (95%CI, 35 -53), 41 (95%CI, 32 -50), 35 (95%CI, 28 - 42), 35.7 (95%CI, 29 u2013 42.5), 31 (95%CI, 23.7 u2013 39), p

Author: Oliver Wilder-Smith
Publisher: Lippincott Williams & Wilkins
ISBN: 149632031X
Category : Medical
Languages : en
Pages : 398

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Postoperative Pain: Science and Clinical Practice compiles the proceedings of the November, 2013 IASP Research Symposium on Operative Pain into one convenient volume, giving you clinically relevant and research-driven information on the state of the art in postoperative pain. Global experts from the IASP provide practical knowledge on everything from basic research in animals to human research on clinical questions of diagnosis and treatment – information that’s ideal for pain researchers and clinicians who deal with perioperative pain.

Author: Phantila Cholvisudhi
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Languages : en
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Background: Enhanced recovery after surgery (ERAS) protocols have increased popularity among colorectal surgeons with being proven to reduce significantly complications, the length and cost of hospitalisation. One of key items considered is the new evidence, and modern alternatives to morphine-based analgesic regimens. While closure loop stoma can be apparently performed as a minor surgery, these patients still suffer from postoperative severe pain due to lysis of adhesion and tension of abdominal wall. With many benefits of transversus abdominis plane (TAP) block such as reduced postoperative pain and opioid consumption, less nausea and emesis, we modified a technique of continuous TAP block (MCTAP) by inserting a catheter into TAP plane by the surgeon under direct visualization for these patients. In the basis of targeted therapy, we also used extreme low dose of local anesthetics continuous infusion. The aim of this analytic cohort study was to evaluate the analgesic effectiveness of MCTAP block compared with opioid-based analgesia in stoma reversal patients.Methods: Patients undergoing closure loop stoma during January 2014 and December 2015 were examined and divided into two groups. Patients receiving continuous infusion of 2 ml/hr bupivacaine 0.2% over three consecutive postoperative days plus intravenous morphine injection as needed were enrolled in MCTAP group, while patients receiving only intravenous morphine injection on demand were in conventional group. Opioid consumption, numeric rating pain scores (NRPS) over three consecutive postoperative days, time to bowel function returns, and surgical recovery were recorded.Results: A total of 42 patients underwent closure loop stoma. Of these, 20 were in MCTAP group and 22 in conventional group. Total morphine consumption in MCTAP patients was significantly lower than conventional patients (7.4, 19.59 mg respectively, P

Author: Chester Buckenmaier (III)
Publisher: Government Printing Office
ISBN: 9780160927539
Category : Medical
Languages : en
Pages : 620

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Developed by UK and US anesthetists with extensive experience in theater, this book describes the latest anesthesia techniques, practices, and equipment used in current combat and humanitarian operations. Includes chapters on topics such as injuries and physiology, team members, protocols, vascular access, airway management, burns, imaging, pain management and medications, regional anesthesia, ventilation, and postoperative management.