Surgical rectus sheath block combined with multimodal pain management reduces postoperative pain and analgesic requirement after single-incision laparoscopic appendectomy: a retrospective study

Background: Laparoscopic cholecystectomy is taken into account as a standard method of performing cholecystectomy and has substituted the old method throughout the world, while laparoscopic appendectomy still not attaining that reputation. In this paper, a retrospective study was done to compare between both laparoscopic and open appendectomy.Methods: Two hundred eighty-five patients were analyzed after appendectomy using either open or laparoscopic procedures. The data was compared over a period of 36 months. Surgical technique was the same among 6 surgeons, standard postoperative care for all patient groups. The outcome measures included comparing of mean operative time, days of hospitalization, postoperative pain and rate of wound infection.Results: Concerning open appendectomy the mean time was 28 minutes with 2 days of hospitalization. The postoperative pain extent was for 36 hours and rate of wound infection was 8/159. While in laparoscopic appendectomy the mean time was 55 minutes with one day hospitalization. The postoperative pain was for 12 hours and zero rate of wound infection.Conclusions: In general laparoscopy has plenty of gains over open surgery as discussed before but laparoscopic appendectomy is not easier, nor does it avoid general anesthesia. The cost for laparoscopic appendectomy is higher than for open appendectomy. The operative and post-operative complications are more critical (e.g.: intra-abdominal abscesses & perforation of bowel) as compared to open appendectomy. We have to assess the advantages and disadvantages, indications and contraindications when taking a decision for laparoscopic surgery. We suppose it would be very early to say that laparoscopic appendectomy is superior or can replace open appendectomy.

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Analgesic combination for robot assisted laparoscopic radical prostatectomy; transversus abdominis plane block and rectus sheath block: Where and how?

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20211457 ◽

2021 ◽

Vol 7 (5) ◽

pp. 284

Author(s):

Sami Kaan Coşarcan

Keyword(s):

Postoperative Pain ◽

Radical Prostatectomy ◽

Rectus Sheath ◽

Transversus Abdominis ◽

Tap Block ◽

Robot Assisted ◽

Rescue Analgesia ◽

Recovery Unit ◽

Rectus Sheath Block ◽

Transurethral Catheter

<p class="abstract">One of the common arguments for advantages of minimally invasive surgery is reduced postoperative pain and faster recovery. Faster recovery is expected with less postoperative pain in robotic surgeries. Robot-assisted radical prostatectomy causes considerable discomfort, mainly during the first postoperative day. The discomfort originates from abdominal pain, bladder spasm and transurethral catheter irritation. We would like to share our experience on use of bilateral subcostal mid axillar TAP block and rectus sheath block for postoperative analgesia in five male patients who underwent robot assisted radical prostatectomy surgery. General anesthesia was performed with 2mg/kg propofol, 1 μg/kg fentanyl, 0.6 mg/kg rocuronium. Anesthesia was maintained by remifentanil infusion and 1 MAC desflurane. After the surgery, TAP block and rectus sheath block performed in supine position. Blocks were done under ultrasound guidance. After the block, patients were extubated. At the end of the surgery patients were administered 1g paracetamol and tramadol 50 mg intravenous. Patients had intravenous tramadol PCA (only bolus dose 10 mg). Rescue analgesia was planned as tramadol 50 mg boluses if VAS scores were above 4 in recovery unit. Neither patient required rescue analgesia nor PCA bolus doses in recovery unit. All patients were satisfied with the analgesia quality. TAP block and rectus sheet block is a very effective combination in robotic prostate surgeries. Perhaps the most important thing is the selection of the most effective analgesic method that contributes to the rapid recovery of the patient.</p>

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Efficacy of ultrasound-guided rectus sheath block, butorphanol for single-incision laparoscopic cholecystectomy: A prospective, randomized, clinical trial

10.21203/rs.2.13618/v2 ◽

2019 ◽

Author(s):

Huimin Fu ◽

Chaochao Zhong ◽

Yongtao Gao ◽

Xingguo Xu

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

General Anesthesia ◽

Visceral Pain ◽

Single Incision ◽

Rectus Sheath ◽

Ultrasound Guided ◽

Rectus Sheath Block ◽

Single Incision Laparoscopic Cholecystectomy ◽

Vas Scores

Abstract Background: Whether rectus sheath block (RSB) combined with butorphanol can relieve incision pain and visceral pain in patients undergoing single-incision laparoscopic cholecystectomy (SILC) remains unknown. The goal of this study was to assess the efficacy of ultrasound-guided bilateral RSB, butorphanol on postoperative analgesia in patients undergoing SILC. Methods: All 116 patients who met the criteria were randomly divided into four groups: (Ⅰ) (n=29) general anesthesia combined with patient controlled intravenous analgesia (PCIA) (sufentanil 100ug); (Ⅱ) (n=29) general anesthesia combined with PCIA (butorphanol 8mg); (Ⅲ) (n=29) ultrasound-guided RSB combined with PCIA (sufentanil 100ug). (Ⅳ) (n=29) RSB combined with PCIA (butorphanol 8mg). Outcomes included visual analog scale (VAS) scores of incisional and visceral pain at rest and cough at 2,6,12 and 24h postoperatively, if a patient’s pain score＞3, then butorphanol 2mg was administered intravenously. the dose of butorphanol and opioids, the pressing numbers of PCIA, the length of hospital stay and the incidence of postoperative adverse events. Results: Both rest and cough pain scores were lower during first 2,6 hours in group Ⅲ than groupⅠ, similarly, group Ⅳwas significantly lower than groupⅡ. GroupⅠneeded more butorphanol as rescue analgesic for pain relief than group Ⅲ, group Ⅳ was better than group Ⅱ. In the above pairwise comparisons, it was clear that group Ⅲ and group Ⅳ had lower VAS scores. VAS scores of visceral pain was lower in groupⅡ at 2, 6 and 12 h after surgery compared with the groupⅠ. In the both groups Ⅲ and Ⅳ, the group Ⅳ was also lower than groupⅢ. Overall, RSB combined with PCIA (butorphanol 8mg) is the best match. Conclusions: Ultrasound-guided RSB combined with butorphanol can provide sufficient pain treatment after SILC. Trial registration: The study was registered prospectively with the Chinese Clinical Trial Registry（reg no.ChiCTR1900020738), obtained ethics committee of Affiliated Hospital of Nantong University approval (approved number: 2018-K067).

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