Regional anaesthesia of the trunk

2017 ◽  
Author(s):  
Andrew Berrill ◽  
Will Jones ◽  
David Pegg
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Regional Anaesthesia ◽  
Rectus Sheath ◽  
Transversus Abdominis ◽  
Respiratory Morbidity ◽  
Major Surgery ◽  
Analgesic Regimen ◽  
Continuous Epidural Analgesia

Analgesia of the thorax and abdomen can be challenging. Surgical incisions are commonly associated with severe postoperative pain. Whilst continuous epidural analgesia remains the ‘gold standard’ in terms of postoperative pain relief after major surgery, there remain concerns regarding rare serious side effects. It has been difficult to demonstrate conclusive evidence of improvement in outcomes when epidural analgesia is used. Superior pain relief and a reduction in postoperative respiratory morbidity are, however, clear advantages of regional anaesthesia. Interest has increased in techniques such as paravertebral and rectus sheath blocks in part due to the ready availability of high-definition portable ultrasound equipment, but also in response to concerns regarding neuraxial blockade and the development of enhanced recovery pathways. In addition, novel approaches to analgesia of the trunk, such as the transversus abdominis plane block, have been developed and are now widely used as part of a multimodal analgesic regimen. In this chapter, techniques of neuraxial and peripheral nerve block are discussed along with their indications and complications.

scholarly journals Comparison of analgesic efficacy of continuous transversus abdominis plane block with continuous epidural analgesia in patients undergoing abdominal surgery: a systematic review and meta-analysis

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092269
Author(s):  
Xiangbo Liu ◽  
Cehua Ou ◽  
Fei Peng ◽  
Guo Mu
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Epidural Analgesia ◽  
Meta Analysis ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Chinese Patients ◽  
Transversus Abdominis Plane ◽  
Novel Technique ◽  
Continuous Epidural Analgesia

Background A novel technique of continuous transversus abdominis plane block (TAPB) has been reported to be beneficial to patients undergoing abdominal surgery because it can significantly relieve postoperative pain. The aim of our study is to compare this novel technique with a traditional technique of continuous epidural analgesia (EA). Methods We conducted our meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only randomized controlled trials (RCTs) that compared the efficacy of continuous TAPB and continuous EA to relieve postoperative pain were included. Patients were classified by nationality (Chinese, non-Chinese) for the subgroup analysis. Results Nine RCTs with 598 patients were included in our study. Pain levels measured by visual analog scale (VAS) scores at rest on postoperative day 1 were equivalent for continuous TAPB groups and continuous EA groups in non-Chinese and Chinese patients. The TAPB groups experienced a lower rate of hypotension, sensorimotor disorder, and nausea compared with the continuous EA group within 48 hours after surgery. Conclusion Continuous TAPB and continuous EA are equally effective in relieving postoperative pain at rest 24 hours after surgery, but EA was associated with more side effects such as hypotension, nausea, and sensorimotor disorder.

scholarly journals Combined subcostal and posterior transversus abdominis plane block for postoperative pain relief after abdominoplasty

2021 ◽  
Author(s):  
Haytham El Sayed ◽  
A Shaheed Fadhul ◽  
Mohamed Al Falalki ◽  
M Nasr Awad
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Aesthetic Surgery ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Postoperative Pain Relief ◽  
Secondary Outcome ◽  
Anesthetic Technique ◽  
Transversus Abdominis Plane ◽  
Analgesic Regimen

Abstract Background: Abdominoplasty is a common aesthetic surgery. Adequate pain management during the postoperative period is of great importance. This research aims to investigate the outcome of the abdominoplasty operation for the patients who have received transversus abdominis plan block in comparison with the non-blocked patients.Methods: 58 patients, undergoing elective abdominoplasty, patients were randomly assigned to two equal groups of 29 patients each. Combined subcostal and posterior transversus abdominis plane block group and non-blocked group. For both groups, the standard postoperative analgesic regimen consisted of IV Paracetamol 1 g every 6 hours. Values of visual analog scale (VAS) were recorded postoperatively, once the patient had a VAS ≥ 4, IV opioids administered. The primary outcome was opioids consumption in the first 72 hours postoperatively, the secondary outcome was the value of VAS at rest and movement (or with knee flexion) in the first 72 hours postoperatively, time to first ambulation and time to first incentive spirometer 900 ml/min were recorded.Results: Pethidine consumption in the first 72 hours was 208.62±85.64 in the non-blocked group and 20.69±25.06 in the blocked group (p < 0.05). VAS was lower in the blocked group during the first 72 hours either during rest or movement where (p < 0.05). Time to first ambulation was 12.41±5.04 hours in the non-blocked group and 4.62±1.08 hours in the blocked group (p < 0.05), time to first incentive spirometer 900 ml/min was 11.45±5.05 hours in the non-blocked group and 4.27±1.09 hours in the blocked group (p < 0.05).Conclusion: Combined subcostal and posterior transversus abdominis plane block is a promising regional anesthetic technique for postoperative pain relief in abdominoplasty surgery, it offers a longer postoperative analgesic effect duration and fewer analgesic requirements with less postoperative complications.Trial Registration Clinical Trial: TCTR20200602001 “Retrospectively registered” Date of registration on May 30, 2020

scholarly journals The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy

2019 ◽  
Author(s):  
Jingli Zhu ◽  
Xue-ting Wang ◽  
Jing Gong ◽  
Hai-bin Sun ◽  
Xiao-qing Zhao ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Rectus Sheath ◽  
Postoperative Nausea And Vomiting ◽  
Postoperative Recovery ◽  
Transversus Abdominis Plane Block ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Rectus Sheath Block

Abstract Background Splenectomy performed with a curved incision results in severe postoperative pain. The aim of this study was to evaluate the effect of transversus abdominis plane block and rectus sheath block on postoperative pain relief and recovery.Methods A total of 150 patients were randomized into control (C), levobupivacaine (L) and levobupivacaine plus morphine (LM) groups. The patients in the C group received only patient-controlled analgesia. The patients in the L and LM groups received transversus abdominis plane block and rectus sheath block with levobupivacaine or levobupivacaine plus morphine. The intraoperative opioid consumption; postoperative pain score; time to first analgesic use; postoperative recovery data, including the times of first exhaust, defecation, oral intake and off-bed activity; the incidence of postoperative nausea and vomiting and antiemetics use; and the satisfaction score were recorded.Results Transversus abdominis plane block and rectus sheath block reduced intraoperative opioid consumption. The patients in the LM group showed lower postoperative pain scores, opioid consumption, postoperative nausea and vomiting incidence and antiemetic use and presented shorter recovery times and higher satisfaction scores.Conclusions Transversus abdominis plane block plus rectus sheath block with levobupivacaine and morphine can improve postoperative pain relief, reduce the consumption of analgesics, and partly accelerate postoperative recovery.

scholarly journals The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy

2019 ◽  
Author(s):  
Jingli Zhu ◽  
Xue-ting Wang ◽  
Jing Gong ◽  
Hai-bin Sun ◽  
Xiao-qing Zhao ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Rectus Sheath ◽  
Postoperative Nausea And Vomiting ◽  
Postoperative Recovery ◽  
Transversus Abdominis Plane Block ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Rectus Sheath Block

Abstract Background: Splenectomy performed with a curved incision results in severe postoperative pain. The aim of this study was to evaluate the effect of transversus abdominis plane block and rectus sheath block on postoperative pain relief and recovery.Methods: A total of 150 patients were randomized into the control (C), levobupivacaine (L) and levobupivacaine/morphine (LM) groups. The patients in the C group received only patient-controlled analgesia. The patients in the L and LM groups received transversus abdominis plane block and rectus sheath block with levobupivacaine or levobupivacaine plus morphine. The intraoperative opioid consumption; postoperative pain score; time to first analgesic use; postoperative recovery data, including the times of first exhaust, defecation, oral intake and off-bed activity; the incidence of postoperative nausea and vomiting and antiemetics use; and the satisfaction score were recorded.Results: Transversus abdominis plane block and rectus sheath block reduced intraoperative opioid consumption. The patients in the LM group showed lower postoperative pain scores, opioid consumption, postoperative nausea and vomiting incidence and antiemetic use and presented shorter recovery times and higher satisfaction scores.Conclusions: The combination of transversus abdominis plane block and rectus sheath block with levobupivacaine and morphine can improve postoperative pain relief, reduce the consumption of analgesics, and partly accelerate postoperative recovery.

scholarly journals The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy

2019 ◽  
Author(s):  
Jingli Zhu ◽  
Xue-ting Wang ◽  
Jing Gong ◽  
Hai-bin Sun ◽  
Xiao-qing Zhao ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Rectus Sheath ◽  
Postoperative Nausea And Vomiting ◽  
Postoperative Recovery ◽  
Transversus Abdominis Plane Block ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Rectus Sheath Block

Abstract Background: Splenectomy performed with a curved incision results in severe postoperative pain. The aim of this study was to evaluate the effect of transversus abdominis plane block and rectus sheath block on postoperative pain relief and recovery.Methods: A total of 150 patients were randomized into the control (C), levobupivacaine (L) and levobupivacaine plus morphine (LM) groups. The patients in the C group received only patient-controlled analgesia. The patients in the L and LM groups received transversus abdominis plane block and rectus sheath block with levobupivacaine or levobupivacaine plus morphine. The intraoperative opioid consumption; postoperative pain score; time to first analgesic use; postoperative recovery data, including the times of first exhaust, defecation, oral intake and off-bed activity; the incidence of postoperative nausea and vomiting and antiemetics use; and the satisfaction score were recorded.Results: Transversus abdominis plane block and rectus sheath block reduced intraoperative opioid consumption. The patients in the LM group showed lower postoperative pain scores, opioid consumption, postoperative nausea and vomiting incidence and antiemetic use and presented shorter recovery times and higher satisfaction scores.Conclusions: The combination of transversus abdominis plane block and rectus sheath block with levobupivacaine and morphine can improve postoperative pain relief, reduce the consumption of analgesics, and partly accelerate postoperative recovery.

scholarly journals The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy: a randomized trial

2020 ◽  
Author(s):  
Jingli Zhu ◽  
Xue-ting Wang ◽  
Jing Gong ◽  
Hai-bin Sun ◽  
Xiao-qing Zhao ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Rectus Sheath ◽  
Postoperative Nausea And Vomiting ◽  
Postoperative Recovery ◽  
Transversus Abdominis Plane Block ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Rectus Sheath Block

Abstract Background: Splenectomy performed with a curved incision results in severe postoperative pain. The aim of this study was to evaluate the effect of transversus abdominis plane block and rectus sheath block on postoperative pain relief and recovery. M ethods: A total of 150 patients were randomized into the control (C), levobupivacaine (L) and levobupivacaine / morphine (LM) groups. The patients in the C group received only patient-controlled analgesia. The patients in the L and LM groups received transversus abdominis plane block and rectus sheath block with levobupivacaine or levobupivacaine plus morphine. The intraoperative opioid consumption; postoperative pain score; time to first analgesic use; postoperative recovery data, including the times of first exhaust, defecation, oral intake and off-bed activity; the incidence of postoperative nausea and vomiting and antiemetics use; and the satisfaction score were recorded. Results: Transversus abdominis plane block and rectus sheath block reduced intraoperative opioid consumption. The patients in the LM group showed lower postoperative pain scores, opioid consumption, postoperative nausea and vomiting incidence and antiemetic use and presented shorter recovery times and higher satisfaction scores. Conclusions: The combination of transversus abdominis plane block and rectus sheath block with levobupivacaine and morphine can improve postoperative pain relief, reduce the consumption of analgesics, and partly accelerate postoperative recovery.

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