Effect of needle type on plane block spread in a cadaveric porcine model

2021 ◽  
pp. bmjmilitary-2021-001827
Author(s):  
Scott Hughey ◽  
J Cole ◽  
G J Booth ◽  
R Gliniecki ◽  
E Stedjelarsen
Keyword(s):  
Plain Film ◽  
Perioperative Period ◽  
Transversus Abdominis ◽  
Tuohy Needle ◽  
Rank Test ◽  
Tap Block ◽  
Ultrasound Guided ◽  
Standard Block ◽  
Signed Rank Test ◽  
The Difference

IntroductionPlane blocks are an increasingly common type of regional anaesthesia technique in the perioperative period. Increased spread of local anaesthesia during plane blocks is thought to be related to an increased area of pain coverage. This study sought to assess differences in injectate spread comparing Tuohy needles with standard insulated stimulating block needles.Methods10 Yorkshire-Cross porcine cadavers were used in this study. Immediately following euthanasia, the cadavers underwent bilateral ultrasound-guided transversus abdominis plane (TAP) block injection with radiopaque contrast dye, with one side placed with a 20 g Tuohy needle, and the other side with a 20 g insulated stimulating block needle. Injectate spread was assessed using plain film X-ray and area of spread was measured to compare differences.ResultsAll 10 animals underwent successful ultrasound-guided TAP block placement. In all 10 animals, the area of contrast spread was greater with the Tuohy than stimulating needle. Wilcoxon signed-rank test was used to analyse the difference between the groups. The average difference between the two sides was 33.02% (p=0.002).ConclusionsThis is the first study to demonstrate differences in injectate spread with different needle types. This suggests enhanced spread with Tuohy needle compared with standard block needle, and may encourage its use during plane blocks.

scholarly journals A COMPARATIVE STUDY OF CAUDAL BLOCK AND ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK WITH LEVOBUPIVACAINE AND DEXAMETHASONE AS ADDITIVE IN EXTRAPERITONEAL LOWER ABDOMINAL SURGERIES IN PEDIATRICS

2021 ◽  
pp. 173-176
Author(s):  
SANDHYA GHODKE ◽  
MADHAVI N ◽  
HIREMATH RN
Keyword(s):  
General Anesthesia ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Caudal Block ◽  
Ultrasound Guided ◽  
Operative Complications ◽  
The Mean ◽  
The Difference ◽  
Post Operative Complications

Objective: The objective of the study was to evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block versus caudal block for post-operative analgesia with levobupivacaine and dexamethasone as additive in extraperitoneal lower abdominal surgeries in pediatrics as there is no available literature showing the same. Methods: This is a randomized control study carried out between two groups among 50 children (1–8 years of age), both sexes, posted for elective extraperitoneal lower abdominal surgeries after taking informed consent from parents. Fifty children were randomly allocated into two groups, 25 in each group. Caudal epidural (CE) group received general anesthesia and caudal block with 1 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. TAP group received general anesthesia and ultrasound-guided TAP block with 0.5 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. Data were collected by means of pre-designed format with pre-/post-operative assessment with standardized scores. Results: The mean age of the patients was 4.84 (SD=2.29). Mean face, legs, activity, cry, and consolability score was low and non-significant before shifting the patient (<2 h post-operative [post-op]) in both the groups. Thereafter from 2 to 12 h, the mean score increased to 4.92 (SD=2.72) in the CE group and 2.92 (SD=2.17) in the TAP group and the difference was statistically significant at 2 h, 4 h, 6 h, and 12 h postoperatively. Mean time to rescue analgesia in the CE group was 4.96 h (SD=4.32) and 5.52 h (SD=7.53) in the TAP group and difference was statistically significant (p=0.000). Mean total rescue analgesic requirement for the CE and TAP groups was 298.40 mg (SD=170.70) and 111.40 mg (SD=138.81) and the difference was also significant. Post-operative complications such as urinary retention and motor blockade were seen in 28% of CE patients, while none of the patients experienced post-operative nausea/vomiting. Conclusions: Our study showed significant increase in duration of post-operative analgesia among TAP patients with reduced requirement of rescue analgesics and lesser post-operative complications as compared to CE patients

The Degree of Subjective Complaints of Students Practice in Mechanical Technology Laboratories

2018 ◽  
Vol 4 (1) ◽  
pp. 22
Author(s):  
I Ketut Widana
Keyword(s):  
Engineering Students ◽  
Standing Position ◽  
Statistical Test ◽  
Rank Test ◽  
Cross Sectional ◽  
Signed Rank ◽  
Before And After ◽  
Signed Rank Test ◽  
The Difference ◽  
Paired T Test

The working practice of the engineering students is part of the learning process that is irreducible and indispensable. The composition of  lecturing between theoretical and practical one is 40% to 60%. With this condition, the students spend more time at the laboratory. Generally, the students perform in the laboratory work by standing position. The design of research is observational cross-sectional. The method applied is observation, interview and measuring. The subjects of research are practicing students amounting to 21 students. Referring to the analysis of statistical test or Wilcoxon signed ranks test, the difference of effect of work position is significant, namely p < 0.05 towards musculoskeletal disorders (MSDs) before and after working. The quantity of the average complaint after working is score 44.62 ± 9.47. The result of Wilcoxon signed rank test shows that there is significant different effects of standing work position, namely p < 0.05 towards fatigue generally before and after working. The degree of the working pulse is on the average of 110.78  ± 17.80 bpm (beats per minutes) which can be categorized into the medium workload. Using paired t-test, the result is p < 0.05.

scholarly journals Transversus abdominis Plane Block for Improved Early Postoperative Pain Management after Periacetabular Osteotomy: A Randomized Clinical Trial

2021 ◽  
Vol 10 (3) ◽  
pp. 394
Author(s):  
Jannis Löchel ◽  
Viktor Janz ◽  
Vincent Justus Leopold ◽  
Michael Krämer ◽  
Georgi I. Wassilew
Keyword(s):  
Postoperative Pain ◽  
Periacetabular Osteotomy ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Control Group ◽  
Block Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Pain Scores

Background: Patients undergoing periacetabular osteotomy (PAO) may experience significant postoperative pain due to the extensive approach and multiple osteotomies. The aim of this study was to assess the efficacy of the transversus abdominis plane (TAP) block on reducing opioid consumption and improving clinical outcome in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial in 42 consecutive patients undergoing a PAO for symptomatic developmental dysplasia of the hip (DDH). The study group received an ultrasound-guided TAP block with 20 mL of 0.75% ropivacaine prior to surgery. The control group did not receive a TAP block. All patients received a multimodal analgesia with nonsteroidal anti-inflammatory drugs (NSAID) (etoricoxib and metamizole) and an intravenous patient-controlled analgesia (PCA) with piritramide (1.5 mg bolus, 10 min lockout-time). The primary endpoint was opioid consumption within 48 h after surgery. Secondary endpoints were pain scores, assessment of postoperative nausea and vomiting (PONV), measurement of the quality of recovery using patient-reported outcome measure and length of hospital stay. Forty-one patients (n = 21 TAP block group, n = 20 control group) completed the study, per protocol. One patient was lost to follow-up. Thirty-three were women (88.5%) and eight men (19.5%). The mean age at the time of surgery was 28 years (18–43, SD ± 7.4). All TAP blocks were performed by an experienced senior anaesthesiologist and all operations were performed by a single, high volume surgeon. Results: The opioid consumption in the TAP block group was significantly lower compared to the control group at 6 (3 mg ± 2.8 vs. 10.8 mg ± 5.6, p < 0.0001), 24 (18.4 ± 16.2 vs. 30.8 ± 16.4, p = 0.01) and 48 h (29.1 mg ± 30.7 vs. 54.7 ± 29.6, p = 0.04) after surgery. Pain scores were significantly reduced in the TAP block group at 24 h after surgery. There were no other differences in secondary outcome parameters. No perioperative complication occurred in either group. Conclusion: Ultrasound-guided TAP block significantly reduces the perioperative opioid consumption in patients undergoing PAO.

scholarly journals Analyzing the use of linking words in concept maps designed for pathophysiology learning in medicine

2021 ◽  
Author(s):  
Nuno Neuparth ◽  
Marta Fonseca ◽  
Beatriz Oliveira ◽  
Inês Canha ◽  
Hélder Dores ◽  
...  
Keyword(s):  
Concept Mapping ◽  
Concept Maps ◽  
Clinical Case ◽  
Visual Display ◽  
Rank Test ◽  
Clinical Vignettes ◽  
Signed Rank ◽  
Signed Rank Test ◽  
The Difference

Pathophysiology at NOVA Medical School adopted the concept mapping methodology to promote the visual display of pathophysiological reasoning and learning, based on clinical vignettes. The objective of this project is to identify and label the linking words, in order to study their role in the structure and organization of the concept maps constructed by the students. We used an adopted classification of linking words, categorized in 5 groups: dynamic, static, illustrative, definition and clinical case information. At the end of the semester the concept maps related to the respiratory (mid-semester) and endocrine systems (end of semester) were analyzed and compared. We found linking words not included in any of the five categories, thus a group named “other” has been created. Statistically significant differences were found in dynamic and “other” categories (p=0,049 and p= 0,011, respectively; Wilcoxon signed-rank test). The dynamic words were the most commonly used, probably reflecting students’ need to better describe pathophysiological mechanisms, and the difference found was probably due an improvement in the learning process and concept maps building technic. It would be interesting next year to conduct a more detailed analysis, increasing the sample and ensuring a more robust dataset. 

scholarly journals Pre and Post test Clinical study to evaluate the Immunomodulatory effect (IgE) of Virecana followed by Citrakaharitaki Leha in Allergic Asthma

2021 ◽  
Vol 12 (1) ◽  
pp. 53-61
Author(s):  
Jyotish S Jayandan ◽  
James Chacko ◽  
Devipriya Soman ◽  
Mahesh C Kundagol
Keyword(s):  
Clinical Study ◽  
Allergic Asthma ◽  
Rank Test ◽  
Drug Induced ◽  
Paired Samples ◽  
Management Protocol ◽  
Post Test ◽  
Signed Rank Test ◽  
Significant Change ◽  
The Difference

Allergic Asthma is one among the diseases which imposes a great burden on the subjects by hampering the quality of life of patients, reducing productivity, and causing work absence. The literary search hinted that there are no published works reporting both clinical and immunological(IgE) outcomes in Allergic Asthma. So the present study was a pre and post test clinical study to evaluate the effect of Ayurvedic line of management in inducing both immunological(IgE) and clinical outcomes in Allergic Asthma. In this study 30 patients were administered classical Virecana Karma (drug induced purgation) followed by Shamanoushadi (internal medicine) for 30 days. Statistical Analysis was done using SPSS VER. 20. Wilcoxon signed rank test was used to evaluate the Subjective parameters, in order to interpret the time of significant change. For objective parameters Paired Samples t- Test was used to evaluate the difference of significant change. The results showed improvement in the subjective criteria, objective criteria and the overall effect of the therapy with the exception of no statistically significant results in immunomodulatory (IgE) effect which proves that the particular management protocol adopted is found to be clinically efficant but not effective in inducing changes at the immune level.

Comparison between Ultrasound Guided Transversus Abdominis Plane Block versus Ultrasound Guided IlioInguinal/Iliohypogastric Nerves Block for Postoperative Analgesia in Patients Undergoing Unilateral Oblique Inguinal Hernia Repair Under General Anesthesia

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Shrouk Ayman Mohamed Soliman Faramawy ◽  
Samia Abdel-Mohsen Abdel-Latif ◽  
Mohamed Abdel-Salam Menshawe Abdel-Atte ◽  
Ibrahim Mohammed El Sayed Ahmed
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
General Anesthesia ◽  
Inguinal Hernia Repair ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Pain Scores

Abstract Background Inguinal hernia considered the third common disease in surgeries for adults after acute appendicitis and proctologic disorders. About 20 millions of inguinal hernia repairs are performed globally. Inguinal herniorrhaphy is frequently associated with persistent postoperative pain. Objectives The aim of this study is to assess the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared to ilioinguinal/iliohypogastric nerves block after unilateral inguinal hernia repair regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods The study was conducted on 70 randomly chosen patients aged 21 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective unilateral open inguinal hernia repair under general anesthesia, in Ain Shams University Hospitals after approval of the medical ethical committee. Results The results of the study revealed that there is Patients receiving TAP block had significantly lower pain scores at 4 h and 6 h after operation, delay time for rescue analgesia and decrease total need of analgesic in first 24 h post operative compared with patients who received ilioinguinal/ iliohypogastric nerves block. Conclusion TAP block was effective in reducing postoperative pain scores for 4-6 hours, lowering total 24-h postoperative opioid and analgesic consumption and delaying the need for rescue analgesia after inguinal hernia repair under general anesthesia, compared to ilioinguinal/iliohypogastric nerves block. This technique can be a promising mode of postoperative analgesia when epidural catheter insertion is contraindicated.

Abstract 108: Optimal In-Hospital Defibrillator Placement

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Kwan Hon Benjamin Leung ◽  
Matthew Yang ◽  
Christopher Sun ◽  
Katherine S Allan ◽  
Natalie Wong ◽  
...  
Keyword(s):  
Average Distance ◽  
Mathematical Optimization ◽  
Rank Test ◽  
Relative Decrease ◽  
Signed Rank ◽  
Out Of Sample ◽  
Signed Rank Test ◽  
Academic Teaching Hospital ◽  
Mathematical Optimization Model ◽  
The Difference

Introduction: Delays in defibrillation of in-hospital cardiac arrests (IHCAs) can reduce the likelihood of survival. Mathematical optimization has been shown to improve public location defibrillator placement but has not been applied to in-hospital defibrillator placement. Objective: To determine if mathematical optimization of in-hospital defibrillator placements can reduce distances to IHCAs compared to current placements in a large academic teaching hospital. Methods: We identified all treated IHCAs and defibrillator placements in St. Michael’s Hospital in Toronto, Canada from Jan. 2007 to Jun. 2017 and mapped them to a 3-D representation of the hospital that we developed from blueprints. An equal number of optimal defibrillator locations was identified using a mathematical optimization model that minimizes the average distance between IHCAs and the closest defibrillator in a 10-fold cross-validation approach. The optimized and current defibrillator locations were compared in terms of average distance to the out-of-sample IHCAs in each fold. We repeated the analysis excluding IHCAs and defibrillators in intensive care units (ICUs), operating theaters (OTs), and the emergency department (ED). Significance in the difference of average distance was determined using a Wilcoxon signed-rank test. Results: We identified 537 treated IHCAs and 53 defibrillators within the hospital during the study period. Of these, 236 IHCAs and 38 defibrillators were outside of ICUs, OTs, and the ED. Optimal defibrillator placements reduced the average defibrillator-to-IHCA distance from 17.1 m to 3.8 m, a relative decrease of 77.8% (P<0.01) on all IHCAs compared to current defibrillator placements. For non-ICU/OT/ED IHCAs, the average distance was reduced from 18.3 m to 9.8 m, a relative decrease of 46.4% (P<0.01). Conclusion: Optimization-guided placement of in-hospital defibrillators can significantly reduce the distance from an IHCA to the closest defibrillator.

scholarly journals The analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic renal surgery: a randomized controlled study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xue Li ◽  
Zhen-Zhen Xu ◽  
Xue-Ying Li ◽  
Ting-Ting Jiang ◽  
Zeng-Mao Lin ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Abdominal Wall ◽  
Analgesic Efficacy ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Controlled Study ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Renal Surgery

Abstract Background Ultrasound-guided lateral transversus abdominis plane (TAP) block can provide definite analgesia to the anterior abdominal wall. However, whether this method is useful in renal surgery through the lateral abdominal wall pathway remains unknown. The study aimed to evaluate the analgesic efficacy of lateral TAP block for retroperitoneoscopic partial or radical nephrectomy. Method In this prospective, randomized, double-blind, placebo-controlled trial, eligible patients were randomized into two groups. After anaesthesia induction, ultrasound-guided lateral TAP block was performed with either 30 ml of 0.4% ropivacaine (Group T) or an equivalent volume of normal saline (Group C). The primary outcomes were opioid consumption during surgery and in the first 24 h after surgery. Secondary outcomes included postsurgical pain intensity immediately awakening from anaesthesia and at 0.5, 1, 2, 6, 12, and 24 h after surgery, as well as recovery variables including the incidence of postoperative nausea and vomiting (PONV), sleep quality, time to first ambulation, drainage and length of hospital stay. Results A total of 104 patients were enrolled and randomized (53 in Group T and 51 in Group C). Laparoscopic surgery was converted to open surgery in one patient of Group T; this patient was excluded from the outcome analysis. The opioid consumption during surgery (intravenous morphine equivalent dose: median 35.0 mg [interquartile range 18.0, 49.6] in Group C vs. 40.3 mg [20.9, 59.0] in Group T, P = 0.281) and in the first 24 h after surgery (10.8 mg [7.8, 21.7] in Group C vs. 13.2 mg [8.0, 26.6] in Group T, P = 0.311) did not differ significantly between groups. There were no significant differences between groups regarding the pain intensity at all time points after surgery and the recovery variables (all P > 0.05). Conclusions Our results showed that, in patients undergoing retroperitoneoscopic renal surgery, preoperative lateral TAP did not decrease intra- and postoperative opioid consumption, nor did it relieve pain intensity or promote postoperative recovery in the first 24 h after surgery. However, the trial might be underpowered. Trial registration This study was registered on November 4, 2017, in the Chinese Clinical Trail Registry with the identification number ChiCTR-INR-17013244.

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