scholarly journals Adding low concentrations of clonidine to ropivacaine for transversus abdominis plane blocks does not reduce plasma ropivacaine levels, suggesting a lack of vasoconstrictor effect

2019 ◽  
Vol 47 (2) ◽  
pp. 134-140
Author(s):  
Jennifer M Crawford ◽  
John A Loadsman ◽  
Kenny XF Yang ◽  
Peter CA Kam
Keyword(s):  
Local Anaesthetics ◽  
Transversus Abdominis ◽  
Control Group ◽  
Transversus Abdominis Plane ◽  
Nerve Blocks ◽  
Duration Of Action ◽  
Low Concentrations ◽  
Vasoconstrictor Effect ◽  
Surrogate Measure ◽  
To Receive

Clonidine has been used successfully to prolong the duration of action of local anaesthetics in peripheral nerve blocks, but its mechanism of action in this setting remains unclear. Some studies suggest that clonidine exerts a vasoconstrictor effect, limiting the washout of local anaesthetic from its site of deposition. We investigated this potential vasoconstrictor effect, using plasma ropivacaine concentrations as a surrogate measure of vasoconstriction, in patients who received transversus abdominis plane (TAP) blocks with and without clonidine. Eighty women undergoing laparoscopic gynaecological surgery were randomly assigned to receive one of four TAP block solutions: 0.2% ropivacaine (control), ropivacaine with clonidine 2 μg/kg (clonidine), ropivacaine with 1:400,000 adrenaline (adrenaline) or ropivacaine and a subcutaneous injection of clonidine 2 μg/kg (SC clonidine). The primary outcome was total venous plasma ropivacaine concentrations up to 6 h after the block. There were no significant differences in plasma ropivacaine concentrations between the control group and the clonidine group at any timepoint in the study, nor were there differences in either the mean maximum ropivacaine concentration ( Cmax) (1.99 μg/mL versus 2.05 μg/mL, P = 0.712) or the time to maximum concentration ( Tmax) (51.0 min versus 56.0 min, P = 0.537). The SC clonidine group also did not differ significantly from the controls ( Cmax 2.13 μg/mL versus 1.99 μg/mL, P = 0.424; Tmax 43.5 min versus 51.0 min, P = 0.201). Plasma ropivacaine concentrations in the adrenaline group were significantly lower than the controls from 10 to 90 min ( P < 0.003 for each comparison), and the Cmax was less than that of the control group (1.36 μg/mL versus 1.99 μg/mL, P < 0.001) with a longer Tmax (103.5 min versus 51.0 min, P = 0.001). These findings indicate that clonidine at a concentration of 1.35 μg/mL added to ropivacaine for TAP blocks did not produce a reduction in plasma ropivacaine concentrations. This suggests a lack of vasoconstrictor effect during TAP blocks. Further studies should evaluate whether vasoconstriction occurs when clonidine is used at higher concentrations or for other blocks.

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 A Rapid and Effective Method to Prolong Pain Relief in Sheep Using Bupivacaine and Intralipid ® Combination

2019 ◽  
Vol 4 (3) ◽  
pp. 1-6
Author(s):  
Farzin Sahebjam
Keyword(s):  
Nerve Block ◽  
Final Concentration ◽  
Noxious Stimulus ◽  
Control Group ◽  
Multiple Time ◽  
Treatment Results ◽  
Time Intervals ◽  
Nerve Blocks ◽  
Duration Of Action ◽  
The Mean

Background : To compare the duration of action of a local anesthetic block using a lipid formulation of bupivacaine to the commercially available aqueous formulation. Bupivacaine 0.5% was mixed with an equal volume of either lipid emulsion (Intralipid, Fresenius Kabi) or normal saline resulting in a final concentration of 0.25% bupivacaine. Eighteen sheep were administered a n erve block of either control or treatment at the metacarpal region of each forelimb to compare the efficacy of the injected formulations. The nociceptive test was determined by applying a blunt noxious stimulus to the foot below the nerve block at multiple time intervals until the sheep responded by withdrawing its foot. The person assessing the response to the noxious stimulus was blinded to the treatment. Results: The Intralipid formulation significantly extended the duration of the nerve block compared to the control group. The mean analgesic period (mean±SD) in the control legs was 4.23±1.8 hr. compared to 5.81±1.78 hr. in the Intralipid injected legs (p=0.013). Conclusions : In conclusion, an Intralipid® - based formulation provided a more prolonged dura tion of local anesthesia after nerve blocks in the sheep metacarpal region compared to aqueous bupivacaine.

Transversus Abdominis Plane and Rectus Sheath Blocks

2021 ◽  
pp. 81-88
Author(s):  
Natalea Johnson ◽  
Jorge A. Pineda
Keyword(s):  
Abdominal Wall ◽  
Umbilical Hernia ◽  
Visceral Pain ◽  
Rectus Sheath ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Nerve Blocks ◽  
Rectus Sheath Block ◽  
Intercostal Nerves

Chapter 9 discusses truncal peripheral nerve blocks, which are utilized for supplemental analgesia for abdominal surgeries by providing local anesthesia to the anterior abdominal wall. These blocks are adjuvants because they will not block visceral pain. Unilateral analgesia to the skin, muscles, and parietal peritoneum of the abdominal wall is achieved. The transversus abdominis plane block (TAP) reliably provides analgesia to the lower abdominal wall in the T10–L1 distribution. Rectus sheath blocks anesthetize the terminal branches of the lower thoracic intercostal nerves and provide midline analgesia from the xiphoid process to the umbilicus. Surgical indications for TAP blocks include laparotomies, laparoscopies, inguinal hernia repairs, and appendectomies. Rectus sheath block indications include midline surgeries such as single-port appendectomies and umbilical hernia repairs.

Injections in rehabilitation medicine

2019 ◽  
pp. 203-212
Author(s):  
Manoj Sivan ◽  
Margaret Phillips ◽  
Ian Baguley ◽  
Melissa Nott
Keyword(s):  
Botulinum Toxin Injection ◽  
Local Anaesthetics ◽  
Rehabilitation Medicine ◽  
Nerve Blocks ◽  
Duration Of Action ◽  
Steroid Injections ◽  
Injection Techniques ◽  
Local Steroid Injection ◽  
Neurological Conditions ◽  
Outpatient Settings

Injection-based interventions are a useful addition to the rehabilitation physician’s practice. These can occur in either inpatient or outpatient settings and be for musculoskeletal (e.g. joint/soft tissue injections) or neurological conditions (such as antispasticity injections and nerve blocks). Local steroid injection is a well-proven and effective treatment for focal pain and inflammation, and this chapter covers commonly used steroid injections, as well as different agents and procedures with their indications (including botulinum toxin injection). It provides a guide to the use of appropriate general injection techniques and includes tables showing the dose and duration of action of commonly used steroids and local anaesthetics for injections.

scholarly journals Effectiveness of Transversus Abdominis Plane Block for Postoperative Analgesia in Obstetric Cases Undergoing Caesarean Section

2019 ◽  
Vol 4 (2) ◽  
pp. 755-758
Author(s):  
Roshan Pradhan ◽  
Seema Kumari Mishra ◽  
Lalit Kumar Rajbanshi ◽  
Kanak Khanal ◽  
Batsalya Arjyal ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pain Score ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia ◽  
Visual Analogue Pain ◽  
Significant Difference

Introduction: Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption. Objective: To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section. Methodology: This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively. Results: Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points.  Conclusion: The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.

scholarly journals A prospective study of efficacy of ultrasound guided transversus abdominis plane block for postcesarean analgesia

2019 ◽  
Vol 8 (5) ◽  
pp. 1951
Author(s):  
Sravani Manam ◽  
R. N. V. Swetha ◽  
A. S. Kameswara Rao ◽  
S. G. K. Murthy
Keyword(s):  
Total Dose ◽  
Postoperative Period ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Significant Difference ◽  
Group B

Background: The ultrasound guided transversus abdominis plane (TAP) block which provides effective analgesia after lower abdominal surgeries including caesarean section. It is a simple and reliable technique. In this prospective, randomized double-blind study, we determined the efficacy of TAP block using 0.25% Bupivacaine and 0.9N Saline with respect to VAS for pain, postoperative Tramadol consumption and post-operative ondansetron usage.Methods: This study was conducted on 100 adult patients of ASA physical status I and II in the   age group of 18 to 40 years undergoing elective lower segment cesarean section under spinal anaesthesia. Study group received TAP block with 0.25% Bupivacaine and control group received 10 ml of 0.9N saline on each side. Patients were analyzed for postoperative pain by pain score (at rest, on movement, on cough) using VAS was recorded at 0, ½, 1, 2, 4, 6, 12 and 24 hours postoperatively. Need for rescue analgesia was assessed by time to first dose of Tramadol requirement and total dose of Tramadol over 24 hours of postoperative period. Ondansetron (4 mg i.v.) was administered whenever nausea score was more than 2 or the patient vomited. All the data was noted using uniform performs.Results: Patients received TAP block with 0.25% Bupivacaine had better pain scores at first hour of postoperative period during rest, cough and movement which was statistically significant (p<0.0010) in comparison to group B. There was a statistically significant difference (p <0.001) in the requirement of total dose of Tramadol as a rescue analgesia in patients who received transversus abdominis block with 0.25% Bupivacaine (138.77 mg) in comparison with other group(240 mg).The mean time to first request for Tramadol was significantly longer in group A (5.8 hrs)  in comparison to group B (1.93 hrs) with p value <0.001. Patients received TAP block with 0.9N saline needed more dose of Ondansetron, however, the difference was not statistically significant (p >0.001).Conclusions: TAP block using ultrasound provides substantial reduction in Tramadol consumption, time to first dose of rescue tramadol when compared with control group. This study reinforces the recommendation for TAP as a part of multimodal post-operative analgesic regimen.

scholarly journals Open transversus abdominis plane block and analgesic requirements in patients following right hemicolectomy

2012 ◽  
Vol 94 (5) ◽  
pp. 327-330 ◽  
Author(s):  
RR Brady ◽  
NT Ventham ◽  
DM Roberts ◽  
C Graham ◽  
T Daniel
Keyword(s):  
Enhanced Recovery ◽  
Intervention Group ◽  
Right Hemicolectomy ◽  
Transversus Abdominis ◽  
Control Group ◽  
Complication Rates ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Post Operative Period ◽  
Early Return

INTRODUCTION Reducing exogenously administered opioids in the post-operative period is associated with early return of bowel function and decreased post-operative complication rates. We evaluated the effectiveness of a surgeon-delivered open transversus abdominis plane (TAP) block as a method to reduce post-operative opioid requirements, sedation and inpatient stay. METHODS The patient cohort was identified from those who had undergone a right hemicolectomy for colonic cancer. Patients received either an open TAP block and post-operative patient controlled anaesthesia (PCA) (n=20) or were part of a control group who received subcutaneous local anaesthetic infiltration and PCA (n=16). RESULTS PCA morphine use was reduced within the first 24 hours post-operatively in the TAP block group compared with controls (42.1mg vs 72.3mg, p=0.002). Sedation was also reduced significantly in the early post-operative period (p<0.04). There was a non-significant trend towards reduced length of stay in the intervention group (8.2 vs 8.73 days). There were no recorded complications attributable to the open TAP block. CONCLUSIONS Open TAP blocks are safe and reduce post-operative opioid requirements and sedation after right hemicolectomies. They should be considered as part of a multimodal enhanced recovery approach to patients undergoing abdominal surgery via a transverse incision.

scholarly journals Comparison of Efficacy of 0.25 % Ropivacaine with Dexmedetomidine versus 0.25 % Ropivacaine Alone for Transversus Abdominis Plane Block for Post-Operative Analgesia in Patients Undergoing Lower Segment Caesarean Section - A Prospective Randomized Clinical Study

2021 ◽  
Vol 8 (17) ◽  
pp. 1133-1138
Author(s):  
Shraddha Agrawal ◽  
Avan Suryawanshi ◽  
Alok Kumar Swain ◽  
Arun Andappan ◽  
Ramesh Kumar M
Keyword(s):  
Side Effects ◽  
Caesarean Section ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Ultra Sound ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Duration Of Action ◽  
Vas Scores ◽  
Safe Condition

BACKGROUND Regional anaesthesia is an armamentarium in the hands of the anaesthesiologist to provide swift, effective and safe condition for surgery. However, local anaesthetics are characterised by slower onset and shorter duration of action, when used in larger doses can cause systemic toxicity. Hence, adjuvants are used to better the quality of blocks. Here, I have used dexmedetomidine as an adjuvant in transversus abdominis plane (TAP) block to assess duration of action, hemodynamic effects and side-effects. METHODS Our study is randomised double blinded comparative study, in which we have compared two groups, one received ropivacaine alone and another received ropivacaine with dexmedetomidine as an adjuvant. Assessment was done for duration of action, visual analog scale (VAS) scores, analgesic drug usage, sedation scoring and incidence of side-effects and complications. This study was conducted on 94 parturients with 47 patients in each group. RESULTS Dexmedetomidine has a statistically significant prolonged action and has given excellent analgesia post-operatively. Additional analgesics were required in a lesser number than the control group. There were no hemodynamic disturbances and complications. CONCLUSIONS Dexmedetomidine added to ropivacaine for ultra-sound guided TAP block is associated with prolonged and excellent analgesia with lesser requirement for additional analgesic usage, lower VAS scores, hemodynamic stability, and minimal sedation. KEYWORDS Caesarean Section, Dexmedetomidine, Analgesia, Post-Operative, Ropivacaine, Transversus Abdominis Plane Block

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