Transverses Abdominis Plane Block Versus Trocar Site Infiltration in Gynecologic Laparoscopy An Observational Study

Background and Aims: Laparoscopic surgery is nowadays gold standard procedure undertaken for various surgical procedures and people prefer laparoscopic approach but the effective analgesic regimen for such patients has not been devised and anaesthesiologists prefer multimodal regimes. Despite the minimally invasive nature of this procedure, patients experience a considerable amount of pain in the first 24 h postoperatively. In our study, we are comparing the degrees of pain relief with TAP block vs Trocar site infiltration using VAS, the duration of postoperative analgesia achieve by TAP block and compare it with Trocar site infiltration and total consumption of rescue analgesia consumed in first 24 hours postoperatively in patients undergoing gynaecologic Laparoscopic surgeries. Methods: After obtaining approval from the hospital Ethical committee and written informed consent from patients, this observational study was undertaken at the Government Lalla Ded Hospital which is one of the associated hospitals of Government Medical College, Srinagar during routine hours on 100 patients posted for elective Gynecological Laparoscopic surgery under general anesthesia. A total sample size of 100 patients (n= 50) for each group was calculated using PASSE (power and sample estimation) for study design and analysis. Assuming 30% improvement in pain score with error of 0.05 (i.e. 5% of DOF (degree of freedom). Results: Visual analogue scale at different time intervals were statistically significantly lower at all times in Group A than Group B p-value (p<0.05). The time to first request for analgesia was higher in group A as compared to group B with statistical difference among the study groups p-value (p<0.05). Conclusion: As a promising novel post-operative pain treatment procedure, TAP block is cost effective and one of the safest, easiest and the most effective supplemental techniques as part of analgesic regimen. It improves pain scores in gynecologic laparoscopy.

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TAP Block in Postoperative Analgesia, A First Time Clinical Trial In Bangladesh

Journal of the Bangladesh Society of Anaesthesiologists ◽

10.3329/jbsa.v27i1.28992 ◽

2016 ◽

Vol 27 (1) ◽

pp. 3-11

Author(s):

Bidhan Paul ◽

Debashis Banik ◽

AKM Shamsul Alam

Keyword(s):

Postoperative Analgesia ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Transversus Abdominis ◽

Control Group ◽

Tap Block ◽

Analgesic Regimen ◽

Time Period ◽

Group A ◽

Group B

Background: In perioperative care, a reliable pain management is a vital appeal. Over recent years, Transversus Abdominis Plane (TAP) block is introduced as an important component of multimodal analgesia.Objective: To evaluate efficacy of TAP block in postoperative analgesia for Total Abdominal Hysterectomy (TAH) with subarachnoid block (SAB) in comparison of morphine consumption and VAS score.Methods: 60 patients were randomly allocated into 2 groups (TAP group-A & control group-B). Standard SAB was applied to all patients for elective TAH. Immediate after operation classical TAP block was performed through both Lumber Triangle Of Petit (LTOP) of group A patients. Both groups were placed in Post Anesthesia Care Unit (PACU), arranged a common standard postoperative analgesic regimen for all, observed periodically and documented it accordingly in pre-designed data sheet.Results: TAP block prolonged the mean time of 1st required I/V morphine (TAP vs control, mean±SD 271.23±40.34 vs 195.33±22.16 min., p=0.001HS). Morphine requirement was also reduced (17.4±5.4 vs 26.2±4.4 mg, p=0.001HS). Pain VAS scores at rest and movement were also reduced at all time period (p? 0.01 to 0.001). There was no complication attributed to the TAP block.Conclusion: TAP block provided considerably effective postoperative analgesia in first 24 hours after major abdominal surgery like TAH.Journal of Bangladesh Society of Anaesthesiologists 2014; 27(1): 3-11

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Tramadol as an adjunct to bupivacaine for brachial plexus block.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.09.3382 ◽

2019 ◽

Vol 26 (09) ◽

pp. 1482-1486

Author(s):

Afifa Zahoor ◽

Ranna Mussrat ◽

Muhammad Ahmad Khan ◽

Shakeel Ahmad

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

University Hospital ◽

Orthopedic Procedures ◽

Controlled Study ◽

P Value ◽

Rescue Analgesia ◽

Group A ◽

Group B ◽

Plexus Block

Objectives: To compare the efficacy of tramadol and 0.25% bupivacaine versus 0.25% bupivacaine alone for brachial plexus block. Study Design: Randomized controlled study. Setting: Orthopedic department of Nishtar Medical University/Hospital Multan. Period: The study duration was Jan-2018 to Aug-2018. Material and Methods: 148 patients planned for with upper limb orthopedic procedures under BPB in the department of orthopedics department Nishtar Hospital Multan were included in this analysis. To Patients were randomly divided into two equal groups by lottery method. Group A patients were given solution with 38 ml 0.25% bupivacaine with 100 mg tramadol 2 ml and group B were given solution with 38 ml 0.25% bupivacaine and 2 ml 0.9 % normal saline. Time of onset of block and its duration and need for rescue analgesics were noted. Results: Time of onset of block was 14.56+1.01 minutes in group A versus 15.96+1.64 minutes in group B (p-value <0.001). Mean analgesia duration was 355.85+42.18 minutes in group A versus 310.47+38.79 minutes in group B (p-value <0.001). There were 51 (68.9%) patients in group A who required rescue analgesia and 68 (91.9%) patients in group B required rescue analgesia (p-value 0.004). Conclusion: We concluded that the addition of tramadol as adjunct to bupivacaine for BPB significantly shortens the duration of onset, prolongs the duration of analgesia and reduces the need for rescue analgesics.

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Pancreaticogastrostomy as a choice of reconstruction after pancreaticoduodenectomy: a hospital based observational study

International Surgery Journal ◽

10.18203/2349-2902.isj20210373 ◽

2021 ◽

Vol 8 (2) ◽

pp. 619

Author(s):

Hetish M. Reddy ◽

Rajendra Bagree ◽

Pradeep Panwar ◽

Gaurav Jalendra

Keyword(s):

Observational Study ◽

P Value ◽

Multicenter Studies ◽

Surgical Units ◽

Significant Difference ◽

Whipple’S Procedure ◽

Group A ◽

Randomized Control ◽

Group B ◽

Larger Sample

Background: The aim of this study was to compare the rate of occurrence of post-operative pancreatic fistulae (POPF) and other complications with pancreaticogastrostomy (PG) or pancreatojejunostomy (PJ) as a choice of reconstruction in classic Whipple’s Procedure.Methods: A hospital based prospective observational study collected data of 60 patients who underwent Whipple’s procedure from June 2018 to august 2019, in two different surgical units, where one-unit preferred PG as routine while the other unit preferred PJ.Results: Two out of 30 patients who underwent PG (Group A) developed POPF while Nine out of 30 patients who underwent PJ (Group B) developed POPF (p-value = 0.04) indicating a significant difference in outcome. The duration of hospital stay (DOHS) in our study in Group A was 12.82±1.74 days when compared to Group B was 13.88±2.01 days (p-value = 0.042).Conclusions: Our results indicate that the preferred reconstruction after classic Pancreaticoduodenectomy should be Pancreaticogastrostomy, but further validation with randomized control trials or multicenter studies with larger sample size are required.

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TRANSVERSUS ABDOMINAL PLANE BLOCK

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.07.137 ◽

2018 ◽

Vol 25 (07) ◽

pp. 1073-1077

Author(s):

Syed Aftab Haider ◽

Atqua Sultan ◽

Zaira Salman ◽

Salman Waris

Keyword(s):

Pain Score ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

University Hospital ◽

P Value ◽

Tap Block ◽

Rescue Analgesia ◽

Arterial Blood ◽

Significant Difference ◽

Group B

Objectives: To determine the efficacy of co-administration of magnesiumsulphate (MgSO4) with bupivacaine in enhancing the analgesic efficacy of Transversusabdominus plane block (TAP block) in patients undergoing total abdominal hysterectomy.Study Design: Randomized clinical single blinded trial. Setting: Department of Anesthesia,Nishtar Medical University/Hospital Multan. Period: 07 months from March 2017 to October2018. Methods: We included female patients who presented with uterine or ovarian cancer andplanned for total abdominal hysterectomy. In group B patients (n=30) TAP block was givenusing 0.25% bupivacaine (20 ml). In group M patients (n=30), 19.4 ml 0.25% bupivacaine plus0.60 ml Mg sulphate. Mean arterial blood pressure, heart rate, VAS pain score and time of1st rescue analgesia and total dose of rescue analgesia was noted in all patients. For dataanalysis we used independent sample t-test (Mann-Whitney U test for skewed data) to comparequantitative variables. Chi-square test we used for comparison of ASA status. P-value < 0.05was taken as significant difference. Results: Mean VAS pain score after 1 hour was 3.27+1.70in group B and 2.23+1.35 in group M (p-value 0.012), after 2 hours mean VAS pain score was4.03+2.10 in group B and 2.47+1.25 in group M (p-value 0.001), after 6 hours mean VAS scorewas 4.53+2.62 in group B and 3.27+1.36 in group M (p-value 0.02). Mean VAS pain score after12 and 24 hour of shifting the patient in recovery room was no significantly different between thegroups (p-value 0.55 & 0.08 resp.). Mean time of 1st rescue analgesia was 7.53+4.92 hours ingroup B versus 13.96+2.25 hours in group M. Conclusion: Administration of 200 mg of MGSO4with bupivacaine for TAP block significantly improves the duration of analgesia and reduces therequirement of rescue analgesics in patients undergoing total abdominal hysterectomy.

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Compare the Analgesic Efficacy of Dexmedetomidineand Fentanyl as an Adjuvant to Bupivacaine for Lower Limb Surgery

10.53350/pjmhs211562153 ◽

2021 ◽

Vol 15 (6) ◽

pp. 2153-2155

Author(s):

Arshi Naz ◽

Mirza Shahzad Baig ◽

Vijai Kumar ◽

Samita S Khan ◽

Sidra Javed ◽

...

Keyword(s):

Spinal Anaesthesia ◽

Lower Limb ◽

P Value ◽

Hyperbaric Bupivacaine ◽

Rescue Analgesia ◽

Sensory Blockade ◽

Significant Difference ◽

Lower Limb Surgery ◽

Group A ◽

Group B

Objective: To compare the analgesic effectiveness of Dexmedetomidine and Fentanyl as an adjuvant to 0.5% Bupivacaine in spinal anaesthesia for patients undergoing lower limb surgery. Study Design: Randomized controlled trial. Place & Duration:The study was conducted at department of Anesthesia, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi for duration from 15thJuly2020 to 15thFebruary 2021. Methods: In this study 52 patients of both genders undergoing lower limb surgeries were included. Patient’s ages were ranging from 20 to 70 years. All the patients were divided into two Groups. Group A included 26 patients and received Inj. Dexmedetomidine 10 μg in 0.5ml normal saline with 12.5mg of 0.5% hyperbaric bupivacaine, Group B had 26 patients and received 25mg fentanyl with 12.5mg of 0.5% hyperbaric bupivacaine. Time to achieve T10 blockade, time to first rescue analgesia were examined and compare between both groups. All the statistical data was analyzed by SPSS 24.0. P-Value <0.05 was significantly considered. Results: Mean age of group A was 40.52±12.28 years and in group B it was 40.14±13.34 years. There were 18 (69.23%) male patients and 8 (30.77%) females in group A while in Group B 19 (73.08%) patients were male and 7 (26.92%) were females. No significant difference was observed between both groups regarding time to T10 blockade with p-value >0.05. A significant difference was found regarding time to rescue analgesia, in Group A it was 426.58±92.44 minutes and in Group B, it was 206.44±48.47 minutes (p-value <0.0001). Patients’ satisfaction was high in dexemedetomidine group as compared to fentanyl group. Conclusion: Dexmedetomidine 10 μg with 0.5% bupvicaine showed better effectiveness regarding time to first rescue analgesia as compared to fentanyl. No significant difference was observed regarding time to sensory blockade between both medications. Keywords: Dexmedetomidine, Fentanyl, Spinal Anaesthesia, Lower Limb Surgery, Sensory Block, Analgesia

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CHOLECYSTECTOMY;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.07.1033 ◽

2017 ◽

Vol 24 (07) ◽

pp. 1062-1066

Author(s):

Bashir Ahmed ◽

Hamid Raza ◽

Kamlaish -

Keyword(s):

Laparoscopic Cholecystectomy ◽

Patient Population ◽

P Value ◽

Care Hospital ◽

Rescue Analgesia ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

Eye Opening ◽

Group B

Objectives: The aim of our study which is to compare total intravenousanesthesia with target controlled infusion using the drugs Propofol and remifenatnil with thetechniques of volatile induction maintenance anesthesia using sevoflurane and sufentanil inpatients undergoing laparoscopic cholecystectomy procedure, at a tertiary care hospital inKarachi, Pakistan. Study Design: The type of study is a randomized control trial, conductedfor a period of 8 months Period: from June 2015 to January 2016 Setting: at a tertiary carehospital in Karachi Pakistan. Method: The patient population consisted of n=100 patientsbelonging to the ASA class I and II and undergoing laparoscopic cholecystectomy procedure atour institute. The patients were divided into two groups group A consisted of all those patientswho underwent total intravenous anesthesia and group B consisted of patients who underwentvolatile induction maintenance anesthesia. Appropriate blinding measures were taken for thosewho were involved in the post-operative care of the patients, and the patients themselves. Duringthe procedure routine monitoring was done, data was recorded in a pre-designed proforma.Patients were analyzed in the post-operative period for side effects and pain levels. Statisticalanalysis was done using SPSS version 23, a p value of less than 0.05 was considered to bestatistically significant. Results: The patient population consisted of n= 100 patients dividedinto two groups. No statistically significant difference was found between the demographicvariables of the patients of both groups (age, weight, baseline values of blood pressure, heartrate, time duration of surgery and anesthesia). The time for the loss of corneal reflex was longerin the group A (109 +/- 90) as compared to group B (45 +/- 10) having a p value of less than0.001. However the time for opening of the eyes and the duration of post anesthesia care unitwas shorter in group A (420 +/- 130 seconds for eye opening and 45 +/- 15 min for PACU) andin group B (484 +/- 116 seconds for eye opening and 53 +/- 25 mins for PACU) having p valuesof 0.006 (eye opening) and 0.017 (PACU) respectively. In group A n= 44 (88%) of the patientsrequired rescue analgesia, and in group B n= 36 (72%) of the patients required it, having a pvalue of 0.013 respectively. The need for the use of ephedrine and atropine in the pre and portoperative period was similar in both the groups. Conclusion: According to the results of ourstudy we found that each method of anesthesia has its own advantages and disadvantagesand the anesthetist present should weigh the risks and benefits for each patient individually,and use the most beneficial method of administration of anesthesia in the patient undergoinglaparoscopic cholecystectomy procedure, accordingly.

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Comparison of intraincisional and intraperitoneal infiltration of local anaesthetic in laparoscopic cholecystectomy to control early postoperative pain.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.02.6013 ◽

2021 ◽

Vol 28 (02) ◽

pp. 192-196

Author(s):

Nadia Bano ◽

Nazim Hayat ◽

Saira Saleem ◽

Farhan Javaid ◽

Ayesha Rehman ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Pain Relief ◽

Local Anaesthetic ◽

Early Postoperative Period ◽

P Value ◽

Analgesic Requirement ◽

Rescue Analgesia ◽

Group A ◽

Group B

Objective: To compare the effects of intraincisional and intraperitoneal infiltration of local anaesthetic to relieve early postoperative pain in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Department of Anaesthesia and Surgery, Madinah Teaching Hospital Faisalabad. Period: July 2017 to March 2018. Material & Methods: A sample of 100 patients with American Society of Anaesthesiologists Physical status (ASA) I and II, undergoing laparoscopic cholecystectomy were selected using simple random sampling technique. Patients were randomly assigned into groups A and B. Group A patients received intraperitoneal infiltration of 20 ml solution of 0.25% bupivacaine and group B patients received intraincisional infiltration of 20 ml solution of 0.25% bupivacaine. Results: Demographic characteristics were not significantly different in both groups. Our study showed that Group A patients had better pain relief as compared to group B patients. Visual analogue score (VAS) for pain relief at 0, 3,6,12 and 24 hours was statistically different in both groups. The requirement of rescue analgesia between group A and B was found to be12% and 38% which is statically significant (p value 0.003). Conclusion: intraperitoneal infiltration of Bupivacaine offers better postoperative pain relief after laparoscopic cholecystectomy and is associated with less analgesic requirement in early postoperative period.

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COMPARISON OF EFFICACY OF LEVOBUPIVACAINE IN TRANSVERSE ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING CAESAREAN SECTION: A DOUBLE BLINDED, RANDOMIZED STUDY

10.36106/gjra/1302492 ◽

2020 ◽

pp. 1-3

Author(s):

Praveen S ◽

Shashank M

Keyword(s):

Caesarean Section ◽

Postoperative Analgesia ◽

Randomized Study ◽

Local Anaesthetics ◽

Tap Block ◽

Rescue Analgesia ◽

Transverse Abdominis ◽

Group A ◽

Group B ◽

Double Blinded

Background: Dexamethasone has a long and efficient glucocorticoid structure and presents anti-inflammatory properties. When used as an adjuvant to local anaesthetics, it prolongs the duration of analgesia. The aim of this study was to determine the effect of dexamethasone as an adjuvant to levobupivacaine in TAP block given to patients who underwent caesarean section. Materials & Methods: 70 patients posted for caesarean section under spinal anaesthesia were included in the study and divided into two groups. Group A received bilateral 30 ml 0.25% levobupivacaine and 2 ml dexamethasone(8mg). Group B received bilateral 30 ml 0.25% levobupivacaine and 2 ml 0.9% NaCl in a TAP block performed with ultrasonography. The time needed for the first rescue analgesia in the postoperative period was recorded. 24hr tramadol consumption & VAS was recorded. Results: Time for first analgesic administration (tramadol) was prolonged significantly in Group A (mean ± SD- 12.24 ± 1.22hrs) as compared to Group B (mean ± SD ‑ 8.37± 1.07 hrs), P < 0.0001. Tramadol requirement for 24hrs in Group A was 115.71± 16.89 mg and for Group B was 198.57± 22.64 mg, which was statistically significant (P < 0.0001). VAS was noted at 2, 4, 6, 8, 12, 18 and 24 h. VAS was greatly reduced in group A for the first 8–10 h post‑operatively as compared to patients in group B. CONCLUSIONS: Dexamethasone when used as an adjuvant to levobupivacaine in TAP block, enhances the duration of block & decreases opioid consumption in the post- caesarean section patients.

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Analgesic efficacy of ultrasound guided transversus abdominis plane (Tap) block after caesarean delivery- A prospective randomized controlled trial

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.038 ◽

2021 ◽

Vol 8 (2) ◽

pp. 185-190

Author(s):

Sonali Prajapati ◽

Nimisha Brahmbhatt

Keyword(s):

Caesarean Section ◽

Spinal Anaesthesia ◽

Elective Caesarean Section ◽

Analgesic Efficacy ◽

Transversus Abdominis ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Rescue Analgesia ◽

Analgesic Regimen ◽

Group B

Transversus abdominis plane block is facial plane block providing post-operative analgesia after lower abdominal surgeries as part of multi-modal analgesia. We evaluated analgesic efficacy of TAP block with Bupivacaine for 24hr after caesarean section done with pffannestiel incision under spinal anaesthesia, the pain being assessed with help of VAS. Total 130 parturients (ASA I OR II) posted for elective caesarean section under spinal anaesthesia were enrolled. They were allocated randomly in to two groups of 65 each. Group B patients received bilateral TAP block under USG at the end of surgery with 15ml of 0.25%Bupivacaine on each side while Group C patients did not receive TAP block. IV paracetamol 1gm was given in both groups as baseline analgesic at the end of surgery. Post-operative pain was assessed with VAS and rescue analgesia was given in form of Inj. Diclofenac Sodium Aq. at VAS score>4. Total rescue analgesia required in mg in post-operative 24 hours was noted.USG guided TAP block after caesarean section produced effective analgesia. Time for 1st rescue analgesia was delayed in group-B (mean+SD-12.25+4.54hr) than group-C (7.96+2.89hr) (P<0.001). Total analgesic requirement was reduced in group-B (107.35+50.32mg) than group-C (183+52.83mg) (P<0.001). USG-guided TAP block is easy to perform and effective as a component of multimodal analgesic regimen after caesarean section without any major complications.

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Comparison of efficacy of labetalol and methyldopa in Gestational Hypertension

10.53350/pjmhs211592282 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2282-2284

Author(s):

Nayyer Sultana ◽

Rana Abid Ali ◽

Uzma Zia ◽

Shirin Gul ◽

Abida Riaz ◽

...

Keyword(s):

Blood Pressure ◽

Observational Study ◽

Diastolic Blood Pressure ◽

Gestational Hypertension ◽

P Value ◽

Exclusion Criteria ◽

Central Park ◽

Group A ◽

Group B ◽

Better Than

Aim: To compare the control of blood pressure after oral alpha methyldopa versus oral labetalol for management of gestational hypertension. Study design: prospective, comparative, observational study. Place & duration: The study was conducted at Department of Obstetrics & Gynecology, Central Park Teaching hospital, Lahore for six months i.e. 1st May 2018 to 31st October 2018. Methodology: Total 150 females were included in the study from OPD after fulfilling the inclusion and exclusion criteria. Then females were randomly divided in two groups by using lottery method. In group A, females were given labetalol orally 100mg 2 times a day for 7 days. In group B, females were given 250mg methyldopa 3 times a day for 7 days. The females were followed-up in OPD after 8 days. After 8 days, females were evaluated for systolic blood pressure (SBP) & diastolic blood pressure (DBP). Results: In this study we compared labetalol with methyldopa for management of gestational hypertension. SBP (Labetalol: 123.41±7.42 vs. Methyldopa: 126.62±7.33, p-value=0.009) as well as DBP (Labetalol: 77.18±4.39 vs. Methyldopa: 79.64±5.9, p-value=0.005) were better controlled in patients received labetalol than alpha methyldopa. Conclusion: Labetalol is better than methyldopa in lowering blood pressure (systolic & diastolic) in women for management of gestational hypertension. Keywords: Management, gestational Hypertension, Systolic, Diastolic, Blood pressure, Alpha methyldopa

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