scholarly journals Efficacy of Dexmedetomidine as an Adjunct to Ropivacaine in Bilateral Dual-Transversus Abdominis Plane Blocks in Patients with Ovarian Cancer Underwent Cytoreductive Surgery

2021 ◽  
Author(s):  
Jian-ping Zhang ◽  
Na Zhang ◽  
Xu Chen ◽  
Yin Zhou ◽  
Zhen Jiang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Pulmonary Function ◽  
Cytoreductive Surgery ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Early Recovery ◽  
Postoperative Control ◽  
Intravenous Analgesia ◽  
Vas Scores ◽  
Postoperative Fev1

Abstract Objective: To evaluate the postoperative control of pain and recovery in patients with ovarian cancer underwent cytoreductive surgery by adding dexmedetomidine to ropivacaine in bilateral dual-transversus abdominis plane (Bd-TAP) blocks.Methods: We enrolled ninety ASA I-III patients undergoing open abdominal cytoreductive surgery in this study. Patients were randomized assigned into three groups (TAP-R, TAP-DR, and CON, n=30 in each). All patients received standardized general anesthesia and postoperative Bd-TAP blocks were performed. The TAP-R, TAP-DR and CON group received Bd-TAP blocks with 0.3% ropivacaine, 0.3% ropivacaine and dexmedetomidine 0.5µg/kg, and 0.9% normal saline, respectively. All patients received patient-controlled intravenous analgesia (PCIA). The first request time for PCIA bolus, the VAS scores at 0, 6, 12, 24, and 48 hours after operation, the cumulative sufentanil consumption in 24 and 48 hours were compared. Pulmonary function was evaluated pre-operation and 24h after operation. The use of rescue drugs, early recovery quality was recorded.Results: Median values of the first request time for PCIA in the TAP-DR was 13.5 (11.0-16.0) hours, which was significantly longer than those in the TAP-R and CON groups [7.0 (6.0-9.0) and 3.0 (1.0-4.5)]. The VAS scores at rest and on coughing of TAP-DR group at all time points after operation were significantly lower than those of CON group (P <0.05). Cumulative sufentanil consumption in TAP-DR group were the least at 48h after surgery. Postoperative FEV1 and FEV1/FVC in TAP-DR group was significantly higher than group CON. Less rescue analgesics was needed by the patients in TAP-DR group (P <0.05). There was no significantly difference in the early recovery quality between TAP-DR and CON group (P >0.05).Conclusion: Dexmedetomidine combined with ropivacaine for Bd-TAP blocks prolonged the first bolus time of PCIA for ovarian cancer surgery and decreased sufentanil consumption. The procedure provided better postoperative analgesia and improved postoperative pulmonary function without excessive sedation.

scholarly journals Efficacy of dexmedetomidine as an adjunct to ropivacaine in bilateral dual-transversus abdominis plane blocks in patients with ovarian cancer who underwent cytoreductive surgery

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jian-ping Zhang ◽  
Na Zhang ◽  
Xu Chen ◽  
Yin Zhou ◽  
Zhen Jiang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Pulmonary Function ◽  
Cytoreductive Surgery ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Postoperative Pulmonary Function ◽  
Significant Difference ◽  
Vas Scores ◽  
Effective Pain Relief ◽  
Rescue Drug

Abstract Objective We sought to evaluate the postoperative control of pain and recovery in patients with ovarian cancer who underwent cytoreductive surgery by adding dexmedetomidine to ropivacaine in bilateral dual-transversus abdominis plane (Bd-TAP) blocks. Methods We enrolled 90 patients with an American Society of Anesthesiologists physical status I to III undergoing open abdominal cytoreductive surgery in this study. Patients were randomized and assigned into three groups (TAP-R, TAP-DR, or CON) of 30 participants each. All of the patients received standardized general anesthesia, and postoperative Bd-TAP blocks were performed. The TAP-R, TAP-DR, and CON groups received Bd-TAP blocks with 0.3% ropivacaine, 0.3% ropivacaine and 0.5 μg/kg of dexmedetomidine, and 0.9% normal saline, respectively. All of the patients received patient-controlled analgesia (PCA) (formula, 100 μg of sufentanil and 16 mg of ondansetron diluted with normal saline to 100 mL). Flurbiprofen axetil was used as a rescue drug if the visual analog scale (VAS) score was more than four points. The first request time for PCA bolus; the VAS scores at 0, 6, 12, 24, and 48 h after operation; and the cumulative sufentanil consumption within 24 and 48 h, respectively, were compared. Pulmonary function was evaluated preoperatively and at 24 h after the operation. The use of the rescue drug was recorded. Postoperative functional recovery, including time to stand, time to walk, time to return of bowel function, time to readiness for discharge, and postoperative complications, were recorded. Results Median values of the first request time for PCA of the TAP-R group was significantly prolonged compared to that of the CON group (median [interquartile range], 7.3 [6.5–8.0] hours vs. 3.0 [2.3–3.5] hours) (P < .001), while the TAP-DR group has the longest request time among the three groups (median [interquartile range], 13.5 [12.4–14.5] hours) (P < .001). The VAS scores at rest and upon coughing of the TAP-R group in the first 12 h were significantly lower than those of the CON group (P < 0.05), but showed no significant difference compared to those of the TAP-DR group. The VAS scores at rest and upon coughing were lower in the TAP-DR group at each time point compared to those of the CON group (P < .05). The cumulative sufentanil consumption in the TAP-DR group was significantly lower at 48 h (P = .04) after surgery than in the CON group, while there was no significant difference compared to that in the TAP-R group (P > .05). Less rescue analgesic was required by patients in the TAP-DR group than in the CON group (P < .05). Postoperative mean measured forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity values in the TAP-DR group were significantly higher than those of the CON group (P = .009), while there was no significant difference compared to those of the TAP-R group (P = .10). There was no significantly difference in postoperative functional recovery between TAP-DR and CON group (P > 0.05). Conclusion TAP blocks can provide effective pain relief up to 12 h postoperatively without a significant improvement in postoperative pulmonary function. The addition of dexmedetomidine to ropivacaine for Bd-TAP block prolonged the first bolus time of PCA when compared to that in the TAP-R group and decreased sufentanil consumption and the need of rescue analgesia relative to in the CON group at 48 h postoperative. The procedure provided better postoperative analgesia and improved postoperative pulmonary function relative to the CON group. Our results indicate that dexmedetomidine as an adjuvant of Bd-TAP can provide effective pain relief up to 48 h.

Impact of transversus abdominis plane blocks versus non-steroidal anti-inflammatory on post-operative opioid use in ERAS ovarian cancer surgery

2019 ◽  
Vol 29 (9) ◽  
pp. 1372-1376
Author(s):  
Steven Peter Bisch ◽  
Joni Kooy ◽  
Sarah Glaze ◽  
Anna Cameron ◽  
Pamela Chu ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Regression Analysis ◽  
Length Of Stay ◽  
Cytoreductive Surgery ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Opioid Use ◽  
Transversus Abdominis Plane ◽  
Anti Inflammatory

BackgroundTreatment of ovarian cancer often requires extensive surgical resection. The transversus abdominis plane (TAP) block has been utilized in benign gynecologic surgery to decrease post-operative pain and opioid use. We hypothesized that TAP blocks would decrease total opioid use in the first 24 hours and decrease length of stay following staging and cytoreductive surgery for ovarian cancer compared with either no local anesthetic or local wound infiltration alone.MethodsAll patients undergoing surgery for ovarian cancer from November 2016 to June 2017 were included in this retrospective cohort study. Median opioid use at 24, 48, and 72 hours post-operatively, as well as length of stay, were assessed. Multivariate median regression analysis was performed to adjust for potential confounders: post-operative non-steroidal anti-inflammatory drug (NSAID) usage, pre-operative opioid consumption, and extent of cytoreductive surgery. Length of stay was compared using Cox regression analysis.ResultsOne-hundred-and-twenty patients were included in the analysis. Eighty-two patients had a TAP block, while 38 did not. After adjusting for potential confounders there was no difference in median 24 hours opioid consumption (p=0.29) or length of stay (HR 0.95, p=0.78) between patients receiving TAP block compared with those without. After adjusting for potential confounders, patients receiving scheduled NSAIDs had a 2.6-fold greater likelihood of being discharged (p<0.0005) and a significant reduction in median opioid use at 24 hours (23.5 vs 14.5 mg) (p=0.017) compared with those patients without NSAIDs.DiscussionPost-operative administration of NSAIDs, but not TAP block, was associated with a decrease in post-operative opioid use and length of stay following surgery for ovarian cancer. Further investigation into alternative regional anesthetics for Enhanced Recovery after Surgery (ERAS) protocols is warranted.

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

Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Analgesia in Abdominal Surgery: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Junheng Chen ◽  
Chao Chen ◽  
Guoliang Sun ◽  
Chunming Guo ◽  
Weifeng Yao
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Side Effects ◽  
Abdominal Surgery ◽  
Meta Analysis ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Quadratus Lumborum ◽  
Vas Scores

Abstract Background: The aim of this systematic review and meta-analysis was to compare the analgesic efficacy of the quadratus lumborum block (QLB) and transversus abdominis plane block (TAPB). Methods: We followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement guidelines. Only trials comparing QLB with TAPB were included. The primary outcomes were visual analog scale (VAS) scores at rest and at movement during the first 48 h after surgery and postoperative analgesic requirements. Secondary outcomes included rates of side effects, such as postoperative nausea and vomiting (PONV) and dizziness, and patient satisfaction. Results: A total of 15 controlled trials, including 1013 patients, were identified. VAS scores at rest at 0–1, 2, 4, 6, 8, 12, and 24 h and at movement at 24 and 48 h were significantly lower in patients who underwent QLB when compared with those in patients who underwent TAPB. QLB performed better in terms of postoperative analgesic requirements, with patients requiring lower levels of intravenous morphine and sufentanil over the first 24 h, fewer patients requiring rescue analgesics, and longer times to first rescue analgesic. Among patients who underwent QLB, rates of PONV and dizziness were lower and the Bruggemann comfort scale (BCS) scores were higher. Conclusion: QLB leads to significantly better outcomes in terms of postoperative VAS scores, opioid consumption, incidence of side effects, and patient satisfaction when compared with TAPB following abdominal surgery.

scholarly journals Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy- A RCT

2021 ◽  
Author(s):  
Usha Shukla ◽  
Pratima Kumari ◽  
Jay Brijesh Singh Yadav ◽  
Atit Kumar
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Analgesia ◽  
Abdominal Hysterectomy ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Analgesic Requirement ◽  
Patient Satisfaction Score ◽  
Quadratus Lumborum ◽  
Vas Scores

Introduction: Abdominal Hysterectomy (AH) is one of the most common surgeries performed in gynaecology and is associated with a medium to high pain level. Newly discovered peripheral blocks such as Transversus Abdominis Plane (TAP) block and Quadratus Lumborum (QL) block have gained immense popularity as an adjunct to regional and general anaesthesia for postoperative pain management and reducing analgesic requirements. Aim: To compare the analgesic efficacy of QL block with TAP block in patients undergoing total AH. Materials and Methods: This was a double-blinded Randomised Clinical Trial (RCT). The study population comprised of 105 patients posted for elective total AH under spinal anaesthesia. They were randomly allocated into three groups of 35 patients each. Group Q received bilateral QL block with 40 mL of 0.25% bupivacaine divided on either side, Group T received bilateral TAP block with 40 mL of 0.25% bupivacaine divided on either side and in Group C no block was given. Patients were monitored for Visual Analogue Scale (VAS) scores at 0, 15 minutes, 30 minutes, 1st, 2nd, 6th, 12th and 24th hour postoperatively, time for first analgesic requirement, total analgesic requirement in 24 hours and patient satisfaction score after 24 hours and also adverse effects, if any. Data were analysed using Statistical Package For The Social Sciences (SPSS) version 16 (Chicago, IL, USA) with independent t-test and Chi-square test as appropriate. The p<0.05 was considered statistically significant. Results: There were significantly lower VAS scores in group Q than group T at 2nd and 6th hour with p-value of 0.003 and 0.001, respectively. The time for first analgesic was early in group C with mean value of 1.37±0.74 hours and it was 4.63±0.97 hours in group T and 7.77±1.51 hours in group Q. The total analgesic requirement was lesser in group Q when compared to group C and T. Patient satisfaction score was comparable between group Q and T (p=0.97). No significant difference in complications among the three groups was observed (p=0.51). Conclusion: QL block is a better postoperative analgesic technique than TAP block for postoperative analgesia in hysterectomy patients.

scholarly journals Combined Subcostal and Posterior Transversus Abdominis Plane Block for Postoperative Pain Relief after Abdominoplasty: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Haytham El Sayed ◽  
A Shaheed Fadhul ◽  
Mohamed Al Falaki ◽  
M Nasr Awad
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Control Group ◽  
Transversus Abdominis Plane ◽  
Esthetic Surgery ◽  
Analgesic Regimen ◽  
Vas Scores ◽  
And Control

Abstract Background: Abdominoplasty is a common esthetic surgery for adequate pain management during the postoperative period. Transversus abdominis plane block (TAPB) is a therapeutic complement for analgesia for postoperative pain following abdominal surgery.Aim: To compare the outcomes of TAPB and systemic opioids in patients undergoing abdominoplasty.Methods: Fifty-eight patients undergoing abdominoplasty were randomly assigned to two groups: Combined subcostal and posterior TAPB group (BG, n=29) and Control group (CG, n=29). The standard postoperative analgesic regimen for both groups consisted of IV Paracetamol 1 g every 6 h. The visual analog scale (VAS) scores for pain were recorded postoperatively, and once the patient had a VAS ≥4, IV pethidine was administered. The primary outcome was pethidine consumption in the first 72 h postoperatively; the secondary outcomes included VAS scores at rest and during movement in the first 72 h postoperatively, time to first ambulation, and time to first incentive spirometer at 900 mL/min.Results: Pethidine consumption in the first 72 h was 208.62±85.64 in the CG group and 20.69±25.06 in BG (p<0.05). VAS was lower in BG during the first 72 h both at rest and during movement (p<0.05). Time to first ambulation was 12.41±5.04 h in the CG group and 4.62±1.08 h in BG (p<0.05), time to first incentive spirometer at 900 mL/min was 11.45±5.05 h in CG and 4.27±1.09 h in BG (p<0.05).Conclusion: Combined subcostal and posterior TAPB offers a longer postoperative analgesic effect and reduced postoperative opioid requirements with fewer postoperative complications.Trial RegistrationClinical Trial: TCTR20200602001 “Retrospectively registered”Date of registration on May 30, 2020.

scholarly journals Analgesic effect of combined transversus abdominis plane block and rectus sheath block in laparoscopic cholecystectomy: prospective randomized study

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Ibrahim Hakki Tor ◽  
Erkan Cem Çelik ◽  
Muhammed Enes Aydın
Keyword(s):  
Rectus Sheath ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Time Intervals ◽  
Wound Infiltration ◽  
Pain Scores ◽  
Group I ◽  
Rectus Sheath Block ◽  
Significant Difference ◽  
Vas Scores

Abstract Background We aimed to investigate the combination of the subcostal transversus abdominis plane block and rectus sheath block (ScTAP-RS) versus wound infiltration on opioid consumption and assess effects on pain scores in laparoscopic cholecystectomy (LC). One hundred patients scheduled for LC were included in this study following the local ethics committee approval. Patients were randomized and divided into two groups as group ScTAP-RS and wound infiltration group (group I). After the surgical intervention, in group ScTAP-RS, ScTAP-RS block with 30 ml 0.25% bupivacaine solution was administered by ultrasound, and in group I, 20 ml 0.25% bupivacaine solution was injected in three port incision sites. Patient-controlled analgesia with tramadol was programmed for 24 h postoperatively. Tramadol consumptions and visual analog scale (VAS) scores were evaluated. Results Compared to the infiltration group, total tramadol consumption was significantly lower in the ScTAP-RS group between 4 and 12 h. There was no statistically significant difference between the groups in other time intervals. VAS scores were significantly lower in the ScTAP-RS group in the 4th and 8th hours at rest and ambulation. There was no statistically significant difference between the groups for VAS scores at other time intervals. Conclusion ScTAP-RS blocks decrease the opioid consumption and pain scores compared to the local infiltration after LC.

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