Effect of the Modified Surgeon Assisted Bilateral Transversus Abdominis Plane Block on Time Required for First Analgesic Dose after Cesarean Section under Spinal Anesthesia: Randomized placebo-control

2021 ◽  
Vol 4 (3) ◽  
pp. 01-05
Author(s):  
Ahmed Mamdouh
Keyword(s):  
Placebo Group ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Interquartile Range ◽  
Transversus Abdominis ◽  
Secondary Outcome ◽  
Control Group ◽  
Placebo Control ◽  
Study Group ◽  
Tap Block

Background: The transverses abdominis plane block (TAP block) is one of the widely used regional analgesic techniques in cesarean section. There are different variations of the procedure. The aim of the present study was to evaluate the analgesic effect of the modified surgeon assisted bilateral TAP block in patients undergoing cesarean section Patients&Methods: Sixty patients undergoing cesarean section under spinal anesthesia were randomized into two groups to receive either TAP block with 40 ml of bupivacaine 0.25%(study group) or 40 ml normal saline as placebo after obtaining informed consent. All patients will receive intravenous diclofencac75mg every 12 hrs postoperatively. Postoperatively, there was an assessment every 2hrs during the first 24hrs by the visual analogue pain scale (VAPS). Time to the first analgesic request will be measured as primary outcome and all patients will receive opioid on demand or VAPS > 4 with 25mg pethidine intramuscularly. Moreover, total opioid requirement in 24hrs will be measured as secondary outcome along with postoperative complications as nausea, vomiting and abdominal distention. Complications related to the TAP procedure will be also assessed. Results: The median (interquartile range) time to the first analgesic request in the first 24hrs postoperatively was significantly shorter in the placebo group compared to the study group; 4h (4, 6) and 24h (10, 24) with p value < 0.001. Postoperative opioid requirement was significantly higher in the control group (30/30{100%}) than the study group (13/30{43.3%}). The median (interquartile range) number of opioid doses was significantly higher in the placebo group compared with the study group; 2(2, 2) and 0(0, 1) respectively. At all points in the study, pain scores both were lower in the study group (p < 0.0001). Conclusion: The modified surgeon assisted bilateral TAP block is relatively new, safe and cost effective technique which provides adequate postoperative analgesia allowing for better maternal ambulation and better postoperative recovery. Trial registration: Clinicaltrial.gov registration number: NCT04623632

scholarly journals The Effect of the Yeast Probiotic Saccharomyces boulardii on Acute Diarrhea in Children

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Abolfazl Mahyar ◽  
Parviz Ayazi ◽  
Haleh Pashaei ◽  
banafsheh arad ◽  
Sonia Oveisi ◽  
...  
Keyword(s):  
Placebo Group ◽  
Hospital Stay ◽  
Acute Diarrhea ◽  
Saccharomyces Boulardii ◽  
Interquartile Range ◽  
Control Group ◽  
Placebo Control ◽  
Trial Group ◽  
Group 4 ◽  
Significant Difference

Objectives: This study aimed to evaluate the effect of yeast probiotic Saccharomyces boulardii on the frequency and duration of acute diarrhea in children. Methods: Sixty children were randomized to receive yeast probiotic S. boulardii in a daily dose of 250 mg (trial group-30 patients) or placebo (control group-30 patients) for five days. The clinical and demographic characteristics of two groups were recorded before the intervention. After intervention, the two groups were compared in terms of frequency of diarrhea, duration of diarrhea, and hospital stay. Results: The median (interquartile range) of frequency of diarrhea in the trial group was significantly lower than placebo group (4 [2] vs. 5 [2.5]) (P = 0.04). Also, the median (interquartile range) of duration of diarrhea in the trial group was significantly lower than placebo group (3 [2] vs. 4 [2.5]) (P = 0.03). There was no significant difference between groups for hospital stay (P = 0.8). Conclusions: The present study reveals that the use of yeast probiotic S. boulardii can reduce the frequency and duration of acute diarrhea. Therefore, we recommended S. boulardii administration to acute diarrhea in children.

scholarly journals Comparative evaluation of intrathecal bupivacaine alone and bupivacaine combined with dexmedetomidine in cesarean section using spinal anesthesia: a meta-analysis

2019 ◽  
Vol 47 (7) ◽  
pp. 2785-2799 ◽  
Author(s):  
Xin Liu ◽  
Xiongjie Zhang ◽  
Xujian Wang ◽  
Jinyan Wang ◽  
Hao Wang
Keyword(s):  
Confidence Interval ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Outcome Measure ◽  
Meta Analysis ◽  
Sensory Block ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Control Group ◽  
Block Level

Objective This meta-analysis was performed to evaluate the effect of spinal anesthesia (SA) using bupivacaine combined with dexmedetomidine (DEX) in cesarean section, analyze the adverse drug reactions induced by this mixture, and provide a reference for rational drug use. Methods Randomized controlled trials were obtained from the PubMed, Cochrane Library, and Embase databases. The primary outcome measure was the time to the highest sensory block level (min), and the secondary outcome measure was adverse effects. Results The time to the highest sensory block level was significantly shorter in the bupivacaine-DEX group than in the control group (standardized mean difference, −0.23; 95% confidence interval, −0.43 to −0.03). The incidence of shivering during the process of anesthesia, especially at a dose of 5 µg DEX, was significantly lower in the bupivacaine-DEX group than in the control group (odds ratio, 0.26; 95% confidence interval, 0.14–0.49). No significant differences were observed in the symptoms of hypotension, bradycardia, nausea/vomiting, or pruritus. Conclusion Compared with the use of bupivacaine alone for SA in cesarean section, adding dexmedetomidine during SA can significantly shorten the onset time and decrease the rate of shivering during anesthesia.

scholarly journals Assessment of Transversus Abdominis Plane Block in Abdominal Surgery by Total Requirement of Diclofenac as a Post-Operative Analgesia Drug

2020 ◽  
Vol 5 (1) ◽  
pp. 41-46
Author(s):  
Jigna R Shah ◽  
Apoorva Moghe ◽  
Maulik Humbal
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Abdominal Wall ◽  
Surgical Procedures ◽  
Transversus Abdominis ◽  
Control Group ◽  
Study Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia

Background: Amongst various techniques of TAP block, landmark technique via the triangle of Petit seems to hold considerable promise for patients undergoing surgical procedures involving abdominal wall incisions. The aim of this study is to evaluate transversus abdominis plane [TAP] block in abdominal surgery by total requirement of diclofenac as postoperative analgesia drug.Subjects and Methods:Present study was carried out at Department of Anesthesia, GMERS medical college, Sola, Ahmedabad, Gujarat, India from May 2014 to May 2015. According to formula based nomogram, sample size for proposed study would be: Study group (n=30): patient received TAP block with injection bupivacaine (0.25%) 20 ml. Control group (n=30): patient not received TAP block and was given injection diclofenac on demand for post-operative analgesia as per institute protocol for routine surgery. Sensory block was assessed by sterile pin prick method in the midaxillary line on both sides of chest. Postoperative pain was assessed by using the visual analogue scale.Results:Majority of the patient were in age group of 30 to 50 in both group. VAS score was significantly higher in control group as compared to the study group at all the time. First dose of rescue analgesia required in study group was at 669.66± 346 min and in control group was 220.33 ± 139.24 min which was statistically significant. Diclofenac requirement in study group was one time in 22 patient and two time in 8 patient which was significantly less as compare to control group in which diclofenac requirement was one time in 2 patient and two time in 5 patient and three time in 23 patient in 24 hour.Conclusion:TAP block is a promising new technique for postoperative pain management in surgery involving the anterior abdominal wall as a part of multimodal analgesia. Further studies are warranted to support this finding before establishing it in routine clinical practice in different type of surgical procedures.

scholarly journals Efficacy of Double Pop Blind TAP Block – Double-Blinded Randomized Controlled Study

2020 ◽  
Vol 9 (2) ◽  
pp. 1-3
Author(s):  
Simon Richard ◽  
Sharad Goel ◽  
Akhilesh Mishra ◽  
S. Ali Imam ◽  
Samir El Said ◽  
...  
Keyword(s):  
Perioperative Period ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Controlled Study ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia

Background: The transversus abdominis plane block (TAP block) in the petit triangle is being used since 2001 for analgesia by blocking      the T6 to T12 nerves, which is devoid of the sympathetic blockade and has opioid-sparing effect during and after abdominal operations.       The appropriateness and efficacy of using double pop blind transversus abdominis plane block were studied in abdominal surgeries using bupivacaine with butorphanol as additive. Subjects and Methods: A total of 78 adult patients of ASA I and II were included, who were to undergo laparoscopic cholecystectomy under general anesthesia. The control group patients received tramadol, diclofenac, and paracetamol in the perioperative period. The study group patients received TAP block by double pop blind technique after induction of anesthesia but before surgical incision as preemptive analgesia. The p-value, the mean and the confidence interval were calculated by using Student t-test with the use of online software by graphpad.com. Results: Each of the two groups had 39 patients, and none met the exclusion criteria. Patients of the study (TAP) group remained pain-free for a longer time by 439 (416 – 463) minutes more than the control (IV, Intravenous) group. Rescue analgesia in the study group was required 640 minutes after the end of the surgery, but in the control group, rescue analgesia was required earlier at 200 minutes only after the surgery. Conclusion: Double pop blind technique for TAP block is appropriate and without complications if done with carefulness as to avoid penetration of the blunted green needle beyond the fascia between the internal oblique and the transversus abdominis muscle.

scholarly journals Reducing Opioid Dependence and Improving Patient Experience for Living Kidney Donors with Transversus Abdominis Plane Block

2021 ◽  
Vol 2 (1) ◽  
pp. 57-63
Author(s):  
Vincent Do ◽  
Elizabeth Cohen ◽  
Danielle J. Haakinson ◽  
Ranjit Deshpande ◽  
Ramesh K. Batra
Keyword(s):  
Opioid Dependence ◽  
Transversus Abdominis ◽  
Control Group ◽  
Study Group ◽  
Tap Block ◽  
Opioid Use ◽  
Transversus Abdominis Plane ◽  
Liposomal Bupivacaine ◽  
Living Kidney Donors ◽  
Pain Scores

Rapid recovery after laparoscopic living donor nephrectomy (LLDN) for kidney donation is highly desirable for living kidney donors. To uphold rapid recovery, good analgesia with minimal adverse effects, including those related to opioid dependence, is essential. A pre-operative transversus abdominis plane (TAP) block with liposomal bupivacaine can effectively aid in perioperative pain management, while reducing opioid requirements. We conducted a single-center retrospective study involving patients 18 years and older who underwent LLDN to determine whether a TAP block with liposomal bupivacaine is efficacious in pain management after LLDN, while reducing opioid use. The study group comprised of patients who received a preoperative TAP block with liposomal bupivacaine in place of hydromorphone patient-controlled analgesia (PCA) and the control group included patients who received hydromorphone PCA post-operatively. Both groups were supplemented with oral and intravenous analgesics for breakthrough pain, as needed. The primary endpoint was reduction in post-operative opioid use in morphine milligram equivalents (MME). Secondary endpoints included: post-operative pain scores, postoperative length of stay, and re-hospitalizations within 7 days of discharge. Sixty-six patients were included in our study, with 33 in each group. Patients in both groups were well matched demographically. The study group who received TAP block demonstrated a significant reduction in post-operative opioid use (92.05 MME vs. 53.98 MME, p < 0.05) when compared to the control group who received hydromorphone PCA. Both groups achieved similar analgesia with comparable pain scores. There was no difference between postoperative hospital lengths of stay for both groups. Two patients in the control group were re-admitted due to small bowel obstruction within seven days of discharge. In conclusion, TAP block with liposomal bupivacaine significantly reduced postoperative opioid use, while also proving to be safe, efficacious and feasible in patients undergoing LLDN.

scholarly journals Assessment the role of tranexamic acid in prevention of postpartum hemorrhage

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Nevein Gerges Fahmy ◽  
Fahmy Saad Latif Eskandar ◽  
Walid Albasuony Mohammed Ahmed Khalil ◽  
Mohammed Ibrahim Ibrahim Sobhy ◽  
Amin Mohammed Al Ansary Amin
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Postoperative Bleeding ◽  
Control Group ◽  
Study Group ◽  
Mortality And Morbidity ◽  
Lower Segment Cesarean Section ◽  
Prophylactic Use

Abstract Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. It is believed that hemostatic imbalance secondary to release of tissue plasminogen activator (tPA) and subsequent hyperfibrinolysis plays a major role in PPH pathogenesis. Antifibrinolytic drugs such as tranexamic acid (TXA) are widely used in hemorrhagic conditions associated with hyperfibrinolysis. TXA reduced maternal death due to PPH and its use as a part of PPH treatment is recommended, and in recent years, a number of trials have investigated the efficacy of prophylactic use of TXA in reducing the incidence and the severity of PPH. The study is aiming to assess the efficacy of tranexamic acid in reducing blood loss throughout and after the lower segment cesarean section and reducing the risk of postpartum hemorrhage. Results The amount of blood loss was significantly lower in the study group than the control group (416.12±89.95 and 688.68±134.77 respectively). Also the 24-h postoperative hemoglobin was significantly higher in the study group (11.66±0.79 mg/dl) compared to the control group (10.53±1.07mg/dl), and the 24-h postoperative hematocrit value was significantly higher in the study group (34.99±2.40) compared to control (31.62±3.22). Conclusion Prophylactic administration of tranexamic acid reduces intraoperative and postoperative bleeding in cesarean section and the incidence of postpartum hemorrhage.

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

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

scholarly journals Study on the method of enucleation of anterior uterine fibroids by transverse incision of the lower uterine segment during cesarean section

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan Dai ◽  
Li Xia ◽  
Jinxiao Lin ◽  
Rongli Xu ◽  
Wenqiang You
Keyword(s):  
Cesarean Section ◽  
Operation Time ◽  
Anterior Wall ◽  
Control Group ◽  
Study Group ◽  
Transverse Incision ◽  
Postoperative Fever ◽  
Postoperative Changes ◽  
Perioperative Bleeding ◽  
Surgical Data

Abstract Introduction A retrospective study was conducted to investigate the effectiveness and feasibility of fibroid enucleation in the anterior wall of the uterus by transverse uterine incision during cesarean section. Methods The medical history, surgical data, preoperative and postoperative changes in the blood system, and complications of 90 pregnant women who underwent myomectomy of the anterior uterine wall during cesarean section at the second Department of Maternal and Child Health Hospital of Fujian Province were analyzed retrospectively. Results No significant differences were noted in the leiomyoma number, pathological type, preoperative and postoperative hemoglobin level, perioperative bleeding incidence, blood transfusion frequency, postoperative fever incidence, and duration of lochia between the study and control groups. The proportion of large fibroids was slightly higher in the study group than in the control group (p < 0.05), and the operation time and average hospitalization time were slightly longer in the study group than in the control group (p < 0.05). The distribution of type III–V fibroids was slightly more in the study group than in the control group (p < 0.05), and the distribution of type VI fibroids in the study group was less than that in the control group (p < 0.05). Conclusion Fibroid enucleation is safe and effective in the anterior wall of the uterus through the lower uterine transverse incision in cesarean section. It has the potential to reduce the risk of pelvic and intrauterine adhesions in the future.

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