scholarly journals Intraperitoneal Versus Ultrasound Guided Transversus Abdominis Plane Block by Bupivacaine-Magnesium Sulphate for Pain Relieafter Laparoscopic Cholecystectomy

2020 ◽  
pp. 81-90
Author(s):  
Nashwa I. Hamoda ◽  
Hesham I. El Tatawy ◽  
Nagat S. El Shmaa ◽  
Mohammad I. Okab
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Relief ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Analgesic Consumption ◽  
Group I ◽  
Group Ii

Background and Aim: Intraperitoneal (IP) administration of local anesthetic is considered a method of control of visceral component of pain. This method cannot be used as sole agent for pain relief after laparoscopic cholecystectomy (LC). Transversus Abdominis Plane block (TAP) becomes a useful anesthetic technique in the treatment of postoperative pain after the LC surgery. The aim of the study was to compare between IP bupivacaine –Magnesiu;m Sulfate (MgSO4) and TAP by bupivacaine- MgSO4 for pain relief after LC. Materials and Methods: This was a randomized double blinded study on sixty patients ASA I &II, age from 18 to 60 years old, undergoing elective LC surgery were randomly classified into two equal groups (30 patients in each group). Group I: IP instillation of 30 ml [15 ml bupivacaine 0.5% (75mg) plus 2.5ml MgSO4 (250 mg) plus 12.5 normal saline].Group II: Ultrasound guided subcostal TAP block was performed by using total volume 20 ml on each side [10 ml bupivacaine %0.5 (50 mg) plus 1.5ml MgSO4 (150 mg) plus 8.5 normal saline]. Heart rate (HR) and Mean Arterial Blood Pressure (MAP) were measured at 5 min before induction and every 15min after induction till the end of operation and then every 5 min for the first 20 mins after administration of study drugs then they recorded at interval of 30mins, 1hr, 2hrs, 4hr and 6hr postoperative. Numeric Rating Scale (NRS) at emergence, 2, 4, 8, 12, 18 and 24hr after recovery, first rescue analgesia time, postoperative analgesic consumption, length of hospital stay(LOS), patients’ satisfaction and post-operative complications were recorded. Results: There were insignificant differences in HR and MAP between the two groups. There was a significant decrease in NRS at 4hr and 8 hr in group II than group I. There was a significant decrease regarding to time of first rescue analgesia, total postoperative analgesic consumption and LOS in group II compared to group I. There was a significant increase of satisfaction in group II compared to group I. There was an insignificant difference between both groups in nausea, vomiting, hypotension, bradycardia, bradypnea or MgSO4 toxicity. Conclusion: TAP by bupivacaine-MgSO4 has superior analgesia, longer duration, less postoperative analgesic consumption and more satisfaction in patients undergoing LC than IP block by bupivacaine-MgSO4.

scholarly journals A Comparison of effect of preemptive versus postoperative use of ultrasound-guided bilateral transversus abdominis plane (TAP) block on pain relief after laparoscopic cholecystectomy

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Poupak Rahimzadeh ◽  
Seyed Hamid Reza Faiz ◽  
Kaveh Latifi-Naibin ◽  
Mahzad Alimian
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Relief ◽  
Pain Score ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Significant Difference

AbstractNowadays, there are various methods to manage pain after laparoscopic cholecystectomy. The aim of this study was to compare the effectof preemptive versus postoperative use of ultrasound-guided transversus abdominis plane (USG-TAP) block on pain relief after laparoscopic cholecystectomy. In this single-blinded randomized clinical trial, the patients who were candidates for laparoscopic cholecystectomy were randomly divided into the two groups (n = 38 per group). In the preemptive group (PG) after the induction of anesthesia and in the postoperative group (POG) after the end of surgery and before the extubation, bilateral ultrasound-guided transversus abdominis plane (TAP) block was performed on patients using 20 cc of ropivacaine 0.25%. Both groups received patient controlled IV analgesia (PCIA) containing Acetaminophen (20 mg/ml) plus ketorolac (0.6 mg/ml) as a standard postoperative analgesia and meperidine 20 mg q 4 h PRN for rescue analgesia. Using the numerical rating scales (NSR), the patients’ pain intensity was assessed at time of arrival to the PACU and in 2th, 4th, 8th, 12th, 24th h. Primary outcome of interest is NSR at rest and coughing in the PACU and in 2th, 4th, 8th, 12th, 24th h. Secondary outcomes of interests were the time to first post-surgical rescue analgesic and level of patients’ pain control satisfaction in the first 24 h. The USG-TAP block significantly decreased pain score in the POG compared to the PG, and also the pain was relieved at rest especially in 8 and 12 h (p value ≤ 0.05) after the surgery. Pain score after coughing during recovery at 2, 8 and 12 h after the operation were significantly decreased. (p value ≤ 0.05) The patient satisfaction scores in the POG were significantly higher in all times. There was a statistically significant difference between the two groups in terms of rate of postoperative nausea and vomiting (PONV), indicating that patients in the POG had significantly lower incidences of the PONV compared tothe PG. The time to first analgesic request was significantly shorterin the POG, which was statistically significant (p value = 0.089). There was no statistically significant difference between the two groups in terms of consumption of analgesics. The postoperative TAP block could offer better postoperative analgesia than preepmtive TAP block.

scholarly journals Evaluation of efficacy of bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia: a prospective, randomized, double blind, comparative study

2017 ◽  
Vol 5 (10) ◽  
pp. 4588 ◽  
Author(s):  
Tauqeer Anjum Mir ◽  
Aabid Hussain Mir ◽  
Tantry Tariq Gani ◽  
Abida Yousuf ◽  
Sheikh Irshad Ahmad
Keyword(s):  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
P Value ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia ◽  
Group I ◽  
Group Ii ◽  
The Difference

Background: Pain is the commonest symptom encountered postoperatively and hence multimodal analgesia is tried to overcome it. In this study, we have compared bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing lower abdominal surgeries under spinal anaesthesia.Methods: Sixty ASA I and II patients in the age range of 18-60 years undergoing various lower abdominal surgeries were randomly divided into two groups, who were operated after giving spinal block using 2.5 ml of 0.5% hyperbaric bupivacine and 25ug of fentanyl. At the end of surgical procedure tranversus abdominis plane (TAP) block was given by giving 25 ml of injection bupivacaine 0.25% in group I and 25 ml of 0.25% of bupivacaine with 1 ug.kg-1 of clonidine in group II. Quality of analgesia was assessed by visual analogue scale (VAS), categorical pain scoring system and frequency of rescue analgesia given and duration was assessed with the time at which first rescue analgesia was given. Side effects of clonidine such as sedation, bradycardia and hypotension were also noted. The hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were noted for both the groups.Results: Demographic characteristics like age, weight, sex, ASA class and type of surgeries were comparable in both groups. SBP, DBP and HR were less in group II than in group I and was statistically significant (p-value<0.05). The overall mean VAS score in group I was 3.03 ± 1.57 and group II was 1.72 ± 1.02 with p-value of 0.0005 and hence better quality of analgesia in group II. Categorical pain scoring system also showed statistically better scores in group II than group I. The duration of analgesia which was calculated by mean time for first rescue analgesia in group I was 6.38 ± 2.56 hours and group II was 14.23 ± 4.63 hours with a p-value of <0.0001 and the difference was statistically significant. The mean number of doses of rescue analgesia in group I for the first 24 hours was 1.37 ± 0.89 and in group II was 0.60 ± 0.62 with a p-value of 0.0003 and the difference was statistically significant. Group II patients showed more sedation scores than group I patients (p-value <0.05). None of the patients had any episode of bradycardia or hypotension.Conclusions: Addition of clonidine 1 ug.kg-1 to 25 ml of 0.25% bupivacaine compared to 25 ml of 0.25% bupivacaine alone in tranverse abdominis plane (TAP) block improves quality of analgesia, increases duration of postoperative analgesia and decreases postoperative analgesic requirements with minimal side effects.

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