RESUMO
Background: Effective postoperative analgesia after lower segment caesarean section (LSCS) is very important for early ambulation and early breast feeding and has a role to play in decreasing postpartum depression. Quadratus lumborum (QL) block, a fascial plane block, is gaining popularity for pain management in lower abdominal surgeries. The aim of the present study was to compare the ultrasound-guided (USG) transversus abdominis plane (TAP) block and QL block in patients undergoing LSCS under spinal anaesthesia. Methods: Double-blinded, randomized, controlled, single-centre study done between Aug 2019 and Oct 2019, randomised 80 patients scheduled for LSCS into two groups, QL (N = 40) and TAP (N = 40), receiving USG TAP or QL block 20 ml of 0.25% bupivacaine with 4 mg dexamethasone bilaterally, postoperatively. Results: SSPS 20 was used for the statistical analysis Patients were evaluated for 24-h using visual analogue scale (VAS) for pain scores, time to rescue analgesia and the analgesic dose requirement at regular time intervals. Fifteen percent patients in QL block and 75% in TAP block required rescue analgesia (P < 0.001). Significant differences were observed in pain scores at 10 h postoperatively, VAS in QL=1.18 (0.55), TAP=3.08 (1.66) (P < 0.001). By 24 h postoperatively the difference ceased to be statistically significant. Time to rescue analgesia in QL group was 1353 min (+/-224.07) and TAP group 915 min (+/-391.62) (P < 0.001). Average requirement of rescue analgesia (paracetamol) in QL group was 153.84 mg, TAP group 756.09 mg. Conclusions: Patients receiving QL block had prolonged analgesic effects and required less use of rescue analgesia in comparison with TAP group in the first 24 h postoperatively. Trial number: CTRI/2019/07/020475.
RESUMO
Shared Decision Making (SDM) in peri-operative medicine is increasingly encouraged as an ideal model of treatment decision making in the medical encounter. Moreover, it has the potential to improve the quality of the decision-making process for patients and ultimately, patient outcomes. This review focuses on several published literature on SDM in peri-operative medicine, its Implementation, barriers faced by Patient and the Provider, Myths regarding SDM and current scenario of SDM in India. Within the anesthetic community, patient consent is vigorously guided. However, this community suffers from lack of advancements in implementing the patient-focused rather than doctor-focused characteristics of SDM. Out of the several barriers, the most common barrier towards the implementation of SDM is the lack of time from the provider community. Within the anesthesia domain, the consultations discussed directly preceding the surgery do not pursue the customary and highly organized stages of typical outpatient consultations. Under these backgrounds and to be successfully implemented, it becomes imperative to begin the process of SDM pre-operative assessment clinic targeting both the high- and low-risk patients. It is critical to summarise that SDM does not end at the time of anesthesia for the peri-operative healthcare professional, but it gets to carry forward until patient discharge. Therefore, it is carried as the Pinnacle of Patient-Centred Care.