Comparison of transversus abdominis plane block and intrathecal morphine for laparoscopic donor nephrectomy: Randomised controlled trial.

BACKGROUND AND AIMS: Postoperative pain following laparoscopic donor nephrectomy (LDN) is significant and no suitable analgesic technique is described. Opioid analgesia in standard doses is often suboptimal and associated with numerous adverse effects. Transversus abdominis plane (TAP) block has been evaluated in various laparoscopic procedures. Intrathecal morphine (ITM) has been seen to provide long-lasting analgesia of superior quality in laparoscopic colorectal procedures. METHODS: The present study was undertaken to evaluate the analgesic efficacy of single-dose ITM 5 µg/kg for LDN. After ethics approval, 60 adult patients scheduled for LDN were randomised to receive intravenous fentanyl, ultrasound-guided TAP block or ITM for postoperative analgesia. Postoperative 24-h patient-controlled analgesia (PCA) fentanyl consumption, visual analogue scale (VAS) score and intraoperative fentanyl and muscle relaxant requirements were compared. Statistical analysis was performed using appropriate statistical tests by using Stata 11.1 software. RESULTS: Haemodynamic stability at pneumoperitoneum and in the post anaesthesia care unit was significantly better in patients receiving ITM. Intraoperative rescue fentanyl requirement (P = 0.01) and postoperative fentanyl requirement until 24 h (P = 0.000) were significantly lower in the morphine group. Postoperative VAS at rest and on movement was significantly lower in the morphine group at all points of assessment (P = 0.000). CONCLUSION: ITM 5 µg/kg provides better intraoperative and postoperative analgesia and reduces postoperative PCA fentanyl requirement in laparoscopic donor nephrectomy compared to TAP block or intravenous fentanyl.

Transversus abdominis plane block for laparoscopic inguinal hernia repair: a randomized trial.

BACKGROUND: Pain after laparoscopic inguinal hernia surgery can be moderate to severe, interfering with return to normal activity. The study aimed to assess the efficacy of bilateral ultrasound-guided (USG) transversus abdominis plane (TAP) block for relieving acute pain after laparoscopic hernia repair as T10-L1 nerve endings are anesthetized with this block. METHODS: Seventy-one American Society of Anesthesiologists I to II patients, aged 18 to 65 years, undergoing unilateral/bilateral laparoscopic hernia repair were randomized to port site infiltration (control, 36) and TAP block groups (35). All patients received general anesthesia (fentanyl 2 µg/kg intravenously at induction, 0.5 µg/kg on 20% increase in heart rate or mean blood pressure) and paracetamol 6 hourly. Postintubation, TAP group received bilateral USG TAP block (15-20 mL 0.5% ropivacaine, maximum 3 mg/kg) with 18-G Tuohy needle. Control group had 20 to 30 mL 0.5% ropivacaine infiltrated preincision, at port sites from skin to peritoneum. Postoperative patient-controlled analgesia fentanyl was provided for 6 hours; pain was assessed using 0- to 100-mm visual analog scale (VAS) at 0, 1, 2, 4, 6, and 24 hours and telephonically at 1 week and 3 months. RESULTS: Demographic profile of the 2 groups was comparable. Significantly more number of patients required intraoperative fentanyl in the control group (24/36) than in the TAP group (13/35); VAS at rest was lower in TAP than control patients in postanesthesia care unit at 0, 2, 6, and 24 hours (median VAS TAP group: 0, 0, 0, and 0; control: 10, 20, 10, and 10; P= .002, P= .001, P= .001, and P= .006, respectively); P< .01 was considered statistically significant. TAP group had significantly lower VAS on deep breathing at 6 hours and on knee bending and walking at 24 hours and lesser patient-controlled analgesia fentanyl requirement. No significant difference in pain scores was observed at 1 week and 3 months. CONCLUSION: TAP block reduced postoperative pain up to 24 hours after laparoscopic hernia repair.

Laparoscopic management of rare retroperitoneal tumors.

Due to their close proximity to major vessels, large size, variable location, and unknown malignant status, retroperitoneal tumors are frequently managed by open surgical exploration. Between 2005 and 2008, 4 patients with retroperitoneal tumors were subjected to laparoscopic management and there was success in 3 cases. Conversion to open resection was needed in 1 case because of bleeding. Mean laparoscopic operative time and blood loss were 154 minutes and 116 mL, respectively. The average hospital stay for the patients who were operated laparoscopically was 4 days. One patient had lymph drainage during the postoperative period and was treated conservatively. The histology reported retroperitoneal ganglioneuroma, retroperitoneal schwannoma, and retroperitoneal paraganglioma. There has been no tumor recurrence at a mean follow-up of 39 months. With advanced laparoscopic skills, better instrumentation, and vastly improved imaging, laparoscopic surgery is feasible even for rare retroperitoneal tumors, and in a selected group of patients it can be the first surgical option.