Transversus Abdominis Plane Block Versus Intraperitoneal Local Anesthetics in Bariatric Surgery: A Systematic Review and Network Meta-analysis.

BACKGROUND: Transversus abdominis plane (TAP) block and intraperitoneal local anesthetics (IPLA) are widely investigated techniques that potentially improve analgesia after bariatric surgery. The analgesic efficacy of TAP block has been shown in previous studies, but the performance of TAP block can be difficult in patients with obesity. We performed a systematic review and meta-analysis to compare the analgesic efficacy of TAP block and IPLA. An alternative technique is useful in clinical setting when TAP block is not feasible. METHODS: We searched PubMed, Embase, and CENTRAL from inception until August 2020 for randomized controlled trials comparing both techniques. The primary outcome was cumulative morphine consumption at 24 h. Secondary pain-related outcomes included pain score at rest and on movement at 2, 6, 12, and 24 h; postoperative nausea and vomiting; and length of hospital stay. RESULTS: We included 23 studies with a total of 2,178 patients. TAP block is superior to control in reducing opioid consumption at 24 h, improving pain scores at all the time points and postoperative nausea and vomiting. The cumulative opioid consumption at 24 h for IPLA is less than control, while the indirect comparison between IPLA with PSI and control showed a significant reduction in pain scores at rest, at 2 h, and on movement at 12 h, and 24 h postoperatively. CONCLUSIONS: Transversus abdominis plane block is effective for reducing pain intensity and has superior opioid-sparing effect compared to control. Current evidence is insufficient to show an equivalent analgesic benefit of IPLA to TAP block.

Evaluate construct validity of the Revised American Pain Society Patient Outcome Questionnaire in gynecological postoperative patients using confirmatory factor analysis.

BACKGROUND: The Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) evaluates the patient-reported quality of pain management in adults. A validated APS-POQ-R is pivotal to guide effective pain management with better patient satisfaction. Previous studies revealed that subscales of "patients' perception of pain management" were unstable cross-culturally. This study aims to evaluate the construct validity of the APS-POQ-R in gynecological postoperative patients with a multi-cultural background using confirmatory factor analysis to allow comparisons among different a priori models at the latent factor level. METHODS: Patients aged 18 years old or above and who were scheduled for gynecology surgery were selected. Three different models with a combination of latent factors were based on a priori hypotheses from previous studies. The root-mean-squared error of approximation, comparative fit index, Tucker-Lewis Index, Chi-squared test, and change in Chi-squared statistic given a change in degrees of freedom between models were used to assess the model fit to the present data. RESULTS: A total of 302 patients completed the questionnaire. The five-factor model which was based on Gordon's study has an acceptable fit for the data and was superior when compared to the one-factor baseline model. Although the four-factor model, which originated from Botti's study, also demonstrates a good model fit, the "perception of care" construct was excluded in this model. The "perception of care" construct is conceptually important as patient-centered care has become the focus of quality improvement of pain service. CONCLUSIONS: The APS-POQ-R is easy to administer and is useful for quality evaluation in postoperative pain management. The present study demonstrates that a five-factor structure of the APS-POQ-R is the best fitting model in our patient sample. The results of this study provide further evidence to support the use of APS-POQ-R as a measurement tool for pain management evaluation in acute postoperative patients with a multi-cultural background.

Baska mask versus endotracheal tube in laparoscopic cholecystectomy surgery: a prospective randomized trial.

Background: Supraglottic airway devices have increasingly been used as the airway technique of choice in laparoscopic surgeries. This study compared the efficacy and safety of the Baska Mask with endotracheal tube (ETT) in patients undergoing elective laparoscopic cholecystectomy.Research design and methods: This single-center, prospective, randomized controlled trial recruited 60 patients aged 18-75 years with American Society of Anesthesiologists' classifications I to III. The time taken to achieve effective airway, number of attempts, ease of insertion, ventilation parameters, hemodynamics data, and pharyngolaryngeal complications were recorded.Results: The time taken to achieve effective airway was shorter for the Baska group (26.6 ± 4.7 vs. 47.2 ± 11.8 s; p < 0.001), although the first-time insertion success rate was ≥90% for both groups. The ETT group experienced more pharyngolaryngeal complications, including cough, trauma, spasm, dysphonia, and sore throat, during device insertion and removal and had higher systolic and diastolic blood pressures during intubation (p = 0.001). The Baska Mask achieved significantly lower peak airway pressure (p = 0.024) with stable oropharyngeal leak pressure ≥33 cmH2O throughout the surgery.Conclusions: The Baska Mask is a suitable alternative to endotracheal intubation in selected patients undergoing laparoscopic cholecystectomy, with shorter insertion times, fewer perioperative complications, and improved ventilatory performance and hemodynamic response.Trial registration: The trial is registered at ClinicalTrials.gov (NCT03045835), 8 February 2017.