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1.
Medicine (Baltimore) ; 98(52): e18448, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876726

RESUMO

BACKGROUND: This study aimed to compare the quadratus lumborum block (QLB) method with transversus abdominis plane block (TAPB) for postoperative pain management in patients undergoing laparoscopic colorectal surgery. METHODS: Seventy-four patients scheduled for laparoscopic colorectal surgery were randomly assigned into 2 groups. After surgery, patients received bilateral ultrasound-guided single-dose of QLB or TAPB. Each side was administered with 20 ml of 0.375% ropivacaine. All patients received sufentanil as patient-controlled intravenous analgesia (PCIA). Resting and moving numeric rating scale (NRS) were assessed at 2, 4, 6, 24, 48 hours postoperatively. The primary outcome measure was sufentanil consumption at predetermined time intervals after surgery. RESULTS: Patients in the QLB group used significantly less sufentanil than TAPB group at 24 and 48 hours (P < .05), but not at 6 hours (P = .33) after laparoscopic colorectal surgery. No significant differences in NRS results were found between the two groups at rest or during movement (P > .05). Incidence of dizziness in the QLB group was lower than in TAPB group (P < .05). CONCLUSIONS: The QLB is a more effective postoperative analgesia as it reduces sufentanil consumption compared to TAPB in patients undergoing laparoscopic colorectal surgery.


Assuntos
Músculos Abdominais/inervação , Músculos Abdominais Oblíquos/inervação , Cirurgia Colorretal/métodos , Laparoscopia/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Anestésicos Locais/administração & dosagem , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Ropivacaina/administração & dosagem , Sufentanil/administração & dosagem , Ultrassonografia de Intervenção
2.
Am Surg ; 85(9): 1013-1016, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638516

RESUMO

Transversus abdominis plane (TAP) blocks are a safe and effective way to provide immediate postoperative pain relief in surgical patients, and have been shown to decrease narcotic requirements. Concerns about complications of narcotics, increase in hospital length of stay (LOS), and health-care costs make this of particular interest. We compared standard bupivacaine TAP blocks with those carried out using liposomal bupivacaine to evaluate postoperative outcomes. Fifty patients undergoing elective laparoscopic colectomy received laparoscopic liposomal bupivacaine TAP blocks using 80 cc of local anesthetic, and data were collected prospectively during hospitalization. Data collected included amount of narcotic medication used during hospitalization, number of days to ambulation, number of days to bowel function, and LOS. These patients were compared with the last 50 patients recruited to the control/bupivacaine TAP block arm of the study. The same data parameters were collected and all patients were on an enhanced recovery protocol, which included scheduled acetaminophen, ibuprofen, and gabapentin by mouth, as well as clear liquid diet starting on postoperative day zero. Statistical analysis was performed using Student's t test and Fisher's exact test; P < 0.05 was considered statistically significant. Patients treated with liposomal bupivacaine needed less narcotics (5.06 vs 18.75 mg, P = 0.0002), had earlier bowel function (1.7 vs 2.4 days, P = 0.0002), and shorter LOS (2.7 vs 3.4 days, P = 0.0146). Patients undergoing laparoscopic colon resections seem to require fewer narcotics and have better patient outcomes with liposomal bupivacaine TAP blocks. Based on our data, liposomal bupivacaine seems to be superior to bupivacaine for TAP blocks.


Assuntos
Músculos Abdominais/inervação , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Colectomia/efeitos adversos , Laparoscopia/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Tempo de Internação , Lipossomos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos
4.
Medicine (Baltimore) ; 98(41): e17542, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593133

RESUMO

BACKGROUND: Patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia are 2 common methods of maintaining analgesia after cesarean section. In recent years, transversus abdominis plane block (TAPB) has been gradually applied clinically to reduce opioid analgesics and has achieved good results. Therefore, we performed this study to compare the efficacy and side effects of TAPB and PCIA in analgesia after cesarean section. METHODS: One hundred patients who underwent cesarean section were randomly classified into 2 groups. Following surgery, one group underwent ultrasound-guided TAPB and the other group underwent PCIA. Pain intensity according to the visual analog scale (VAS; 0 for no pain and 10 for severe intolerable pain) was assessed at 2, 4, 6, 8, 12, and 24-hour postsurgery in both groups. The postoperative complication rate and patient satisfaction were also measured. RESULTS: No significant differences were found in the VAS scores between the groups (P > .05). However, the incidence of postoperative complications in the TAPB group was significantly lower than that in the PCIA group (P < .05). Furthermore, patient satisfaction in the TAPB group was significantly higher than that in the PCIA group (P < .05). CONCLUSION: This study demonstrated that ultrasound-guided TAPB can achieve the same analgesic effect as PCIA after cesarean section but with even higher patient satisfaction.


Assuntos
Músculos Abdominais/inervação , Analgesia Controlada pelo Paciente/métodos , Cesárea/efeitos adversos , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Músculos Abdominais/diagnóstico por imagem , Músculos Abdominais/efeitos dos fármacos , Adulto , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Cesárea/métodos , Feminino , Humanos , Incidência , Bloqueio Nervoso/efeitos adversos , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Gravidez , Qualidade de Vida , Escala Visual Analógica
5.
Medicine (Baltimore) ; 98(42): e17545, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626118

RESUMO

BACKGROUND: Controversy still exists regarding the efficiency and safety of ilioinguinal/iliohypogastric nerve (II/IH) block versus transversus abdominis plane (TAP) block for pain management after inguinal hernia repair. The purpose of the current meta-analysis was to perform a relatively credible and comprehensive assessment to compare the efficiency and safety of II/IH versus TAP for pain management after inguinal hernia repair. METHODS: The PUBMED, CENTRAL, and EMBASE were systematically searched. Studies comparing II/IH versus TAP for pain management in adult patients undergoing inguinal herniorrhaphy were included. The results of this study are synthesized and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: Six studies with 632 patients were included in this study. No statistically significant difference was observed between the II/IH and TAP groups in postoperative opioid use, the time to first request for rescue analgesia, the incidence of postoperative nausea and vomiting (PONV), incidence of complication related with nerve blocks and patient satisfaction. The TAP group had a significantly higher pain score at 6 and 8 hours postoperatively (6 hours: mean difference [MD] = 0.94, 95% confidence interval [CI] 0.67-1.22, I = 0%, P < .01; 8 hours: MD = 1.02, 95% CI 0.3-1.74, I = 59%, P < .01). However, no statistically significant difference was observed at 1, 2, 4, 12, 24, 48 hours, and 6 months postoperatively. CONCLUSIONS: In general, this meta-analysis revealed that both approaches have similar postoperative opioid consumption and no significant difference in postoperative complication and patient satisfaction. The II/IH block provides excellent analgesic effects at 6 and 8 hours after inguinal herniorrhaphy in compared with the TAP block. However, more high-quality randomized controlled trials with long-term follow-up are still required to make the conclusion.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Bloqueio Nervoso/métodos , Neuralgia/tratamento farmacológico , Dor Pós-Operatória/tratamento farmacológico , Músculos Abdominais/inervação , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Feminino , Herniorrafia/métodos , Humanos , Plexo Hipogástrico , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Manejo da Dor/métodos , Dor Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
6.
Surgery ; 166(6): 1111-1116, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31500906

RESUMO

BACKGROUND: Patients with an open abdomen after trauma or emergency surgery may benefit from reduced sedation and chemical paralysis. We studied the effect of attending surgeon experience on sedation depth and paralytic use, as well as enteral nutrition and time between laparotomies. METHODS: We performed an institutional review board-approved survey (Sedation Level after Emergent ExLap without Primary Fascial Closure) of the senior and active Eastern Association for the Surgery of Trauma membership using Qualtrics (Qualtrics, Inc, Provo, UT). We obtained 393/1,655 responses (23.7%). Spearman's rho was used for ordinal data, and multivariate logistic regression was used to adjust for trauma center level and presence of trainees in the relationship between surgeon experience and use of deep sedation. RESULTS: Surgeon experience was associated with deep sedation (Richmond Agitation and Sedation Score ≤-3, P = .001) and chemical paralysis (P = .001). Surgeon experience was associated with less concern about delirium and more concern for evisceration as the reason for sedation depth (P = .001) and for paralysis (P = .001). Using multivariate logistic regression, surgeon experience was associated with deep sedation (odds ratio 3.6 [95% confidence interval 1.3, 10.4], P = .017 for ≥20 years; odds ratio 3.5 [95% confidence interval 1.1, 10.4], P = .025 for 15-20 years). Trauma center level was also significant (odds ratio 7.2 for Richmond Agitation and Sedation Score ≤-3 [95% confidence interval 1.7, 31.0], P = .008 for level III/IV versus level I/II). Increased surgeon experience was associated with delay of commencement of enteral feeds until return of bowel function (P = .013). Few respondents indicated willingness to extubate or mobilize open abdomen patients. Experienced surgeons were likely to wait for a defined time rather than for normalization of resuscitation markers to perform the first takeback laparotomy (P = .047) and waited longer between subsequent laparotomies (P = .004). CONCLUSION: There were significant variations in practice among respondents based on the length of time since their last residency or fellowship, including variations that deviate from current best practice for management of patients with an open abdomen.


Assuntos
Traumatismos Abdominais/cirurgia , Parede Abdominal/cirurgia , Sedação Profunda/estatística & dados numéricos , Delírio/terapia , Bloqueio Neuromuscular/estatística & dados numéricos , Traumatismos Abdominais/complicações , Músculos Abdominais/efeitos dos fármacos , Músculos Abdominais/inervação , Parede Abdominal/inervação , Delírio/etiologia , Nutrição Enteral/estatística & dados numéricos , Humanos , Bloqueadores Neuromusculares/administração & dosagem , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
7.
Einstein (Sao Paulo) ; 17(4): eAO4905, 2019 Sep 09.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31508661

RESUMO

OBJECTIVE: To compare analgesia and opioid consumption for patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. METHODS: The medical records of patients undergoing unilateral total hip arthroplasty between January 1st, 2017 and March 31, 2018 were reviewed, and 238 patients were included in the study. The primary outcome was postoperative opioid consumption in the first 24 postoperative hours. Secondary outcomes were intraoperative, post anesthesia care unit, and 48-hour opioid consumption, postoperative pain Visual Analog Scale scores, and post-anesthesia care unit length of stay. Primary and secondary endpoint data were compared between patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. RESULTS: For the patients who received quadratus lumborum block, the 24-hour total oral morphine equivalent (milligram) requirements were lower (53.82mg±37.41), compared to the patients who did not receive quadratus lumborum block (77.59mL±58.42), with p=0.0011. Opioid requirements were consistently lower for the patients who received quadratus lumborum block at each additional assessment time point up to 48 hours. Pain Visual Analog Scale scores were lower up to 12 hours after surgery for the patients who received a posterior quadratus lumborum block, and the post-anesthesia care unit length of stay was shorter for the patients who received quadratus lumborum block. CONCLUSION: Preoperative posterior quadratus lumborum block for primary total hip arthroplasty is associated with decreased opioid requirements up to 48 hours, decreased Visual Analog Scale pain scores up to 12 hours, and shorter post-anesthesia care unit length of stay. Level of evidence: III.


Assuntos
Analgésicos/uso terapêutico , Anestésicos Locais/uso terapêutico , Artroplastia de Quadril , Dor Pós-Operatória/tratamento farmacológico , Músculos Abdominais/inervação , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Período de Recuperação da Anestesia , Anestesia Geral , Raquianestesia , Anestésicos Locais/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Relação Dose-Resposta a Droga , Bloqueio Nervoso/métodos , Manejo da Dor , Dor Pós-Operatória/etiologia , Período Perioperatório/métodos , Estudos Retrospectivos , Fatores de Tempo
8.
Dis Colon Rectum ; 62(10): 1248-1255, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31490834

RESUMO

BACKGROUND: Multimodal analgesia is important for postoperative recovery in laparoscopic colorectal surgery. Multiple randomized controlled trials have investigated the use of transversus abdominis plane local anesthetic infiltration as a method of decreasing postoperative pain and opioid consumption, with variable results. OBJECTIVE: This study aimed to examine the overall effect of transversus abdominis plane block in postoperative pain, opioid use, and speed of recovery in laparoscopic colorectal surgery. DATA SOURCES: A literature search was done with PubMed, EMBASE, Web of Knowledge, and Cochrane Library. Only randomized controlled trials were selected for review. INTERVENTIONS: Transversus abdominis plane local anesthetic infiltration versus no intervention, saline, or other techniques in laparoscopic colorectal surgeries was investigated. MAIN OUTCOME MEASURES: The primary outcome measured was postoperative pain on day 1, at rest or with activity. The secondary outcomes measured were postoperative pain beyond day 1, consumptions of opioid, and length of hospital stay. RESULTS: Eight clinical trials including 649 patients between 2013 and 2018 were included. Resting pain scores within 2 hours (standardized mean difference, -0.53; p = 0.01), 4 hours (standardized mean difference, -0.42; p = 0.004), and 6 hours (standardized mean difference, -0.47; p = 0.03) showed statistically significant reduction. Six studies including 413 patients demonstrated lower cumulative opioid consumption within 24 hours after surgery (standardized mean difference, -0.82; p = 0.01). Five studies including 357 patients did not show a significant difference in length of stay (standardized mean difference, -0.04; p = 0.82). LIMITATIONS: Local anesthetic used in block varied in type and quantity across different studies. There were heterogeneities in pain score measurements and opioid consumption. Patient populations may be different among studies. CONCLUSIONS: Transversus abdominis block can lead to a lower pain score at rest within the first 6 hours and reduce opioid consumption within the first 24 hours. See Video Abstract at http://links.lww.com/DCR/A997.


Assuntos
Músculos Abdominais/inervação , Anestesia Local/métodos , Colectomia/métodos , Laparoscopia/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Humanos
9.
Trials ; 20(1): 391, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266529

RESUMO

BACKGROUND: Transversus abdominis plane (TAP) block and wound infiltration (WI) are common locoregional anesthesia techniques for pain management in patients undergoing colorectal laparoscopic surgery. Comparative data between these two practices are conflicting, and a clear benefit of TAP block over WI is still debated. The main purpose of this study is to determine the efficacy in pain control of WI compared with WI plus laparoscopic TAP block (L-TAP) in cases of laparoscopic colorectal resection. Secondary aims are to evaluate other short-term results directly related to pain management: the need for rescue analgesic drugs, the incidence of postoperative nausea and vomiting, the resumption of gut functions, and the length of hospital stay. METHODS/DESIGN: This is a prospective, randomized, controlled, two-arm, multicenter, single-blind study evaluating the efficacy of postoperative analgesic management of WI versus WI plus L-TAP in the context of laparoscopic colorectal surgery. Randomization is at the patient level, and participants are randomized 1:1 to receive either WI alone or WI plus L-TAP. Those eligible for inclusion were patients undergoing laparoscopic resection for colorectal tumor or diverticular disease at the Division of General and Hepatobiliary Surgery, Verona University, Verona, Italy, and at the Colorectal Cancer Center, Kyungpook National University, Daegu, Korea. Fifty-four patients are needed in each group to evidence a difference greater than 1 of 10 according to the numeric rating scale for pain assessment to establish that this difference would matter in practice. DISCUSSION: The demonstration of a noninferiority of WI compared with WI plus L-TAP block would call into question TAP block usefulness in the setting of laparoscopic colorectal surgery. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03376048 . Prospectively registered on 15 December 2017.


Assuntos
Músculos Abdominais/inervação , Anestésicos Locais/administração & dosagem , Colectomia/métodos , Neoplasias Colorretais/cirurgia , Doenças Diverticulares/cirurgia , Laparoscopia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Ropivacaina/administração & dosagem , Adulto , Idoso , Anestésicos Locais/efeitos adversos , Colectomia/efeitos adversos , Estudos de Equivalência como Asunto , Feminino , Humanos , Itália , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , República da Coreia , Ropivacaina/efeitos adversos , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
J Surg Res ; 244: 15-22, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31279259

RESUMO

BACKGROUND: Intrathecal morphine (ITM) and peripheral nerve blocks are accepted techniques for analgesia after abdominal surgery, but their efficacy has not been evaluated in the context of an enhanced recovery pathway (ERP) in pancreatic surgery. MATERIALS AND METHODS: We retrospectively compared postoperative analgesia (pain scores and opioid requirements) after open or robotic pancreatoduodenectomy or distal pancreatectomy among ERP patients receiving either ITM or transversus abdominis plane/quadratus lumborum (TAP/QL) nerve blocks. RESULTS: We identified 303 ERP patients who underwent pancreatectomy with either ITM (n = 251) or TAP/QL blocks (n = 52). Patient demographics and procedural variables were similar between groups. Few preoperative patient characteristics (preoperative stroke and pain medication intake) differed between the two groups. In an unmatched patient cohort, the median pain score on postoperative day (POD 0) zero was 4.5 (interquartile range [IQR] 2.3-5.8) in ITM patients compared with 5.7 (IQR, 3.4-6.9) in patients who received TAP/QL (P < 0.05). Median opioid consumption in intravenous morphine equivalents on POD 0 was 2.7 mg (IQR, 0-11.7) in ITM patients compared with 8.4 mg (IQR, 2.5-20.8) in TAP/QL patients (P < 0.001). After propensity matching for patient characteristics, pain scores and opioid consumption were significantly (P < 0.05) lower on POD 0 and POD 5 in patients who received ITM. The difference in quality of analgesia between ITM and TAP/QL was also maintained in the pancreaticoduodenectomy and distal pancreatectomy subgroups. Extubation in the operating room was achieved in a higher percentage of patients receiving ITM (92%) compared with those receiving TAP/QL (63%). The incidence of postoperative nausea and vomiting was similar in both groups. CONCLUSIONS: ITM was associated with reduced pain scores and opioid requirements compared with peripheral nerve blocks in an ERP for pancreatic surgery.


Assuntos
Analgésicos Opioides/administração & dosagem , Morfina/administração & dosagem , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Pancreatectomia/efeitos adversos , Pancreaticoduodenectomia/efeitos adversos , Músculos Abdominais/inervação , Idoso , Analgésicos Opioides/efeitos adversos , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Injeções Espinhais , Masculino , Pessoa de Meia-Idade , Morfina/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Manejo da Dor/efeitos adversos , Manejo da Dor/estatística & dados numéricos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Pancreatectomia/métodos , Pancreaticoduodenectomia/métodos , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/etiologia , Estudos Retrospectivos , Fatores de Tempo
11.
Plast Reconstr Surg ; 144(1): 35-44, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246796

RESUMO

BACKGROUND: Postoperative pain control after abdominally based autologous microvascular breast reconstruction is critical to functional recovery, patient satisfaction, and early discharge. The transversus abdominis plane block using 0.25% bupivacaine hydrochloride has been shown to be effective, but it is limited by a short duration of effect. Liposomal bupivacaine is a recently U.S. Food and Drug Administration-approved preparation of bupivacaine that can provide up to 72 hours of pain relief. The purpose of this randomized, controlled trial was to compare the analgesic efficacy of liposomal bupivacaine and conventional bupivacaine. METHODS: This study was a prospective, single-blind, randomized, controlled trial of 44 patients undergoing abdominally based autologous breast reconstruction between June of 2016 and February of 2018 performed by a single surgeon. Each patient was randomized to receive either 266 mg of liposomal bupivacaine or 75 mg of conventional bupivacaine to the transversus abdominis plane at the conclusion of the reconstruction procedure. All patients were managed postoperatively according to an enhanced recovery protocol. RESULTS: In our study of 44 patients, 22 patients received a transversus abdominis plane block with conventional bupivacaine and 22 patients received liposomal bupivacaine. There were no significant differences with regard to any outcome measure. No differences were found in total opioid consumption (p = 0.98), Quality of Recovery-15 scores (p = 0.72), pain scores (p = 0.39), or length of stay (p = 0.20). CONCLUSION: In the setting of a robust enhanced recovery after surgery protocol, liposomal bupivacaine does not confer advantages over conventional bupivacaine when used as single injections in transversus abdominis plane blocks after abdominally based microvascular breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Mamoplastia/métodos , Bloqueio Nervoso/métodos , Músculos Abdominais/inervação , Analgésicos Opioides/uso terapêutico , Esquema de Medicação , Feminino , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Tempo de Internação/estatística & dados numéricos , Lipossomos , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
12.
Trials ; 20(1): 276, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109368

RESUMO

BACKGROUND: Quadratus lumborum block (QLB) is increasingly gaining popularity as a novel abdominal truncal block in abdominal surgery; however, the mechanism of QLB is not yet thoroughly illustrated. The focus of our study is transmuscular QLB (TMQLB), as the latest anatomical evidence shows that anesthetics spread into the thoracic paravertebral space to exert an analgesic effect. Therefore, we designed this study to compare TMQLB with thoracic paravertebral block (TPVB) in laparoscopic renal surgery in the hope of providing clinical evidence on the analgesic mechanism of TMQLB and its application in laparoscopic renal surgery. METHODS: This trial is a prospective, randomized, single-center, open-label, parallel, three-arm, non-inferiority trial. We intend to include 120 participants undergoing laparoscopic nephrectomy and before surgery they will be randomized into three groups for postoperative pain control: TMQLB experimental group 1 (0.4 ml/kg body weight 0.5% ropivacaine), TMQLB experimental group 2 (0.6 ml/kg body weight 0.5% ropivacaine) or TPVB control group (0.4 ml/kg body weight 0.5% ropivacaine at vertebra T10). Patients will be excluded if they have allergy to anesthetics, infection at the injection site, are on coagulopathy or anticoagulants, on analgesics for chronic illness, have history of substance abuse or have a barrier to communication. Morphine is given in boluses of 1.5~2 mg by intravenous patient-controlled analgesia (IPCA) in the first 48 h after surgery. The primary outcome is the difference between TMQLB group 1 and the TPVB group in the mean visual analogue scale (VAS) pain score in the first 24 h after surgery. Secondary outcomes are the difference between TMQLB group 2 and the TPVB group in the mean VAS score in the first 24 h after surgery, cumulative morphine consumption, long-term pain control, dermatomal distribution of sensory loss, nausea score, pruritus score, ambulation time, time till recovery of bowel movement, quality of recovery, postoperative length of hospital stay and patient satisfaction with anesthesia. Safety data on procedure-related complications will also be summarized. DISCUSSION: This will the first randomized controlled trial to compare TMQLB with TPVB for analgesia in laparoscopic surgery. This trial aims to provide important clinical evidence to elaborate on the analgesic mechanism of TMQLB. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03414281 . Registered on 9 January 2018.


Assuntos
Dor Aguda/terapia , Laparoscopia , Nefrectomia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Músculos Abdominais/inervação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Estudos Prospectivos , Adulto Jovem
13.
Niger J Clin Pract ; 22(4): 478-484, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30975950

RESUMO

Background: Analgesic protocol is needed following gynecologic surgery to ensure early mobilization, decrease the duration in the post-anesthetic care unit and hospitalization, and provide patient comfort. Transversus abdominis plane (TAP) blocks are used in the treatment of acute postoperative pain after lower abdominal surgery. TAP block may be a better choice of postoperative pain control. In the present study, the efficacy of ultrasound-guided TAP block on pain control and postoperative opioid consumption was evaluated in patients undergoing a total abdominal hysterectomy. Methods: Fifty patients undergoing total abdominal hysterectomy were included in this study. Patients were divided into TAP block (n = 25) and control groups (n = 25). Both groups postoperative patient-controlled analgesia (PCA) was planned during 24 h postoperatively. Patients were assessed 1, 2, 4, 6, 12, 18, and 24 h postoperatively using the Visual Analog Scale (VAS), Ramsey Sedation Score, PCA demand, morphine consumption, first analgesic requirement time, and adverse reactions. Results: When compared with the control group, the time to first analgesic requirement in the TAP block group was significantly lower (P < 0.05). The amount of additional analgesia also differed significantly (P < 0.001). In the TAP group, the VAS was significantly lower at 2, 4, 6, 12, 18, and 24 h postoperatively compared to the control group (P < 0.05). There was no statistically significant difference in adverse reactions. Conclusion: TAP block can effectively treat postoperative pain as part of multimodal analgesia in patients undergoing total abdominal hysterectomy.


Assuntos
Músculos Abdominais/inervação , Analgesia/métodos , Analgésicos Opioides/administração & dosagem , Histerectomia , Morfina/administração & dosagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Manejo da Dor , Estudos Prospectivos , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Escala Visual Analógica
14.
Curr Urol Rep ; 20(5): 20, 2019 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-30904960

RESUMO

PURPOSE OF REVIEW: Amid the opioid crisis, postoperative pain management is a major challenge for practitioners. Recent pain management guidelines emphasize the importance of using regional anesthesia as part of opioid-sparing multimodal analgesia. This report aims to review recent evidence regarding the utilization of transversus abdominis plane (TAP) block in minimally invasive urologic surgery. RECENT FINDINGS: TAP block has been shown to improve early and late pain at rest, and to reduce opioid consumption after minimally invasive surgery. These benefits have indirectly reduced the incidence of postoperative delirium, pneumonia, urinary retention, and falls. Compared to epidural analgesia, TAP block provides similar pain control, has a lower incidence of hypotension, and is associated with a shorter length of stay. Few studies focus specifically on the outcomes of TAP block in minimally invasive urologic surgery. TAP block decreases postoperative pain and reduces opioid consumption without increasing complications. TAP block should be integrated as an indispensable component in enhanced recovery after surgery protocols.


Assuntos
Músculos Abdominais/inervação , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Procedimentos Cirúrgicos Urológicos , Analgesia Epidural , Previsões , Humanos , Laparoscopia , Bloqueio Nervoso/tendências , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/prevenção & controle , Procedimentos Cirúrgicos Urológicos/métodos
15.
Br J Surg ; 106(6): 692-699, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30919948

RESUMO

BACKGROUND: Transverse abdominis plane (TAP) block is considered an effective alternative to neuraxial analgesia for abdominal surgery. However, limited evidence supports its use over traditional analgesic modalities in colorectal surgery. This study compared the analgesic efficacy of liposomal bupivacaine TAP block with intrathecal (IT) opioid administration in a multicentre RCT. METHODS: Patients undergoing elective small bowel or colorectal resection were randomized to receive TAP block or a single injection of IT analgesia with hydromorphone. Patients were assessed at 4, 8, 16, 24 and 48 h after surgery. Primary outcomes were mean pain scores and morphine milligram equivalents (MMEs) administered within 48 h after surgery. Secondary outcomes included duration of hospital stay, incidence of postoperative ileus and use of intravenous patient-controlled analgesia. RESULTS: In total, 209 patients were recruited and 200 completed the trial (TAP 102, IT 98). The TAP group had a 1·6-point greater mean pain score than the IT group at 4 h after surgery, and this difference lasted for 16 h after operation. The TAP group received more MMEs within the first 24 h after surgery than the IT group (median difference in MMEs 10·0, 95 per cent c.i. 3·0 to 20·5). There were no differences in MME use at 24 and 48 h, or with respect to secondary outcomes. CONCLUSION: IT opioid administration provided better immediate postoperative pain control than TAP block. Both modalities resulted in low pain scores in patients undergoing elective colorectal surgery and should be considered in multimodal postoperative analgesic plans. Registration number: NCT02356198 ( http://www.clinicaltrials.gov).


Assuntos
Músculos Abdominais/inervação , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Hidromorfona/administração & dosagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Cirurgia Colorretal , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Hidromorfona/uso terapêutico , Injeções Espinhais , Lipossomos , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Resultado do Tratamento
16.
Reg Anesth Pain Med ; 44(2): 228-233, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30700617

RESUMO

BACKGROUND AND OBJECTIVES: The major concern after inguinal hernioplasty is chronic postsurgical pain and impaired quality of life due to central sensitization. Preoperative, intraoperative, and postoperative pre-emptive analgesia using regional techniques may help prevent the development of central sensitization. This study evaluated the effect of regional anesthesia followed by continuous regional analgesia on postoperative pain and functional outcome following inguinal hernioplasty. METHODS: Seventy-two consecutive patients scheduled to undergo open mesh inguinal hernioplasty were randomly allocated to one of three groups: subarachnoid block alone (group SAB), general anesthesia alone (group GA), or subarachnoid block combined with a continuous transverse abdominis plane block (group TAP). Pain and functional outcome was assessed before and 6 months following the surgery using the Core Outcome Measures Index score adapted for patients with hernia (COMI-hernia). During the first 72 hours postoperatively, pain was assessed at rest and during five different activities using the numerical rating scale. RESULTS: Six months following the surgery, the COMI-hernia score was lower in group TAP than in group GA or group SAB (0.54±0.41 vs 0.88±0.43 and 1.00±0.54, respectively; p<0.02). Pain at rest (p<0.02) and during activities (p<0.001) was lowest in group TAP during the first 72 hours postoperatively. CONCLUSIONS: A subarachnoid block combined with continuous postoperative analgesia via a transverse abdominis plane catheter provided better pain control and functional outcome 6 months following inguinal hernioplasty as well as better postoperative analgesia. CLINICAL TRIAL REGISTRATION: CTRI/2016/09/007238.


Assuntos
Cateteres de Demora , Dor Crônica/prevenção & controle , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Músculos Abdominais/inervação , Adulto , Cateteres de Demora/tendências , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Feminino , Hérnia Inguinal/diagnóstico , Herniorrafia/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/tendências , Manejo da Dor/métodos , Manejo da Dor/tendências , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Recuperação de Função Fisiológica/fisiologia , Método Simples-Cego , Espaço Subaracnóideo , Resultado do Tratamento
17.
Int J Surg ; 63: 63-70, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30769214

RESUMO

BACKGROUND: This prospective double-blind randomized study aimed at evaluating the short- and long-term postoperative analgesic efficacy of the ultrasound-guided tranversus abdominis plane (TAP) block in inguinal hernia repair under general anesthesia. METHODS: Sixty patients undergoing inguinal hernia repair were allocated to TAP block with either ropivacaine 0.75% 20 mL or placebo 20 mL. Postoperatively, they had access to a patient-controlled analgesia (PCA) device administering 1 mg doses of morphine as rescue analgesia. Pain was assessed at rest and during movement with the numeric rating scale (NRS) score 3,6 and 24 hs postoperatively. Other variables recorded were intraoperative dose of remifentanil required to maintain systolic arterial pressure within 20% of baseline, mg of morphine used in the Post Anesthesia Care Unit (PACU) and total dose of morphine administered via the PCA device. Six months after surgery, the occurrence of chronic pain was assessed with the NRS score at rest and during movement. Patients were also asked to fill in the DN4 questionnaire to estimate the development of neuropathic pain. RESULTS: Patients who were administered ropivacaine demonstrated significantly less pain at rest and on movement, as expressed by NRS scores in comparison to patients in the placebo group. The former group also required less remifentanil intraoperatively, less morphine during the PACU stay and had lower morphine consumption through the PCA device. Six months after surgery, pain scores at rest and during movement were comparable between the two groups. At the same time DN4 scores were low and comparable between the two groups. CONCLUSION: Ultrasound-guided TAP block provided better pain control than placebo in the acute setting after inguinal hernia repair. However, the incidence of chronic pain was low and not significantly affected by the performance of the block.


Assuntos
Dor Aguda/prevenção & controle , Dor Crônica/prevenção & controle , Hérnia Inguinal/cirurgia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Músculos Abdominais/inervação , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Estudos Prospectivos , Ropivacaina/administração & dosagem
20.
Obes Surg ; 29(4): 1099-1104, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30661208

RESUMO

INTRODUCTION: Postoperative pain remains the most common challenge following inpatient and outpatient surgeries, and, therefore, opioid analgesics are widely used during the perioperative period. The aim of this study is to examine the efficiency of transversus abdominis plane (TAP) block using liposomal bupivacaine in reducing the use of opioid analgesics during the perioperative period of bariatric procedures. MATERIAL AND METHODS: A retrospective chart review was performed on 191 patients who underwent a laparoscopic bariatric procedure between September 13, 2017, and February 26, 2018. A total of 97 patients received TAP block with liposomal bupivacaine, and 94 patients did not receive TAP block. RESULTS: Baseline patient characteristics were comparable between the two groups. The mean age was 43.7 and 41.1 years, and the mean preoperative body mass index (BMI) was 45.6 and 46.1 kg/m2 in TAP and non-TAP groups, respectively. In the TAP group, 65 patients (69.2%) received intravenous (IV) hydromorphone or morphine while 93 (95.9%) did in the non-TAP group (p < 0.0001). In the TAP group, 44 (46.8%) received oral opioid analgesic while 73 (75.3%) did in the non-TAP group (p < 0.0001). The odds of receiving IV hydromorphone or morphine for TAP group was about 0.10 times the corresponding odds for non-TAP group, and the odds of receiving oral opioid analgesic for the TAP group was about 0.29 times the corresponding odds for the non-TAP group. CONCLUSION: The use of preoperative TAP block with liposomal bupivacaine significantly decreased the use of IV and oral opioid analgesics. A larger prospective study may be needed to further validate the results.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Bloqueio Nervoso/métodos , Obesidade Mórbida/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Músculos Abdominais/inervação , Adulto , Cirurgia Bariátrica , Feminino , Humanos , Hidromorfona/administração & dosagem , Laparoscopia , Lipossomos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Medição da Dor , Cuidados Pré-Operatórios , Estudos Retrospectivos
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