Transversus abdominis plane block or intravenous lignocaine in open prostate surgery: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Transversus abdominis plane block (TAP) and intravenous lignocaine are two analgesic techniques frequently used after abdominal surgery. We hypothesized that these two techniques improve post-operative analgesia after open prostate surgery and sought to compare their efficacy on immediate post-operative outcome after open prostate surgery. METHODS: After ethics committee approval, 101 patients were enrolled in this prospective study and randomly allocated to receive bilateral ultrasound-guided TAP (n = 34), intravenous lignocaine (n = 33) or placebo (n = 34). In addition, intravenous paracetamol was given every 6 h. The primary endpoint was the cumulative opioid consumption during the first 48 post-operative hours (median[IQR]). Secondary endpoints included pain scores at rest and upon coughing, need for rescue tramadol, incidence of post-operative nausea and vomiting (PONV), recovery of bowel function and incidence of bladder catheter-related discomfort. RESULTS: Cumulative piritramide consumption after 48 h was 28 [23] mg in the control group, 21 [29] mg in the TAP group and 21 [31] mg in the lignocaine group (P = 0.065). There was no significant difference in post-operative pain scores between groups. The proportions of patients requiring rescue tramadol, experiencing PONV or bladder catheter-related discomfort were similar in each group. Recovery of bowel function was also similar in the three groups. CONCLUSIONS: Our study suggests that TAP block and intravenous lignocaine do not improve the post-operative analgesia provided by systematic administration of paracetamol after open prostatectomy.

[Peri-anaesthetic anaphylactic shock: myths and facts]. / Choc anaphylactique péri-anesthésique: mythe et réalités.

Peri-anaesthetic anaphylactic shock is a fortunately rare event, which nevertheless often turns out to be life-threatening. Only fast recognition and reaction can permit to avoid its sometimes dramatic consequences. This implies, from the anaesthetist, good knowledge of the mechanisms, of the events'sequence, of the usual triggering drugs and, of course, of the anaphylactic shock's treatment. After such an accident has occured the patient should be referred to an allergy specialist in order to perform a thorough exploration, thus pointing out which drug is responsible for the reaction, and by which mechanism. Drugs to be banished in the future would so be identified and should be taken to the patient's as well as his general practician's knowledge.