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1.
Akihiko Maeda Sho Carl Shibata Hiroshi Wada Shigeru Marubashi Takahiko Kamibayashi Hidetoshi Eguchi Yuji Fujino 《Journal of anesthesia》2016,30(1):39-46
Purpose
Postoperative pain management for living liver donors has become a major concern as a result of the increasing number of living liver donations. Transversus abdominis plane (TAP) block has been known to provide effective analgesia for abdominal surgery. The aim of this study was to evaluate the efficacy of ultrasound-guided continuous subcostal TAP block as a part of a multimodal analgesic regimen in comparison with conventional intravenous (IV) fentanyl-based analgesia in living liver donors.Methods
Thirty-two donors were retrospectively classified into either the continuous subcostal TAP block group (TAP group) or the IV fentanyl-based analgesia group (control group). TAP group donors received bilateral continuous subcostal TAP infusion of 0.125 % levobupivacaine at 6 ml/h. Control group donors did not receive any neural blockade.Results
Cumulative fentanyl consumption was significantly lower in the TAP group for 48 h (P < 0.01) as compared to the control group. Further, the donors in the TAP group had significantly lower incidence of nausea and vomiting during 24–48 h postoperatively (P < 0.01) and fewer delays in the initiation of oral intake than those in the control group (P = 0.02).Conclusions
In conclusion, continuous subcostal TAP block provided an effective opioid-sparing analgesia for living liver donors.2.
Tak?Kyu?Oh Jiyeon?Yim Jaehyun?Kim Woosik?Eom Soon?Ae?Lee Sung?Chan?Park Jae?Hwan?Oh Ji?Won?Park Boram?Park Dae?Hyun?Kim
Background
Although laparoscopic colorectal surgery decreases postoperative pain and facilitates a speedier recovery compared with laparotomy, postoperative pain at trocar insertion sites remains a clinical concern. The objective of this study was to assess the effects of a preoperative ultrasound-guided transversus abdominis plane (TAP) block on pain after laparoscopic surgery for colorectal cancer.Methods
In total, 58 patients scheduled to undergo laparoscopic surgery following a diagnosis of colorectal cancer were included in this study. The patients were randomized into TAP and control groups; the TAP group patients received a preoperative ultrasound-guided bilateral TAP block with 0.5 mL/kg of 0.25 % bupivacaine, while the control patients received the block with an equal amount of saline. Pain on coughing and at rest was assessed during postanesthetic recovery (PAR; 1 h after surgery) and on postoperative days (PODs) 1 (24 h), 2 (48 h), and 3 (72 h) by an investigator blinded to group allocations using the numeric rating scale (NRS). The primary outcome was pain on coughing on postoperative day (POD) 1.Results
Fifty-five patients were included in the final analysis, including 28 in the TAP and 27 in the control groups. The pain intensity on coughing and at rest during PAR and on PODs 1, 2, and 3 showed no significant differences between groups. Furthermore, there was no significant difference in postoperative opioid consumption, sedation scores, nausea scores at the four time points, complication rates, and length of hospital stay between groups.Conclusions
In colorectal cancer patients undergoing laparoscopic colorectal surgery, a TAP block did not offer enough benefit for clinical efficacy in terms of postoperative pain or analgesic consumption.3.
Kunihisa Hotta Soichiro Inoue Koki Taira Naho Sata Kenji Tamai Mamoru Takeuchi 《Journal of anesthesia》2016,30(1):31-38
Purpose
Both single-injection transversus abdominis plane (TAP) block and continuous wound infiltration (CWI) provide postoperative analgesia, but no study has compared the two regional techniques. We tested the hypothesis that CWI is more effective for controlling postoperative pain compared with single-injection TAP block after laparotomy.Methods
We conducted a prospective randomized study of patients undergoing gynecologic laparotomy with midline incision through the umbilicus under general anesthesia. The patients were allocated to receive either single-injection TAP block (TAP group) or CWI (CWI group) for postoperative analgesia. All patients received intravenous patient-controlled analgesia with morphine and intravenous flurbiprofen twice daily after surgery. Postoperative pain at rest and on coughing, postoperative morphine consumption, incidence of postoperative nausea and vomiting (PONV), pruritus and urinary retention, ambulation, and satisfaction score were recorded. Patients were assessed at 3 h after surgery and twice daily on postoperative days (POD) 1 and 2.Results
Data of 54 patients were analyzed. Compared to the TAP group (n = 27), pain score on coughing was significantly lower in the CWI group (n = 27) on POD1 and POD2 (P < 0.05). Pain score on coughing at 3 h after surgery, pain score at rest at all assessed time points, morphine consumption, incidence of PONV, pruritus and urinary retention, ambulation, and satisfaction score were not different between the two groups.Conclusion
CWI reduced pain on coughing after the day of surgery compared with single-injection TAP block when performed as part of multimodal analgesia in patients undergoing gynecologic laparotomy.4.
Eric Albrecht Kyle R. Kirkham Ryan V. W. Endersby Vincent W. S. Chan Timothy Jackson Allan Okrainec Todd Penner Rongyu Jin Richard Brull 《Obesity surgery》2013,23(8):1309-1314
Background
Despite the laparoscopic approach, patients can suffer moderate to severe pain following bariatric surgery. This randomized controlled double-blinded trial investigated the analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) blocks for laparoscopic gastric-bypass surgery.Methods
Seventy patients undergoing laparoscopic gastric-bypass surgery were randomized to receive either bilateral ultrasound-guided subcostal TAP block injections after induction of general anesthesia or none. All patients received trocar insertion site local anesthetic infiltration and systemic analgesia. The primary outcome was cumulative opioid consumption (IV morphine equivalent) during the first 24 h postoperatively. Interval opioid consumption, pain severity scores, rates of nausea or vomiting, and rates of pruritus were measured during phase I recovery, and at 24 and 48 h postoperatively.Results
There was no difference in cumulative opioid consumption during the first 24 h postoperatively between the TAP (32.2 mg [95% CI, 27.6–36.7]) and control (35.6 mg [95% CI, 28.6–42.5]; P?=?0.41) groups. Postoperative opioid consumptions during phase I recovery and the 24–48-h interval were similar between groups, as were pain scores at rest and with movement during all measured intervals. The rates of nausea or vomiting and pruritus were equivalent.Conclusions
Bilateral TAP blocks do not provide additional analgesic benefit when added to trocar insertion site local anesthetic infiltration and systemic analgesia for laparoscopic gastric-bypass surgery. 相似文献5.
Nai-Liang Li Chia-Chuan Liu Skye Hung-Chun Cheng Chen-Fang Hung Wei-Ju Lai I-Fang Chao Wen-Ling Peng Chii-Ming Chen 《Acta anaesthesiologica Taiwanica》2013,51(3):103-107
ObjectivesSubcostal transversus abdominis plane (TAP) block and paravertebral block (PVB) offer postoperative analgesia for laparoscopic and thoracoscopic surgery, respectively. We investigated the early postoperative analgesic effects of PVB in combination with subcostal TAP block in patients undergoing minimally invasive esophagectomy (MIE) for esophageal cancer.MethodsSeventeen patients undergoing MIE without nerve block for postoperative analgesia and 16 patients undergoing MIE with PVB and subcostal TAP block for postoperative analgesia were enrolled for the study. The surgeon performed PVB with bupivacaine at T4, T6, and T8 levels under video-assisted thoracoscopy at the end of the thoracoscopic stage. The anesthesiologist responsible for the anesthesia performed ultrasound-guided bilateral subcostal TAP with bupivacaine at the end of the surgery. Postoperative morphine consumption, pain severity, vital capacity, intensive care unit (ICU) stay, and complication rate were compared between groups.ResultsThe group receiving nerve blocks consumed less morphine on postoperative Day 0 (p = 0.016), experienced lower levels of pain at postoperative 0 hour (p = 0.005) and 2 hours (p = 0.049), and had a shorter ICU stay (p = 0.02). No between-group differences in postoperative vital capacity and respiratory complications were observed.ConclusionPVB in combination with subcostal TAP block could reduce morphine consumption and pain severity in the early postoperative period but did not offer other clinical benefits in MIE. 相似文献
6.
Aissou M Ghalayini M Yazid L Abdelhalim Z Dufeu N Beaussier M 《Annales fran?aises d'anesthèsie et de rèanimation》2011,30(9):641-644
Objective
TAP is a regional anaesthetic technique where local anaesthesic (LA) is injected between the internal oblique and the transversus abdominis muscles in order to block intercostal nerves. The technique originally described, is based on the identification of the lumbar triangle of Petit as the area where to insert the needle before the LA injection. We performed a study to determine, using ultrasonography, the actual location of the LA when TAP block was performed using landmark-based technique.Study design
Prospective and observational study.Methods
Fifty-two patients scheduled for ileostomy closure surgery under general anaesthesia received a TAP block (20 mL 0.75% ropivacaine) based on standard anatomical landmarks technique. Ultrasonography was used immediately after the block to determine the LA placement. Failed blocks were considered when the patient required intravenous morphine in the immediate postoperative period for pain localised at the operative site.Results
LA solution was injected in the right place in 14 cases out of 52. Only one of these patient received morphine in the postoperative period. In the remaining 38 blocks, the LA was administered in adjacent anatomical structures and 25 failed. Two injections in the peritoneum were observed.Conclusion
The localization of LA after the TAP block being performed by landmark-based techniques is highly variable. In the majority of patients, the LA was injected in adjacent anatomical structures with unpredictable block results. This may promote the use of ultrasound-guided technique to perform the TAP block. 相似文献7.
Basem M. Mishriky MD Ronald B. George MD Ashraf S. Habib MBBCh 《Journal canadien d'anesthésie》2012,59(8):766-778
Purpose
To assess the efficacy of transversus abdominis plane (TAP) block in improving analgesia following Cesarean delivery (CD).Source
We searched MEDLINE, CENTRAL, EMBASE, and CINAHL for randomized controlled trials that assessed the efficacy of TAP block following CD and reported on postoperative pain scores and/or opioid consumption. Studies were combined according to the use or non-use of intrathecal morphine (ITM). Another analysis was performed for studies comparing TAP block with ITM.Principal findings
Nine studies were included. Transversus abdominis plane block significantly reduced opioid consumption (mg morphine equivalents) after Cesarean delivery at six hours (mean difference [MD] ?10.18; 95% confidence interval [CI] ?13.03 to ?7.34), at 12 hr (MD ?13.83; 95% CI ?22.77 to ?4.89), and at 24 hr (MD ?20.23; 95% CI ?33.69 to ?6.77). The TAP block also reduced pain scores for up to 12 hr and nausea in patients who did not receive ITM. When added to ITM, TAP block produced a small reduction in pain scores on movement in the first six hours (MD ?0.82, 95% CI ?1.52 to ?0.11). When compared with ITM, pain scores on movement and opioid consumption at 24 hr were lower (MD 0.98; 95% CI 0.06 to 1.91 and MD 8.42?mg; 95% CI 1.74 to 15.10, respectively), and time to first rescue analgesic was longer with ITM (8 hr vs 4 hr), although opioid-related side effects were more common.Conclusion
Transversus abdominis plane block significantly improved postoperative analgesia in women undergoing CD who did not receive ITM but showed no improvement in those who received ITM. Intrathecal morphine was associated with improved analgesia compared with TAP block alone at the expense of an increased incidence of side effects. 相似文献8.
Catherine J. Walter Charles Maxwell-Armstrong Thomas D. Pinkney Philip J. Conaghan Nigel Bedforth Christopher B. Gornall Austin G. Acheson 《Surgical endoscopy》2013,27(7):2366-2372
Background
Optimal analgesia following laparoscopic colorectal resection is yet to be determined; however, recent studies have questioned the role of postoperative epidural anaesthesia, suggesting other analgesic modalities may be preferable. The aim of this randomised controlled trial was to assess the effect of transversus abdominis plane (TAP) blocks on opioid requirements in patients undergoing laparoscopic colorectal resection.Methods
After appropriate trial registration (www.clinicaltrials.gov NCT 00830089) and local medical ethics review board approval (REC 09/H0407/10), all adult patients who were to undergo laparoscopic colorectal surgery at a single centre were randomised into the intervention group receiving bilateral TAP blocks or the control group (no TAP block). The blocks were administered prior to surgery after the induction of a standardised anaesthetic by an anaesthetist otherwise uninvolved with the case. The patient, theatre anaesthetist, surgeon, and ward staff were blinded to treatment allocation. All patients received postoperative analgesia of paracetamol and morphine as a patient-controlled analgesia (PCA). Cumulative opioid consumption and pain scores were recorded at 2, 4, 6, and 24 h postoperatively and compared between the groups as were clinical outcomes and length of stay.Results
The intervention (TAP block) group (n = 33) and the control group (n = 35) were comparable with respect to characteristics, specimen pathology, and type of procedure. The TAP block group’s median cumulative morphine usage (40 mg [IQR = 25–63]) was significantly less than that of the control group (60 mg [IQR = 39–81]). Pain scores and median length of stay (LOS) were similar between the two groups.Conclusion
Preoperative TAP blocks in patients undergoing laparoscopic colorectal resection reduced opioid use in the first postoperative day in this study. 相似文献9.
Neil A. Hanson MD Ryan E. Derby MD David B. Auyong MD Francis V. Salinas MD Christina Delucca MD Ryan Nagy MD Zhuoxin Yu PhD April E. Slee MS 《Journal canadien d'anesthésie》2013,60(9):874-880
Purpose
The saphenous nerve block using a landmark-based approach has shown promise in reducing postoperative pain in patients undergoing arthroscopic medial meniscectomy. We hypothesized that performing an ultrasound-guided adductor canal saphenous block as part of a multimodal analgesic regimen would result in improved analgesia after arthroscopic medial meniscectomy.Methods
Fifty patients presenting for ambulatory arthroscopic medial meniscectomy under general anesthesia were prospectively randomized to receive an ultrasound-guided adductor canal block with 0.5% ropivacaine or a sham subcutaneous injection of sterile saline. Our primary outcome was resting pain scores (numerical rating scale; NRS) upon arrival to the postanesthesia care unit (PACU). Secondary outcomes included NRS at six hours, 12 hr, 18 hr, and 24 hr; postoperative nausea; and postoperative opioid consumption.Results
There was a statistically significant difference in mean NRS pain scores upon arrival to the PACU (P = 0.03): block group NRS = 1.71 (95% confidence interval [CI] 0.73 to 2.68) vs sham group NRS = 3.25 (95% CI 2.27 to 4.23). Cumulative opioid consumption (represented in oral morphine equivalents) over 24 hr was 71.8 mg (95% CI 56.5 to 87.2) in the sham group vs 44.9 mg (95% CI 29.5 to 60.2) in the block group (P = 0.016).Conclusions
An ultrasound-guided block at the adductor canal as part of a combined multimodal analgesic regimen significantly reduces resting pain scores in the PACU following arthroscopic medial meniscectomy. Furthermore, 24-hr postoperative opioid consumption and pain scores were also reduced. 相似文献10.
《Journal of clinical anesthesia》2014,26(4):294-299
Study ObjectiveTo evaluate the effectiveness of subcostal TAP block and to compare its efficacy with that of posterior TAP block in decreasing postoperative pain in patients undergoing laparoscopic cholecystectomy during general anesthesia.DesignProspective, randomized, double-blind study.SettingAcademic medical center.Patients60 adult, ASA physical status 1 and 2 patients of both genders, aged 18-60 years, scheduled for elective laparoscopic cholecystectomy.InterventionsPatients were randomized to three groups of 20 patients each. Group 1 patients received standard general anesthesia (control group); Group 2 patients received an ultrasound-guided posterior TAP block using 15 mL of 0.375% ropivacaine on each side; and Group 3 patients underwent a subcostal TAP block with 15 mL of 0.375% ropivacaine on each side.MeasurementsThe presence and severity of pain during rest and movement, as well as nausea or vomiting and sedation, were assessed in all patients postoperatively on PACU admission, then at 2, 4, 6, 8, 12, and 24-hour intervals. Patients with a visual analog score (VAS) greater than 4, or those requesting analgesic were given intravenous tramadol 2 mg/kg as an initial dose; subsequent 1 mg/kg doses of tramadol, if needed, were given.ResultsPatients who received a subcostal TAP block had significantly lower pain scores at rest and on movement than the control group at all times postoperatively. Although, in the initial postoperative measurement times, the subcostal and posterior TAP groups had comparable pain scores, after 4 hours these scores were significantly lower in patients who had received the subcostal TAP block.ConclusionFor incisions mainly involving the supra-umbilical region, subcostal TAP block may be a better alternative than the posterior approach for providing postoperative analgesia. 相似文献
11.
Background
Tranversus-abdominis plane (TAP) block is a novel technique alternative to central neural blockade in providing analgesia to the anterior abdominal wall. As such, we compared the analgesic efficacy of TAP block with low thoracic-epidural analgesia (TEA) in ischemic heart disease patients after abdominal laparotomy.Methods
Forty-four American Society of Anesthesiologists physical status (ASA) III patients, 59–75 years of age and undergoing elective upper abdominal surgery under general anesthesia, were assigned randomly to receive either continuous low TEA or intermittent administration of local anesthetic in TAP block. Supplemental analgesia was provided with intravenous morphine with patient-controlled-analgesia. Morphine consumption and pain intensity using verbal rating scale (VRS) at rest and coughing over the first 48 h were recorded.Results
Whereas all patients in the TAP group required morphine, 16 (72.2 %) patients in TEA group received morphine postoperatively (p = 0.021). Morphine consumed on day 1 and day 2 was 11.5 mg (7.5–12.3 mg) and 7mg (4.5–8 mg) for the TEA group, while in the TAP group, it was 18 mg (16–19 mg) and 11 mg (10–13 mg), respectively (p < 0.001). Time for first request of morphine was 311.2 ± 18.5 min in the TEA group versus 210 ± 22.2 min in the TAP group (p < 0.001). VRS at rest and cough were lower in the TEA group compared with the TAP group at 1, 6, 12, 18, 24, 36 and 48 h (p < 0.001). Incidence of hypotension and ephedrine administration were significantly higher in the TEA group than in the TAP group (p = 0.007).Conclusion
Low TEA reduced morphine consumption and provided a higher analgesic efficacy compared with TAP block after laparotomy in ischemic heart disease patients. 相似文献12.
Purpose
In the present study, we evaluated the effects of interscalene brachial plexus block on postoperative pain relief and morphine consumption after modified radical mastectomy (MRM).Methods
Sixty ASA I–III patients scheduled for elective unilateral MRM under general anesthesia were included. They were randomly allocated into two groups: group 1 (n = 30), single-injection ipsilateral interscalene brachial plexus block; group 2 (n = 30), control group. Postoperative analgesia was provided with IV PCA morphine during 24 h postoperatively. Pain intensity was assessed with the visual analogue scale (VAS). Morphine consumption, side effects of opioid, antiemetic requirement, and complications associated with interscalene block were recorded.Results
VAS scores were significantly lower in group 1, except in the first postoperative 24 h (p < 0.007). The patients without block consumed more morphine [group 1, 5 (0–40) mg; group 2, 22 (6–48) mg; p = 0.001]. Rescue morphine requirements were also higher in the postoperative first hour in group 2 (p = 0.001). Nausea and antiemetic requirements were significantly higher in group 2 (p = 0.03 and 0.018). Urinary retention was observed in 1 patient in group 2 and signs of Horner’s syndrome in 2 patients in group 1.Conclusions
The optimal method has not been defined yet for acute pain palliation after MRM. Our study demonstrated that the use of interscalene block in patients undergoing MRM improved pain scores and reduced morphine consumption during the first 24 h postoperatively. The block can be a good alternative to other invasive regional block techniques used for postoperative pain management after MRM. 相似文献13.
Purpose
It is reported that following abdominal surgery, transversus abdominis plane (TAP) block can reduce postoperative pain. The primary outcome of this study was the evaluation of the efficacy of TAP block on pain intensity following cesarean delivery with Pfannenstiel incision.Methods
Fifty pregnant women were randomized blindly to receive either a TAP block with 15?ml 0.25% bupivacaine in both sides (group T, n?=?25) or no blockade (group C, n?=?25) at the end of the surgery, which was performed with a Pfannenstiel incision under general anesthesia. The pain intensity in the patients was assessed by a blinded investigator at the time of discharge from recovery and at 6, 12, and 24?h postoperatively, with a visual analogue scale (VAS) for pain.Results
The women in the TAP block group had significantly lower VAS pain scores at rest and during coughing and consumed significantly less tramadol than the women in group C [50?mg (0?C150) vs. 250?mg (0?C400), P?=?0.001]. There was a significantly longer time to the first request for analgesic in the TAP block group [210?min (0?C300) vs. 30?min (10?C180) in group C, P?=?0.0001].Conclusion
Two-sided TAP block with 0.25% bupivacaine in parturients who undergo cesarean section with a Pfannenstiel incision under general anesthesia can decrease postoperative pain and analgesic consumption. The time to the first analgesic rescue was longer in the parturients who received the TAP block. 相似文献14.
15.
Purpose
Local anaesthesia (LA) has proven effective for inguinal hernia repair in developed countries. Hernias in low to middle income countries represent a different issue. The aim of this study was to analyse the feasibility of LA for African hernia repairs in a limited resource environment.Methods
Data from patients who underwent herniorrhaphy under LA or spinal anaesthesia (SA) by the 6th and 7th Forward Surgical Team were prospectively collected. All of the patients benefited from a transversus abdominis plane (TAP) block for postoperative analgesia. Primary endpoints concerned the pain response and conversion to general anaesthesia. Secondary endpoints concerned the complication and recurrence rates. Predictors of LA failure were then identified.Results
In all, 189 inguinal hernias were operated during the study period, and 119 patients fulfilled the inclusion criteria: 57 LA and 62 SA. Forty-eight percent of patients presented with inguinoscrotal hernias. Local anaesthesia led to more pain during surgery and necessitated more administration of analgesics but resulted in fewer micturition difficulties and better postoperative pain control. Conversion rates were not different. Inguinoscrotal hernia and a time interval <50 min between the TAP block and skin incision were predictors of LA failure. Forty-four patients were followed-up at one month. No recurrence was noted.Conclusions
Local anaesthesia is a safe alternative to SA. Small or medium hernias can easily be performed under LA in rural centres, but inguinoscrotal hernias required an ultrasound-guided TAP block performed 50 min before surgery to achieve optimal analgesia, and should be managed only in centres equipped with ultrasonography.16.
Study Objective
To study the efficacy of the transversus abdominal plane (TAP) block.Design
Meta-analysis.Setting
District general hospital.Patients
86 patients in the TAP block group and 88 in the non-TAP block group.Measurements
Statistical analyses were performed using Microsoft Excel 2007 for Windows XP. Hedges g statistic was used for the calculation of standardized mean differences (SMD). Binary data (nausea) were summarized as risk ratios (RR).Main Results
Patients with TAP block required less morphine after 24 hours than those who did not have the block (random effects model: SMD -4.81, 95% CI [-7.45, -2.17], z = -3.57, P < 0.001). There was less time to first request of morphine in the non-TAP block group (random effects model: SMD 4.80, 95% CI [2.16, 7.43], z = 3.57, P < 0.001). Patients in the TAP block group had less pain up to 24 hours postoperatively. No statistical differences were found with respect to nausea.Conclusions
TAP block reduces the need for postoperative opioid use, it increases the time first request for further analgesia, it provides more effective pain relief, and it reduces opioid-associated side effects. 相似文献17.
Study objectiveOur hypothesis was that a pre-operative posteromedial quadratus lumborum (QL) block would reduce postoperative morphine consumption and provide superior analgesia in the setting of multimodal analgesia compared with a lateral transversus abdominis plane (TAP) block for laparoscopic colorectal surgery.DesignA randomized controlled study.SettingA single tertiary hospital. March to August 2018.Patients80 ASA I–II colorectal cancer patients undergoing laparoscopic radical resection were enrolled. 77 patients (group QL 38, group TAP 39) were included in the analysis.InterventionPre-operatively, patients were randomized to receive either a QL or TAP block (0.375% ropivacaine 20 ml bilaterally for each group).MeasurementsThe primary outcome was cumulative morphine consumption 24 h postoperatively. Secondary outcomes included postoperative pain scores, clinical recovery, and side-effect profiles of the blocks.Main resultsFor the primary outcome measure, morphine consumption 24 h postoperatively was significantly lower in the QL group than in the TAP group (estimated median difference −8 mg, adjusted 95% confidential interval −12 to −6 mg, P < 0.001). The pain visual analogue scores at rest and during movement were found to be statistically significantly lower in the QL group than in the TAP group 8, 12, and 24 h postoperatively (P < 0.006). The QL group reported higher overall satisfaction scores regarding postoperative analgesia than the TAP group (P = 0.014). One patient in the QL group experienced moderate back pain close to the needle entry site postoperatively. There was no statistically significant difference in postoperative nausea and vomiting, bowel recovery or length of hospital stay between the groups.ConclusionsThe pre-operative bilateral, ultrasound-guided posteromedial QL block reduces morphine consumption and improves analgesia in the setting of multimodal analgesia compared with the lateral TAP block after laparoscopic colorectal surgery. 相似文献
18.
D. Ozkan T. Akkaya N. Karakoyunlu E. Arık J. Ergil Z. Koc H. Gumus H. Ersoy 《Der Anaesthesist》2013,62(12):988-994
Background
The aim of the study was to investigate the effect of preoperative ultrasound-guided (US) intercostal nerve block (ICNB) in the 11th and 12th intercostal spaces on postoperative pain control and tramadol consumption in patients undergoing percutaneous nephrolithotomy (PCNL).Methods
After obtaining ethical committee approval and written informed patient consent, 40 patients were randomly allocated to the ICNB group or the control group. For the ICNB group US-guided ICNB was performed with 0.5?% bupivacaine and 1/200,000 epinephrine at the 11th and 12th intercostal spaces after premedication. A sham block was performed for the control group and postoperative pain and tramadol consumption were recorded by anesthesiologists blinded to the treatment.Results
Postoperative visual analog scale scores at all follow-up times were found to be significantly lower in the ICNB group than in the control group (p?<?0.05). The mean 24 h intravenous tramadol consumption was 97.5?±?39.5 mg for the ICNB group which was significantly lower than the 199.7?±?77.6 mg recorded for the control group (p?<?0.05).Conclusion
In PCNL with nephrostomy tube placement US-guided ICNB performed at the 11th and 12th intercostal spaces provided effective analgesia. 相似文献19.
José Osvaldo Barbosa Neto Maria Deneb Tavares Machado Marta de Almeida Correa Hamilton Alves Scomparim Irimar Paula Posso Hazem Adel Ashmawi 《Journal of anesthesia》2014,28(4):505-510
Purpose
Postoperative pain is an important health-care issue. Patient-controlled analgesia (PCA) is considered the gold standard for systemic postoperative pain treatment. Methadone PCA is used for patients with chronic pain and those in the palliative care setting. However, its efficacy as a first-line drug for acute postoperative pain is unknown. This study evaluated the use of postoperative methadone PCA after total hip arthroplasty (THA) compared with morphine PCA.Methods
This was a randomized, double-blind, controlled, parallel-group study. Patients were randomized into two groups: group methadone—methadone PCA, and group morphine—morphine PCA, for postoperative analgesia. Drugs were delivered through PCA pumps throughout the first 24 h after surgery (T1:6, T2:12, T3:18, T4:24 h).Results
Opioid consumption in 24 h was significantly lower for group methadone than for group morphine. Group methadone patients experienced significantly less pain than group morphine at rest. Pain after movement was significantly lower in group methadone at T1 and T3 and marginally lower at T2 and T4. Adverse events more frequently reported were sleepiness, nausea, and vomiting, but no statistical difference between groups was found.Conclusion
This study demonstrated that methadone PCA prompted less opioid consumption and lower pain scores at rest and at motion in comparison with morphine PCA as postoperative analgesia after THA. 相似文献20.
Marie T. Aouad Ghassan E. Kanazi Krystel Malek Hani Tamim Lama Zahreddine Roland N. Kaddoum 《Journal of anesthesia》2016,30(1):72-79