The Analgesic Efficacy of Subarachnoid Morphine in Comparison with Ultrasound-Guided Transversus Abdominis Plane Block After Cesarean Delivery (original) (raw)
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ANAESTHESIA, PAIN & INTENSIVE CARE CONTENTS MARCH 2018 ISSUE
Technology and the future of anesthesiology 01 Amer Majeed How could fundamental disagreements 05 about the correct anatomy of the pediatric larynx develop during the last 15 years? Josef Holzki ORIGINAL ARTICLES A combination of intrarectal lignocaine 08 cream plus periprostatic nerve block improves pain control in transrectal ultrasound guided prostate biopsy: A prospective evaluation Ekrem Akdeniz, Sevda Akdeniz Evaluation of clinical effectiveness of three 16 different sedation protocols (intravenous propofol vs. ketamine vs. ketofol) in anxious children Gözde Yalçın, Nurhan Öztaş,Gülay Kip Effect of low dose intrathecal clonidine as an 26 adjuvant to hyperbaric bupivacaine on postoperative analgesia in patients undergoing elective infra umbilical surgeries Prachi Surve, Neeta Dsouza, Rajendra Patil, Dheeraj Narayan Agrawal, Anshumali Study to evaluate transversus abdominis 32 plane (TAP) block with ropivacaine in appendectomy patients by total requirement of diclofenac as a postoperative analgesia drug Intravenous regional anesthesia: comparing 48 efficacy of magnesium sulphate and clonidine as an adjuvant to lignocaine for intraoperative and postoperative analgesia. Deepak Solanki, Meena Singh Effectiveness of audio visual distraction using 55 virtual reality eyeglasses versus tablet device in child behavioral management during inferior alveolar nerve block A prospective randomized controlled trial 62 comparing the effects of dexmedetomidine and fentanyl on attenuation of pressor response during laryngoscopy and intubation Baikady Vasudevarao Sunil, Neeta Santha Comparison of postoperative pain relief 67 following use of spinal anesthesia versus general anesthesia for patients undergoing laparoscopic cholecystectomy Amna Sharaf, Ahmed Mujadid Burki, Saira Mahboob, Razia Bano Awareness, knowledge and attitude about 73 labor analgesia among providers and parturients; a survey based study Effectiveness of algorithm based teaching 81 on recognition and management of periarrest bradyarrhythmias among interns -a randomized control study Kusha Nag, Rani P. VR. Hemanth Kumar, Anand Monickam, Dewan Roshan Singh, T. Sivashanmugam Ultrasound guided 4 in 1 block -a newer, 87 single injection technique for complete postoperative analgesia for knee and below knee surgeries A comparison between intrathecal isobaric 94 levobupivacaine 0.5% and isobaric ropivacaine 0.5% in lower limb surgeries: a prospective, randomized, double blind study Kajal A. Bhatt, Ila A. Prajapati REVIEW ARTICLE Common low back pain, is it really a mystery? 125 Kjetil Larsen EDUCATION Fundamentals of clinical research 131 2: Designing a research study
Cumhuriyet Medical Journal, 2018
The aim of this study is to investigate the contribution of transversus abdominis plane (TAP) block supported by intravenous ketamine sedation in children on intraoperative anesthesia and analgesia. Method: A total of 60 patients aged between 2 and 6 years, were included in the study. The patients were divided in three groups;the TAP block and ketamine group; the TAP block by inserting the laryngeal mask(LMA) and sevoflurane grup; and the LMA and sevoflurane group. Peroperative heart rates(HR), mean arterial pressures(MAP), amount of sevoflurane used, postoperative pain scores, number of children needing rescue analgesia, time required for the first analgesia were recorded. Results: Of the patients average age was 4 ± 1.1. There was no difference between the two block groups, in terms of HR and MAP; HR were higher and MAP were lower in the only sevoflurane group.In the group supported by a TAP block, the amount of sevoflurane used decreased(p<005). In the postoperative period, the HR, MAP and pain scores were higher in the only sevoflurane group(p <0,05). Rescue analgesia was applied to less number of patients in the groups with added block. There were longer analgesia durations in the block-supported groups(p<0.05). Conclusions: In this study, it was determined that TAP block added to general anesthesia or sedation in pediatric lower abdominal surgery reduced the need for intraoperative anesthesia, provided a more stable intraoperative hemodynamics and analgesia, and provided less pain scores, longer analgesia duration and less analgesia need in the postoperative period. Keywords: Children;ultrasound-guided transversus abdominis plane block; intraoperative anesthesia ÖZET Amaç: Bu çalışmanın amacı,çocuklarda intravenöz ketamin sedasyonuyla desteklenen transversus abdominis plane(TAP) bloğun intraoperatif anesteziye ve analjeziye katkısını araştırmaktır. Yöntem: 2-6 yaş arası toplam 60 hasta çalışmaya dahil edilmiştir. Hastalar 3 gruba ayrıldı; TAP blok ve ketamin grubu; larıngeal maske takılarak(LMA) TAP blok yapılan ve sevofluran grubu; LMA ve sevofluran grubu. Peroperatif kalp hızları(KH), ortalama arter basınçları(OAB), kullanılan sevofluran miktarı, postoperatif ağrı skorları, kurtarma analjezisine ihtiyaç olan çocuk sayısı, ilk analjeziye ihtiyaç duyulan zaman kaydedildi. Bulgular: Hastaların yaş ortalaması 4±1,1 idi. İki blok grup arasında KH ve OAB açısından fark yoktu; sadece sevofluran grubunda KH daha yüksek ve OAB daha düşüktü. TAP bloğu tarafından desteklenen grupta, kullanılan sevofluran miktarı azalmıştı(p <005). Postoperatif dönemde sadece sevofluran grubunda KH, OAB ve ağrı skorları daha yüksek bulundu(p <0,05). Blok eklenen gruplarda daha az sayıda hastaya kurtarma analjezi uygulandı. Blok destekli gruplarda daha uzun analjezi süreleri vardı(p <0.05). Sonuç: Bu çalışma ile, pediatrik alt batın cerrahisinde, genel anestezi ya da sedasyona eklenen TAP bloğun, intraoperatif anestezi ihtiyacını azalttığı, daha stabil intraoperatif hemodinami ve analjezi sağladığı, postoperatif dönemde ise daha düşük ağrı skorları, daha uzun analjezi süresi ve daha az analjezi ihtiyacı sağladığı saptanmıştır. Anahtar sözcükler: çocuk; ultrason eşliğinde transversus abdominis plane(TAP) blok; intraoperatif anestezi ClinicalTrials.gov.
Biomedical Research, 2018
Objective: In this study, we evaluated the efficacy of ultrasound guided Transversus Abdominis Plane Block (TAPB) procedure that was performed for the purpose of postoperative analgesia in patients who underwent caesarian section operation under spinal anesthesia. Patients and methods: This study included a total of 50 patients who underwent elective Caesarian section under spinal anesthesia. Patients were divided into two groups: those who postoperatively underwent guided ultrasound TAPB (Group TAPB, 20 ml. of 0.25% bupivacaine injected bilaterally); and those who did not undergo TAPB (Group C). Post-operatively, all patients received patientcontrolled analgesia using tramadol. Visual Analog Scale (VAS) scores were recorded at the time of patient's transport to and from the recovery room, and at the post-operative 1 st , 2 nd , 4 th , 6 th , 12 th and 24 th h. Tramadol consumption was recorded at the recovery phase and at 24 h. Results: Demographical data of the patients did not show any statistically significant difference. The amount of tramadol administered during recovery and at the end of postoperative 24 h were significantly lower in group TAPB (32.50 ± 15.51 and 226.00 ± 66.44 mg, respectively) in comparison to group C (47.52 ± 19.15 mg and 280.80 ± 35.34 mg, respectively) (p<0.01). VAS scores at time of transport to the recovery room, at the time of exit from the recovery room, and at the post-operative 1 st , 2 nd , 3 rd , 4 th , 6 th and 12 th h were significantly lower in group TAPB when compared to group C (p<0.05). Conclusions: It has been determined that ultrasound-guided TAPB performed after spinal anesthesia results in lower VAS scores, reduced analgesic consumption.
Ultrasound-Guided Regional Anesthesia and Analgesia
Regional Anesthesia and Pain Medicine, 2009
Ultrasound guidance has become popular for performance of regional anesthesia and analgesia. This systematic review summarizes existing evidence for superior risk to benefit profiles for ultrasound versus other techniques. Medline was systematically searched for randomized controlled trials (RCTs) comparing ultrasound to another technique, and for large (n 9 100) prospective case series describing experience with ultrasound-guided blocks. Fourteen RCTs and 2 case series were identified for peripheral nerve blocks. No RCTs or case series were identified for perineural catheters. Six RCTs and 1 case series were identified for epidural anesthesia. Overall, the RCTs and case series reported that use of ultrasound significantly reduced time or number of attempts to perform blocks and in some cases significantly improved the quality of sensory block. The included studies reported high incidence of efficacy of blocks with ultrasound (95%Y100%) that was not significantly different than most other techniques. No serious complications were reported in included studies. Current evidence does not suggest that use of ultrasound improves success of regional anesthesia versus most other techniques. However, ultrasound was not inferior for efficacy, did not increase risk, and offers other potential patient-oriented benefits. All RCTs are rather small, thus completion of large RCTs and case series are encouraged to confirm findings.
Ultrasound-Guided Regional Anesthesia and Analgesia: A Qualitative Systematic Review
Regional Anesthesia and Pain Medicine, 2009
Ultrasound guidance has become popular for performance of regional anesthesia and analgesia. This systematic review summarizes existing evidence for superior risk to benefit profiles for ultrasound versus other techniques. Medline was systematically searched for randomized controlled trials (RCTs) comparing ultrasound to another technique, and for large (n 9 100) prospective case series describing experience with ultrasound-guided blocks. Fourteen RCTs and 2 case series were identified for peripheral nerve blocks. No RCTs or case series were identified for perineural catheters. Six RCTs and 1 case series were identified for epidural anesthesia. Overall, the RCTs and case series reported that use of ultrasound significantly reduced time or number of attempts to perform blocks and in some cases significantly improved the quality of sensory block. The included studies reported high incidence of efficacy of blocks with ultrasound (95%Y100%) that was not significantly different than most other techniques. No serious complications were reported in included studies. Current evidence does not suggest that use of ultrasound improves success of regional anesthesia versus most other techniques. However, ultrasound was not inferior for efficacy, did not increase risk, and offers other potential patient-oriented benefits. All RCTs are rather small, thus completion of large RCTs and case series are encouraged to confirm findings.
European Journal of Anaesthesiology, 2012
Context Previous studies examining the efficacy of transversus abdominis plane block after caesarean section have mostly been in parturients under spinal anaesthesia. Objectives We postulated that the advantage of performing transversus abdominis plane block after caesarean section might be even more obvious after general anaesthesia, resulting in reduced 24-h consumption of morphine. Design, setting, patients and interventions In this single centre, randomised double-blind controlled trial, 40 women who underwent caesarean delivery under general anaesthesia were allocated randomly to receive a transversus abdominis plane block or no block. In those who received the block, 20 ml of levobupivacaine 2.5 mg ml À1 was deposited bilaterally into the transversus abdominis plane under ultrasound guidance using a Sonosite Titan (SonoSite, Bothell, Washington, USA) 7-13 MHz linear transducer at the end of surgery when the patient was still anaesthetised. Main outcome measures We recorded patientcontrolled intravenous morphine use for 24 h, pain scores at rest and activity, sedation, nausea and vomiting, use of antiemetic medication and overall maternal satisfaction. The primary outcome was 24-h morphine consumption. Results Patients who received the transversus abdominis plane block used significantly less morphine in 24 h than those in the control group [12.3 (2.6) vs. 31.4 mg (3.1), P < 0.001) and had higher satisfaction scores [16 (80%) vs. 5 (25%), P ¼ 0.012). There were no differences between groups in the visual analogue pain scores, sedation level, nausea and vomiting or the use of antiemetic medication. Conclusion Ultrasound-guided transversus abdominis plane block reduced morphine consumption following caesarean section under general anaesthesia, with increased maternal satisfaction.
BMC anesthesiology, 2024
Background Although the efficacy and safety of epidural block (EB) are fairly high, complications such as inadvertent dural puncture may limit its use. Ultrasound-guided quadratus lumborum block (QLB) is a relatively new regional technique that provides perioperative somatic and visceral analgesia for pediatric patients. This trial compared the quality of pain relief in pediatric patients undergoing abdominal surgery who received either QLB or EB. Methods Patients were randomly allocated into two equal groups: Group E(n = 29): received EB; Group QL(n = 29): received QLB. Both groups were injected with 0.25% bupivacaine (0.5 ml/kg). Assessment of total analgesia consumption was the primary outcome measure, whereas the secondary outcome measures were assessment of postoperative analgesic effect by Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and time of first analgesic request. Results Our study showed that the mean total fentanyl consumption was comparable between both groups(38.67 ± 5.02 and 36.47 ± 5.13 µg in the E and QL groups, respectively, P = 0.246). Only five patients did not require rescue analgesia (3 in the E group,2 in the QL group, P = 0.378). The mean duration of analgesia showed no significant difference between the two groups (9.9 ± 1.58 and 11.02 ± 1.74 h in the E and QL groups, respectively, P = 0.212). Evaluation of CHEOPS score values immediately in PACU and for the initial 24 h following operation showed no significant difference between the two study groups(P > 0.05). Conclusion QLB can achieve analgesic effects comparable to those of EB as a crucial part of multimodal analgesia in children undergoing abdominal surgeries. Clinical trial registration number PACTR202203906027106.
IP innovative publication pvt ltd, 2020
Introduction: Ultrasound guided (US) rectus sheath block, blocks ventral rami of 7th to 12th thoracic nerves by injection of local anaesthetics (LA) into the space between the rectus muscle and posterior sheath. The aim of the study was to evaluate the analgesic efficacy of Bupivacaine, Levobupivacaine and Ropivacaine in ultrasound guided bilateral rectus sheath block in patients undergoing umbilical surgeries. Materials and Methods: Patients received bilateral US-guided injection of total 30 mL of levobupivacaine (GpL) 0.25 % (or 0.375% of Ropivacaine (GpR) or 0.25%of Bupivacaine (GpB) respectively, behind the rectus muscle to detach it from its sheath. Analgesic efficacy of LA was evaluated using duration of analgesia, pain score at extubation and 1-16 hrs postoperatively and mean VAS (visual analogue scale) score to assess the quality of analgesia. Results: There were statistically significant differences in VAS scores between the groups L, R and B at all postoperative time points - 1hr, 2 hr, and 3hr till 16hrs. (P < 0.00001). The mean duration of analgesia in three groups was 9.300.92 hrs in Gp L, 13.021.17 hrs in Gp R and 6.2 0.83hrs in Gp B respectively. This difference was statistically significant (p =< 0.0001). Conclusions: Single shot of different local Anaesthetics in Ultrasound guided bilateral rectus sheath block provides postoperative analgesia up till 16hrs in patients with BMI 25-40kg/m2 undergoing umbilical surgeries with excellent VAS scores with Ropivacaine.
Sedation and analgesia in children undergoing invasive procedures
Archivos argentinos de pediatría
Introduction. As a result of the increased number of both diagnostic and therapeutic procedures in pediatric outpatients, sedation and analgesia have gained relevance in this context. Objective. To characterize the type of sedation and analgesia used by pediatric sedation teams in procedures done outside the operating room, as well as its safety and outcome. Population and Methods. All procedures performed in 1 month to 5 year old patients under intravenous sedation with midazolam, ketamine, propofol or lidocaine were analyzed over a 14-month period. The Ramsay sedation scale and the CHEOPS pain scale were used to determine the response to the sedation and analgesia administered. Results. A total of 186 procedures were analyzed. The results of the evaluation of response to sedation and analgesia indicated that an adequate deep sedation was obtained in 98% of cases, and that an adequate analgesia was achieved in 92% of patients. Around 12% of the procedures were associated with adverse events, all related to the airways, and none was serious. The only statistically significant endpoint associated with adverse events were procedures which involved airway interventions, i.e., fibrobronchoscopy, upper gastrointestinal endoscopy or transesophageal echocardiogram, with an OR of 6.27 (95% CI: 1.28-30.63; p = 0.023). Conclusions. In this group of patients, intravenous outpatient sedation and analgesia administered by a specialized team were safe and effective.
World Journal of Cardiovascular Surgery, 2020
Introduction: Regional anaesthesia combined with general anaesthesia reduces stress response to surgery, duration of ventilation, intensive care unit (ICU) stay and promotes early recovery. Studies on thoracic epidural, caudal analgesia along with general anaesthesia (GA) in paediatric cardiac surgery are limited hence we aimed to compare efficacy and safety of caudal, thoracic epidural and intravenous analgesia in paediatric cardiac surgery. Methodology: This study was conducted in the Department of Anaesthesiology in a tertiary care teaching hospital in southern India from February 2019 to December 2019. 90 children were randomised into group A, group B, group C. Children in group A received caudal analgesia along with GA. Group B children received thoracic epidural along with GA. Group C patients received intravenous analgesia along with GA. Rescue analgesia 1 mcg/kg fentanyl given in all 3 groups if pain score is more than 4. Primary outcome assessed was post-op pain scores. Secondary outcome assessed was duration of ventilation, duration of intensive care unit stay. Results: All patients were comparable in terms of age, sex, weight, mean RACHS score, baseline heart rate and blood pressure. Pain scores were significantly lower in thoracic epidural group compared to other two groups. Duration of ventilation was lower in thoracic epidural group (91.17 ± 43.85) minutes and caudal (199.6 ± 723.59) minutes compared to intravenous