<b>Objectives:</b> To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. <b>Methods:</b> This was a descriptive prospective s...<b>Objectives:</b> To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. <b>Methods:</b> This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. <b>Results:</b> In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38;at H12 of 1.15 ± 0.62;at H24 of 0.84 ± 0.51;at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61;at H24 of 1.53 ± 0.56;at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. <b>Conclusion:</b> Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.展开更多
Introduction/Purpose: The “transverse abdominal plane block” or TAP block was described by Rafi in 2001. It describes an approach to the neurofascial plane of the transverse abdominal muscle via the Jean-Louis Petit...Introduction/Purpose: The “transverse abdominal plane block” or TAP block was described by Rafi in 2001. It describes an approach to the neurofascial plane of the transverse abdominal muscle via the Jean-Louis Petit triangle and provides analgesia of the entire homolateral hemi abdomen. The aim of our study was to compare post-operative analgesia and post-operative morphine requirements between transverse abdominal plane block (TAP) and peri-orificial infiltration during laparoscopic abdominal surgery. Material and method: Prospective, randomized study conducted over a 2-year period. The study was conducted in the operating theatre of the Saint Louis Regional Hospital in Senegal. All adult patients undergoing laparoscopic abdominal surgery were included. Clinical aspects, pain scales and morphine consumption were analyzed. Results: A total of 60 patients were enrolled: 30 patients in the TAP group and 30 patients in the infiltration group. The average age was 32.9 years. The indications for laparoscopy were acute appendicitis in 50% of cases, gallbladder stones in 16% and inguinal hernia in 8%. For the TAP group, the mean numerical pain scale was 3.9 at 6 hours post-operatively and 2.1 at 24 hours post-operatively. For the infiltration group, the mean numerical pain scale was 4.3 at 6 hours post-op and 3 at 24 hours post-op. Morphine consumption at 6 hours post-op was on average 0.4 mg/patient for the TAP group and 0.9 mg/patient for the infiltration group. Discussion/conclusion: Analgesia provided by ultrasound-guided TAP block for laparoscopic abdominal surgery appears to be identical to periorificial infiltration. However, the simplicity and reproducibility of ultrasound-guided TAP block gives it a definite advantage.展开更多
Background: The efficacy of transversus abdominis plane (TAP) block has been demonstrated in postoperative analgesia, but few studies have evaluated its intraoperative effects. We aimed to describe the intraoperative ...Background: The efficacy of transversus abdominis plane (TAP) block has been demonstrated in postoperative analgesia, but few studies have evaluated its intraoperative effects. We aimed to describe the intraoperative hemodynamic and analgesic effects of pre-incisional TAP block in patients undergoing total abdominal hysterectomy. Methods: Seventy women proposed for total abdominal hysterectomy indicated for uterine fibroids, classified ASA I and II were randomized in a double-blinded model to Group A (n = 35) receiving bilateral ultrasound-guided TAP block with ropivacaine and Group B (n = 35) receiving bilateral ultrasound-guided TAP block with normal saline, followed by general anesthesia. The variations of the heart rate (HR) and mean arterial blood pressure (MABP) and intraoperative fentanyl consumption were studied. Results: At the arrival in the operating room, there was no significant difference in heart rate and mean arterial pressure noted in both groups. (HR: 85.38 ± 8.44 pulsations/min versus 86.30 ± 10.05 pulsations/min, p = 0.621;MABP: 94.97 ± 13.46 mmHg versus 96.36 ± 12.41 mmHg, p = 0.533). Before surgical incision, no statistically significant difference was detected between the two groups regarding the heart rate and the mean arterial blood pressure. After surgical incision, both the heart rate and mean arterial blood pressure were significantly higher in the Group B. There was a significant decrease in intraoperative fentanyl requirements in the Group A compared to the Group B (293.58 ± 60.59 mcg versus 449.44 ± 71.31 mcg, p Conclusion: Pre-incisional TAP block attenuates hemodynamic responses to surgical stress and decreases intraoperative fentanyl requirements in patients undergoing total abdominal hysterectomy.展开更多
目的比较超声引导下的肋缘下入路腹横肌平面阻滞(TAP)阻滞与后路TAP阻滞对于腹腔镜胆囊切除术患者的术后镇痛效果。方法选择本院2018年6月至2019年6月行腹腔镜胆囊切除术的60名患者为研究对象,设计前瞻性、随机对照、双盲临床试验,将所...目的比较超声引导下的肋缘下入路腹横肌平面阻滞(TAP)阻滞与后路TAP阻滞对于腹腔镜胆囊切除术患者的术后镇痛效果。方法选择本院2018年6月至2019年6月行腹腔镜胆囊切除术的60名患者为研究对象,设计前瞻性、随机对照、双盲临床试验,将所有患者随机分为三组,分别为全身麻醉组、后路TAP阻滞组及肋缘下入路TAP阻滞组。I组患者接受标准的全身麻醉(对照组);II组患者接受超声引导下后路TAP阻滞,每侧使用15 ml 0.375%罗哌卡因;III组患者接受超声引导下肋缘下入路的TAP阻滞,两侧各15 ml 0.375%罗哌卡因。观察指标:评估患者术后0、2、4、6、8、12和24 h静息和运动状态下的疼痛VAS评分,记录首次按压镇痛泵的时间、术后镇痛药物的用量以及恶心、呕吐和过度镇静等并发症的发生。结果术后随访结果证实,术后4 h以内II组及III组患者在静息和运动时的疼痛评分相当(P>0.05),并且显著低于I组患者(P<0.05);但术后4 h以后,III组患者的术后镇痛效果明显优于II组患者(P<0.05)。结论对于脐平面以上区域切口的腹部手术,肋缘下入路的TAP阻滞能够比后路TAP阻滞提供更好的术后镇痛效果。展开更多
Background: The study was done to assess the postoperative analgesic efficacy of ultrasound-guided continuous transverses abdominis plane block, continuous lumbar paravertebral block and a continuous lumbar epidural b...Background: The study was done to assess the postoperative analgesic efficacy of ultrasound-guided continuous transverses abdominis plane block, continuous lumbar paravertebral block and a continuous lumbar epidural block in patients undergoing lower abdominal surgeries (unilateral inguinal hernia repair). We compared their analgesic efficacy over the first 48 hour postoperative, in a randomized, single-blind study in 120 patients divided into four equal groups, 30 patients in each group. Methods: 120 patients randomly assigned into four equal groups, with 30 patients in each group. Group T received ultrasound-guided transverses abdominis plane block with 20 ml of bupivacaine 0.25% followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group P received ultrasound-guided continuous lumbar paravertebral block with bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr). Group E received continuous lumbar epidural infusion of bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group C received normal saline bolus dose 20 ml, followed by continuous infusion of normal saline (0.1 ml/kg/hr). General anesthesia induced with fentanyl 1 - 2 μg/kg and propofol 1 - 3 mg/kg followed by atracurium 0.5 mg/kg. At the end of the surgical procedure, we activated the regional block with recording of parameters in the postoperative period each patient was assessed for visual analog scale (VAS) at rest and on movement, analgesic consumption, vital signs and presence of complications (nausea, vomiting, sedation), and postoperative patient satisfaction all data collected postoperatively by a blinded investigator at one, two, 6, 12, 24 and 48 hours postoperatively. Results: Postoperative analgesic efficacy is more in group E than group P and group T, the latter is least effective in pain control. Also in group E the postoperative analgesic consumption is lower than in group P and group T, re-garding complications as nausea and vomiting more recorded in epidural than the other two groups. Conclusion: Regarding postoperative analgesic efficacy, the continuous lumbar epidural block is more effective than continuous paravertebral and continuous transverses abdominis plane block, but regarding complications, there was a higher incidence in epidural group than other two groups.展开更多
Transverse abdominis Plane blocks (TAP) provide effective postoperative analgesia following surgical incisions of the lower and middle abdominal wall, including those associated with cesarean section. This study inves...Transverse abdominis Plane blocks (TAP) provide effective postoperative analgesia following surgical incisions of the lower and middle abdominal wall, including those associated with cesarean section. This study investigated the efficacy of liposomal bupivacaine diluted with 0.25% bupivacaine administered in bilateral TAP blocks for post-operative analgesia after Ce-sarean section preformed under neuraxial anesthesia. The patients who received the TAP blocks with liposomal bupivacaine had noticeably low pain scores of 1.0 ± 1.4, 1.4 ± 2.1, 1.7 ± 1.9, 1.9 ± 3.3 and 1.9 ± 2.3 at 6, 12, 24, 48 and 72 hours respectively. Only 3 patients used oxycodone (5 mg)/acetaminophen (325 mg) postoperative. One patient took two tables of oxycodone (5 mg)/acetamino-phen (325 mg) after 24 hours, a second patient used oxycodone (5 mg)/aceta-minophen (325 mg) after 72 hours and the third patient was transferred to the intensive care unit (ICU) since she developed postpartum cardiac complications, and was give oxycodone (5 mg)/acetaminophen (325 mg) despite having a 0 pain score. These results suggest that patients treated bilateral TAP blocks with a mixture of liposomal and regular bupivacaine will have low pain scores, high patient satisfaction and reduce the use of postoperative narcotics.展开更多
文摘<b>Objectives:</b> To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. <b>Methods:</b> This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. <b>Results:</b> In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38;at H12 of 1.15 ± 0.62;at H24 of 0.84 ± 0.51;at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61;at H24 of 1.53 ± 0.56;at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. <b>Conclusion:</b> Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.
文摘Introduction/Purpose: The “transverse abdominal plane block” or TAP block was described by Rafi in 2001. It describes an approach to the neurofascial plane of the transverse abdominal muscle via the Jean-Louis Petit triangle and provides analgesia of the entire homolateral hemi abdomen. The aim of our study was to compare post-operative analgesia and post-operative morphine requirements between transverse abdominal plane block (TAP) and peri-orificial infiltration during laparoscopic abdominal surgery. Material and method: Prospective, randomized study conducted over a 2-year period. The study was conducted in the operating theatre of the Saint Louis Regional Hospital in Senegal. All adult patients undergoing laparoscopic abdominal surgery were included. Clinical aspects, pain scales and morphine consumption were analyzed. Results: A total of 60 patients were enrolled: 30 patients in the TAP group and 30 patients in the infiltration group. The average age was 32.9 years. The indications for laparoscopy were acute appendicitis in 50% of cases, gallbladder stones in 16% and inguinal hernia in 8%. For the TAP group, the mean numerical pain scale was 3.9 at 6 hours post-operatively and 2.1 at 24 hours post-operatively. For the infiltration group, the mean numerical pain scale was 4.3 at 6 hours post-op and 3 at 24 hours post-op. Morphine consumption at 6 hours post-op was on average 0.4 mg/patient for the TAP group and 0.9 mg/patient for the infiltration group. Discussion/conclusion: Analgesia provided by ultrasound-guided TAP block for laparoscopic abdominal surgery appears to be identical to periorificial infiltration. However, the simplicity and reproducibility of ultrasound-guided TAP block gives it a definite advantage.
文摘Background: The efficacy of transversus abdominis plane (TAP) block has been demonstrated in postoperative analgesia, but few studies have evaluated its intraoperative effects. We aimed to describe the intraoperative hemodynamic and analgesic effects of pre-incisional TAP block in patients undergoing total abdominal hysterectomy. Methods: Seventy women proposed for total abdominal hysterectomy indicated for uterine fibroids, classified ASA I and II were randomized in a double-blinded model to Group A (n = 35) receiving bilateral ultrasound-guided TAP block with ropivacaine and Group B (n = 35) receiving bilateral ultrasound-guided TAP block with normal saline, followed by general anesthesia. The variations of the heart rate (HR) and mean arterial blood pressure (MABP) and intraoperative fentanyl consumption were studied. Results: At the arrival in the operating room, there was no significant difference in heart rate and mean arterial pressure noted in both groups. (HR: 85.38 ± 8.44 pulsations/min versus 86.30 ± 10.05 pulsations/min, p = 0.621;MABP: 94.97 ± 13.46 mmHg versus 96.36 ± 12.41 mmHg, p = 0.533). Before surgical incision, no statistically significant difference was detected between the two groups regarding the heart rate and the mean arterial blood pressure. After surgical incision, both the heart rate and mean arterial blood pressure were significantly higher in the Group B. There was a significant decrease in intraoperative fentanyl requirements in the Group A compared to the Group B (293.58 ± 60.59 mcg versus 449.44 ± 71.31 mcg, p Conclusion: Pre-incisional TAP block attenuates hemodynamic responses to surgical stress and decreases intraoperative fentanyl requirements in patients undergoing total abdominal hysterectomy.
文摘目的比较超声引导下的肋缘下入路腹横肌平面阻滞(TAP)阻滞与后路TAP阻滞对于腹腔镜胆囊切除术患者的术后镇痛效果。方法选择本院2018年6月至2019年6月行腹腔镜胆囊切除术的60名患者为研究对象,设计前瞻性、随机对照、双盲临床试验,将所有患者随机分为三组,分别为全身麻醉组、后路TAP阻滞组及肋缘下入路TAP阻滞组。I组患者接受标准的全身麻醉(对照组);II组患者接受超声引导下后路TAP阻滞,每侧使用15 ml 0.375%罗哌卡因;III组患者接受超声引导下肋缘下入路的TAP阻滞,两侧各15 ml 0.375%罗哌卡因。观察指标:评估患者术后0、2、4、6、8、12和24 h静息和运动状态下的疼痛VAS评分,记录首次按压镇痛泵的时间、术后镇痛药物的用量以及恶心、呕吐和过度镇静等并发症的发生。结果术后随访结果证实,术后4 h以内II组及III组患者在静息和运动时的疼痛评分相当(P>0.05),并且显著低于I组患者(P<0.05);但术后4 h以后,III组患者的术后镇痛效果明显优于II组患者(P<0.05)。结论对于脐平面以上区域切口的腹部手术,肋缘下入路的TAP阻滞能够比后路TAP阻滞提供更好的术后镇痛效果。
文摘Background: The study was done to assess the postoperative analgesic efficacy of ultrasound-guided continuous transverses abdominis plane block, continuous lumbar paravertebral block and a continuous lumbar epidural block in patients undergoing lower abdominal surgeries (unilateral inguinal hernia repair). We compared their analgesic efficacy over the first 48 hour postoperative, in a randomized, single-blind study in 120 patients divided into four equal groups, 30 patients in each group. Methods: 120 patients randomly assigned into four equal groups, with 30 patients in each group. Group T received ultrasound-guided transverses abdominis plane block with 20 ml of bupivacaine 0.25% followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group P received ultrasound-guided continuous lumbar paravertebral block with bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr). Group E received continuous lumbar epidural infusion of bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group C received normal saline bolus dose 20 ml, followed by continuous infusion of normal saline (0.1 ml/kg/hr). General anesthesia induced with fentanyl 1 - 2 μg/kg and propofol 1 - 3 mg/kg followed by atracurium 0.5 mg/kg. At the end of the surgical procedure, we activated the regional block with recording of parameters in the postoperative period each patient was assessed for visual analog scale (VAS) at rest and on movement, analgesic consumption, vital signs and presence of complications (nausea, vomiting, sedation), and postoperative patient satisfaction all data collected postoperatively by a blinded investigator at one, two, 6, 12, 24 and 48 hours postoperatively. Results: Postoperative analgesic efficacy is more in group E than group P and group T, the latter is least effective in pain control. Also in group E the postoperative analgesic consumption is lower than in group P and group T, re-garding complications as nausea and vomiting more recorded in epidural than the other two groups. Conclusion: Regarding postoperative analgesic efficacy, the continuous lumbar epidural block is more effective than continuous paravertebral and continuous transverses abdominis plane block, but regarding complications, there was a higher incidence in epidural group than other two groups.
文摘Transverse abdominis Plane blocks (TAP) provide effective postoperative analgesia following surgical incisions of the lower and middle abdominal wall, including those associated with cesarean section. This study investigated the efficacy of liposomal bupivacaine diluted with 0.25% bupivacaine administered in bilateral TAP blocks for post-operative analgesia after Ce-sarean section preformed under neuraxial anesthesia. The patients who received the TAP blocks with liposomal bupivacaine had noticeably low pain scores of 1.0 ± 1.4, 1.4 ± 2.1, 1.7 ± 1.9, 1.9 ± 3.3 and 1.9 ± 2.3 at 6, 12, 24, 48 and 72 hours respectively. Only 3 patients used oxycodone (5 mg)/acetaminophen (325 mg) postoperative. One patient took two tables of oxycodone (5 mg)/acetamino-phen (325 mg) after 24 hours, a second patient used oxycodone (5 mg)/aceta-minophen (325 mg) after 72 hours and the third patient was transferred to the intensive care unit (ICU) since she developed postpartum cardiac complications, and was give oxycodone (5 mg)/acetaminophen (325 mg) despite having a 0 pain score. These results suggest that patients treated bilateral TAP blocks with a mixture of liposomal and regular bupivacaine will have low pain scores, high patient satisfaction and reduce the use of postoperative narcotics.
