La anestesia regional guiada por ultrasonido ocupa ya un lugar preponderante en los diversos bloqueos nerviosos y en los accesos vasculares. Hoy iniciamos una serie de envíos con temas selectos incluyendo artículos en PDF y enlaces a videoclips.
The ultrasound-guided regional anesthesia occupies a prominent place in several nerve blocks and vascular access. Today we begin a series of posts with selected topics including articles in PDF and links to video clips
Eficacia del bloqueo subcostal del plano transverso abdominal en colecistectomía laparoscópica: comparación con la infiltración de sitio del ¨puerto¨
Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Comparison with conventional port-site infiltration.
Tolchard S, Davies R, Martindale S.
North Bristol NHS Trust, Bristol, UK.
J Anaesthesiol Clin Pharmacol. 2012 Jul;28(3):339-43.
Abstract
BACKGROUND: Pain experienced following laparoscopic cholecystectomy is largely contributed by the anterior abdominal wall incisions. This study investigated whether subcostal transversus abdominis (STA) block was superior to traditional port-site infiltration of local anesthetic in reducing postoperative pain, opioid consumption, and time for recovery. MATERIALS AND METHODS: Forty-three patients presenting for day case laparoscopic cholecystectomy were randomly allocated to receive either an ultrasound-guided STA block (n = 21) or port-site infiltration of local anesthetic (n = 22). Visual analog pain scores were measured at 1 and 4 h postoperatively to assess pain severity, and opioid requirement was measured in recovery and up to 8 h postoperatively. The time to discharge from recovery was recorded. RESULTS: STA block resulted in a significant reduction in serial visual pain analog score values and significantly reduced the fentanyl requirement in recovery by >35% compared to the group that received local port-site infiltration (median 0.9 vs. 1.5 μcg/kg). Furthermore, STA block was associated with nearly a 50% reduction in overall 8-h equivalent morphine consumption (median 10 mg vs. 19 mg). In addition, STA block significantly reduced median time to discharge from recovery from 110 to 65 min. CONCLUSION: The results suggest that STA block provides superior postoperative analgesia and reduces opioid requirement following laparoscopic cholecystectomy. It may also improve theater efficiency by reducing time to discharge from the recovery unit.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409944/
http://www.joacp.org/temp/JAnaesthClinPharmacol283339-7357759_202617.pdf
Implicaciones clínicas del bloqueo del plano transverso abdominal en adultos
Clinical implications of the transversus abdominis plane block in adults.
Young MJ, Gorlin AW, Modest VE, Quraishi SA.
Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
Anesthesiol Res Pract. 2012;2012:731645. Epub 2012 Jan 19.
Abstract
The transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique that provides analgesia to the parietal peritoneum as well as the skin and muscles of the anterior abdominal wall. It has a high margin of safety and is technically simple to perform, especially under ultrasound guidance. A growing body of evidence supports the use of TAP blocks for a variety of abdominal procedures, yet, widespread adoption of this therapeutic adjunct has been slow. In part, this may be related to the limited sources for anesthesiologists to develop an appreciation for its sound anatomical basis and the versatility of its clinical application. As such, we provide a brief historical perspective on the TAP block, describe relevant anatomy, review current techniques, discuss pharmacologic considerations, and summarize the existing literature regarding its clinical utility with an emphasis on recently published studies that have not been included in other systematic reviews or meta-analyses.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270549/pdf/ARP2012-731645.pdf
Eficacia de la analgesia preventiva con el bloqueo del plano transverso abdominal guiado con ultrasonido en pacientes con cirugía ginecológica con incisión transversa en abdomen inferior
Preemptive analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision.
Shin HJ, Kim ST, Yim KH, Lee HS, Sim JH, Shin YD.
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Korean J Anesthesiol. 2011 Nov;61(5):413-8. Epub 2011 Nov 23.
Abstract
BACKGROUND: The transversus abdominis plane block is recently described peripheral block to providing analgesia to the anterior abdominal wall. The goal of this study is to evaluate the analgesic efficacy of the ultrasound-guided transversus abdominis plane block (US-TAP block) in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision. METHODS: Thirty-two patients undergoing gynecologic surgery were randomized to undergo standard care such as PCA, or to receive additional US-TAP block with standard care. After general anesthesia induction, a bilateral US-TAP block was performed using 0.375% ropivacaine 20 ml on each side. Postoperative demand of rescue analgesics in PACU and ward were recorded. Each patient was assessed postoperatively by a blinded investigator in the postanesthesia care unit (PACU) and at 2, 6, 10, 24, 48 hr postoperatively to investigate pain, drowsiness, nausea and itch. RESULTS: The US-TAP block reduced pain intensity compared to standard care in the PACU (5.2 ± 3.1 vs 8.4 ± 1.3) and at 2, 24 postoperative hours (3.0 ± 2.4 vs 5.2 ± 2.4, 0.9 ± 1.5 vs 2.2 ± 1.9). Fentanyl requirements in PACU was reduced (20.3 ± 20.9 vs 62.5 ± 35.4 µg, P < 0.05). In ward, pethidine requirements was reduced (21.9 ± 28.7 vs 56.3 ± 34.8 mg, P < 0.05). CONCLUSIONS: The US-TAP block with standard care provide more effective analgesia after gynecologic surgery via a transverse lower abdominal skin incision.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229021/pdf/kjae-61-413.pdf
Atentamente
Dr. José Ramón Saucillo-Osuna
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
The ultrasound-guided regional anesthesia occupies a prominent place in several nerve blocks and vascular access. Today we begin a series of posts with selected topics including articles in PDF and links to video clips
Eficacia del bloqueo subcostal del plano transverso abdominal en colecistectomía laparoscópica: comparación con la infiltración de sitio del ¨puerto¨
Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Comparison with conventional port-site infiltration.
Tolchard S, Davies R, Martindale S.
North Bristol NHS Trust, Bristol, UK.
J Anaesthesiol Clin Pharmacol. 2012 Jul;28(3):339-43.
Abstract
BACKGROUND: Pain experienced following laparoscopic cholecystectomy is largely contributed by the anterior abdominal wall incisions. This study investigated whether subcostal transversus abdominis (STA) block was superior to traditional port-site infiltration of local anesthetic in reducing postoperative pain, opioid consumption, and time for recovery. MATERIALS AND METHODS: Forty-three patients presenting for day case laparoscopic cholecystectomy were randomly allocated to receive either an ultrasound-guided STA block (n = 21) or port-site infiltration of local anesthetic (n = 22). Visual analog pain scores were measured at 1 and 4 h postoperatively to assess pain severity, and opioid requirement was measured in recovery and up to 8 h postoperatively. The time to discharge from recovery was recorded. RESULTS: STA block resulted in a significant reduction in serial visual pain analog score values and significantly reduced the fentanyl requirement in recovery by >35% compared to the group that received local port-site infiltration (median 0.9 vs. 1.5 μcg/kg). Furthermore, STA block was associated with nearly a 50% reduction in overall 8-h equivalent morphine consumption (median 10 mg vs. 19 mg). In addition, STA block significantly reduced median time to discharge from recovery from 110 to 65 min. CONCLUSION: The results suggest that STA block provides superior postoperative analgesia and reduces opioid requirement following laparoscopic cholecystectomy. It may also improve theater efficiency by reducing time to discharge from the recovery unit.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409944/
http://www.joacp.org/temp/JAnaesthClinPharmacol283339-7357759_202617.pdf
Implicaciones clínicas del bloqueo del plano transverso abdominal en adultos
Clinical implications of the transversus abdominis plane block in adults.
Young MJ, Gorlin AW, Modest VE, Quraishi SA.
Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
Anesthesiol Res Pract. 2012;2012:731645. Epub 2012 Jan 19.
Abstract
The transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique that provides analgesia to the parietal peritoneum as well as the skin and muscles of the anterior abdominal wall. It has a high margin of safety and is technically simple to perform, especially under ultrasound guidance. A growing body of evidence supports the use of TAP blocks for a variety of abdominal procedures, yet, widespread adoption of this therapeutic adjunct has been slow. In part, this may be related to the limited sources for anesthesiologists to develop an appreciation for its sound anatomical basis and the versatility of its clinical application. As such, we provide a brief historical perspective on the TAP block, describe relevant anatomy, review current techniques, discuss pharmacologic considerations, and summarize the existing literature regarding its clinical utility with an emphasis on recently published studies that have not been included in other systematic reviews or meta-analyses.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270549/pdf/ARP2012-731645.pdf
Eficacia de la analgesia preventiva con el bloqueo del plano transverso abdominal guiado con ultrasonido en pacientes con cirugía ginecológica con incisión transversa en abdomen inferior
Preemptive analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision.
Shin HJ, Kim ST, Yim KH, Lee HS, Sim JH, Shin YD.
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Korean J Anesthesiol. 2011 Nov;61(5):413-8. Epub 2011 Nov 23.
Abstract
BACKGROUND: The transversus abdominis plane block is recently described peripheral block to providing analgesia to the anterior abdominal wall. The goal of this study is to evaluate the analgesic efficacy of the ultrasound-guided transversus abdominis plane block (US-TAP block) in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision. METHODS: Thirty-two patients undergoing gynecologic surgery were randomized to undergo standard care such as PCA, or to receive additional US-TAP block with standard care. After general anesthesia induction, a bilateral US-TAP block was performed using 0.375% ropivacaine 20 ml on each side. Postoperative demand of rescue analgesics in PACU and ward were recorded. Each patient was assessed postoperatively by a blinded investigator in the postanesthesia care unit (PACU) and at 2, 6, 10, 24, 48 hr postoperatively to investigate pain, drowsiness, nausea and itch. RESULTS: The US-TAP block reduced pain intensity compared to standard care in the PACU (5.2 ± 3.1 vs 8.4 ± 1.3) and at 2, 24 postoperative hours (3.0 ± 2.4 vs 5.2 ± 2.4, 0.9 ± 1.5 vs 2.2 ± 1.9). Fentanyl requirements in PACU was reduced (20.3 ± 20.9 vs 62.5 ± 35.4 µg, P < 0.05). In ward, pethidine requirements was reduced (21.9 ± 28.7 vs 56.3 ± 34.8 mg, P < 0.05). CONCLUSIONS: The US-TAP block with standard care provide more effective analgesia after gynecologic surgery via a transverse lower abdominal skin incision.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229021/pdf/kjae-61-413.pdf
Atentamente
Dr. José Ramón Saucillo-Osuna
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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