domingo, 17 de noviembre de 2013

Bloqueo por ultrasonido del plano abdominal transverso/Ultrasound-guided TAPB

Efecto de TAPB guiado por ultrasonido sobre el manejo del dolor después de histerectomía abdominal total

The Effect of Ultrasound-guided TAPB on Pain Management after Total Abdominal Hysterectomy.
Gharaei H, Imani F, Almasi F, Solimani M.
Department of Anesthesiology and Pain Medicine, Amiralmomenin Hospital, Tehran, Islamic Republic of Iran.
Korean J Pain. 2013 Oct;26(4):374-8. doi: 10.3344/kjp.2013.26.4.374. Epub 2013 Oct 2.
BACKGROUND:Incisional pain is particularly troublesome after hysterectomy. A method called transversus abdominis plane block (TAPB) has shown promise in managing postoperative pain. In this study, we evaluated the analgesic efficacy of ultrasound-guided TAPB after hysterectomy at different time points and at each time point separately for 48 hours. METHODS: Forty-two patients (ASA I, II) who were electively chosen to undergo total abdominal hysterectomy were divided into 2 groups, control (group C) and intervention (group I). Twenty-one patients underwent TAPB (group I) and 21 patients received only the standard treatment with a fentanyl pump (group C). Both groups received standard general anesthesia. For patients in group I, following the surgery and before emergence from anesthesia, 0.5 mg/kg of ropivacaine 0.2% (about 20 cc) was injected bilaterally between the internal oblique and transverse abdominis muscles using sonography. Pain scores using the Visual Analogue Scale (VAS) and drug consumption were measured at 2, 6, 12, 24, and 48 hours afterTAPB. RESULTS: There were no significant differences in demographics between the two groups. VAS scores appeared to be lower in group I, although there was no interaction with time when we compared mean VAS measurements at different time points between group I and group C (P > 0.05). The amount of fentanyl flow was consistently higher in group C, but when we compared the two groups at each time point separately, the observed difference was not statistically significant (P < 0.053). The incidence of vomiting was 10% in group I and 28% in group C. There were no complaints of itching, and sedation score was 0 to 3. There were no complications. CONCLUSIONS: This study showed that TAPB did not result in a statistically significant decrease in VAS scores at different time points. TAPB did lead to decreased fentanyl flow, but when we compared the two groups at each time point separately, the observed difference was not statistically significant.
KEYWORDS: fentanyl, hysterectomy, transversus abdominis plane block

El efecto analgésico del bloqueo del plano abdominal transverso guiado con ultrasonido después de hernioplastía extraperitoneal laparoscópica.

The analgesic effect of ultrasound-guided transverse abdominis plane block after laparoscopic totally extraperitoneal hernia repair.

Kim MG, Kim SI, Ok SY, Kim SH, Lee SJ, Park SY, Lee SM, Jung BI.

Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.

Korean J Anesthesiol. 2012 Sep;63(3):227-32. doi: 10.4097/kjae.2012.63.3.227. Epub 2012 Sep 14.


BACKGROUND: The ultrasound-guided transverse abdominis plane block (TAPB) reduces postoperative pain after laparoscopic abdominal surgery. But, its effect post laparoscopic totally extraperitoneal hernia repair (TEP) is not clear. In this study, we evaluated the analgesic effect of ultrasound-guided TAPB in TEP. METHODS: In this prospective, randomized study, forty adult patients (ASA I-II) scheduled for a TEP under general anesthesia were studied. In theTAPB group (n = 20), an ultrasound-guided bilateral TAPB was performed with 0.375% ropivacaine 15 ml on each side after the induction of general anesthesia. The control group (n = 20) did not have TAPB performed. Fentanyl 50 µg was repeatedly injected as per the patient's request in the recovery room. Pain scores at rest and on coughing were assessed postoperatively in the recovery room (20 min, at discharge) and at 4, 8, and 24 hours after surgery. RESULTS: In the recovery room, pain scores (numeric rating scale, 0-10) at postoperative 20 min were lower in the TAPB group (3.9 ± 1.6, 4.9 ± 1.8) than the control group (6.9 ± 1.6, 8.0 ± 1.6) at rest and on coughing. Also, pain scores upon discharge from the recovery room were lower in theTAPB group (3.2 ± 1.2, 4.2 ± 1.5) than the control group (5.3 ± 1.6, 6.5 ± 1.8) at rest and on coughing. CONCLUSIONS: The ultrasound-guided TAPB in patients that had undergone TEP reduced postoperative pain scores and the fentanyl requirement in the recovery room. Also, pain scores on coughing were reduced until postoperative 8 hours.

KEYWORDS: Herniorrhaphy, Laparoscopy, Ropivacaine, Transverse abdominis plane block, Ultrasonography

Anestesiología y Medicina del Dolor
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