Viabilidad y eficacia analgésica del bloque del plano transverso abdominal después de la laparoscopia de puerto único en pacientes sometidos a cirugía bariátrica
Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery.
Wassef M, Lee DY, Levine JL, Ross RE, Guend H, Vandepitte C, Hadzic A, Teixeira J.
J Pain Res. 2013 Nov 27;6:837-41. doi: 10.2147/JPR.S50561.
Abstract
PURPOSE:The transversus abdominis plane (TAP) block is a technique increasingly used for analgesia after surgery on the anterior abdominal wall. We undertook this study to determine the feasibility and analgesic efficacy of ultrasound-guided TAP blocks in morbidly obese patients. We describe the dermatomal spread of local anesthetic in TAP blocks administered, and test the hypothesis that TAP blocks decrease visual analog scale (VAS) scores. PATIENTS AND METHODS:After ethics committee approval and informed consent, 35 patients with body mass index >35 undergoing single-port sleeve gastrectomy (SPSG) were enrolled. All patients received balanced general anesthesia, followed by intravenous patient-controlled analgesia (IV-PCA; hydromorphone) postoperatively; all reported VAS >3 upon arrival to the recovery room. From the cohort of 35 patients having single-port laparoscopy (SPL), a sealed envelope method was used to randomly select ten patients to the TAP group and 25 patients to the control group. The ten patients in the TAP group received ultrasound-guided TAP blocks with 30 mL of 0.2% Ropivacaine injected bilaterally. The dermatomal distribution of the sensory block (by pinprick test) was recorded. VAS scores for the first 24 hours after surgery and opioid use were compared between the IV-PCA+TAP block and IV-PCA only groups. RESULTS: Sensory block ranged from T5-L1. Mean VAS pain scores decreased from 8 ± 2 to 4 ± 3 (P=0.04) within 30 minutes of TAP block administration. Compared with patients given IV-PCA only, significantly fewer patients who received TAP block had moderate or severe pain (VAS 4-10) after block administration at 6 hours and 12 hours post-surgery. However, cumulative consumption of hydromorphone at 24 hours after SPSGsurgery was similar for both groups. CONCLUSION: Ultrasound-guided TAP blocks in morbidly obese patients are feasible and result in satisfactory analgesia following SPSG in the immediate postoperative period.
KEYWORDS:analgesia, nerve blocks, postoperative pain, regional anesthesia, ultrasound
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849080/pdf/jpr-6-837.pdf
Efecto de la pregabalina oral en la premedicación sobre el dolor postoperatorio en el bypass gástrico laparoscópico
Effect of oral pregabalin premedication on post-operative pain in laparoscopic gastric bypass surgery.
Alimian M, Imani F, Faiz SH, Pournajafian A, Navadegi SF, Safari S.
Anesth Pain Med. 2012 Summer;2(1):12-6. doi: 10.5812/aapm.4300. Epub 2012 Jul 10.
Abstract
BACKGROUND:Post-operative pain and the administration of opioids to relieve it, is considered to be one of the important issues in surgery wards. This issue is even more significant in obese patients, because of the side effects of opioids. Pregabalin is an analog of gamma aminobutyric acid (GABA) which can be effective in dealing with post-operative pain. OBJECTIVES:This study will consider the effect of oral pregabalin in relieving the pain of obese patients after gastric bypass surgery. PATIENTS AND METHODS: In a double blind clinical trial, 60 candidates for laparoscopic gastric bypass surgery were enrolled in the study through convenience and non-random sequential sampling, into two groups; pregabalin group and control group. Inclusion criteria consisted of: morbid obesitywith a body mass index (BMI) > 35, age 18-50, American Society of Anesthesiologists (ASA) status I or II, and willingness to take part in the study. Patients in the pregabalin group received 300 mg of oral pregabalin on the morning of the surgery. Post-operative pain was controlled by the patient-controlled intravenous analgesia (PCIA) method, an AutoMed infusion pump containing 20 mg of morphine and normal saline (total volume 100 cc) was administered to all patients after surgery. Patients' level of pain were compared by considering their pain intensity on a visual analog scale (VAS), and the occurrence of nausea/vomiting from recovery, until 24 hours after surgery. RESULTS:A total of 60 patients were compared; 30 patients in each of the pregabalin and control groups. Both groups were similar in age and sex distribution. Mean pain intensity levels during the whole follow up were lower in the pregabalin group than in the control group, up to a maximum of 24 hours after the operation (P < 0.001). Incidence of nausea/vomiting was greater in the control group than in the pregabalin group (P < 0.001). CONCLUSIONS: The findings of this study indicate that oral pregabalin (300 mg dose) can alleviate patients' pain and nausea/vomiting and notably reduce adverse effects.
KEYWORDS:Gastric Bypass, Laparoscopy, Pain, Postoperative, Pregabalin
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821101/pdf/aapm-02-12.pdf
Aerosolización intraperitoneal de bupivacaína es segura y efectiva para controlar el dolor postoperatorio en bypass laparoscópico en Y de Roux
Intraperitoneal aerosolization of bupivacaine is a safe and effective method in controlling postoperative pain in laparoscopic Roux-en-Y gastric bypass.
Alkhamesi NA, Kane JM, Guske PJ, Wallace JW, Rantis PC.
J Pain Res. 2008 Dec 1;1:9-13.
Abstract
INTRODUCTION: Obesity is a worldwide problem and has grown in severity in the last few decades making bariatric surgery and, in particular, laparoscopic banding and Roux-en-Y gastric bypass efficacious and cost-effective procedures. The laparoscopic approach has been shown to offer significant healthcare benefits, of particular interests are reports of decreased postoperative pain resulting in a shorter hospital stay and an earlier return to normal activity. However, many patients still experience significant pain, including shoulder tip pain, that require strong analgesia including opiates during their early recovery period. The aims of this study were to establish the safe use of the aerosolization technique in bariatric surgery and to investigate the possible benefits in reducing postoperative pain. METHODS: In this study, fifty patients undergoing laparoscopic gastric bypass were recruited and divided into two groups; control (n = 25) and therapeutic (n = 25). The control group received intraperitoneal aerosolization of 10 mL of 0.9% normal saline while the therapeutic group received 10 mL of 0.5% bupivacaine. All the patients had standard preoperative, intraoperative, and postoperative care. Pain scores were carried out by the nursing staff in recovery and 6 h, 12 h and 24 h postoperatively using a standard 0-10 pain scoring scale. In addition, opiate consumption via patient-controlled analgesia (PCA) was recorded. RESULTS: Aerosolized bupivacaine reduced postoperative pain in comparison to normal saline (p < 0.05). However, PCA usage showed no statistically significant change from the control group. CONCLUSION: The aims of this study were achieved and we were able to establish the safe use of the aerosolization technique in bariatric surgery and its benefits in reducing postoperative pain.
KEYWORDS: Roux-en-Y gastric bypass, aerosolization, bupivacaine, intraperitoneal therapeutics, laparoscopy, local anesthetic
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004614/pdf/jpr-1-009.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery.
Wassef M, Lee DY, Levine JL, Ross RE, Guend H, Vandepitte C, Hadzic A, Teixeira J.
J Pain Res. 2013 Nov 27;6:837-41. doi: 10.2147/JPR.S50561.
Abstract
PURPOSE:The transversus abdominis plane (TAP) block is a technique increasingly used for analgesia after surgery on the anterior abdominal wall. We undertook this study to determine the feasibility and analgesic efficacy of ultrasound-guided TAP blocks in morbidly obese patients. We describe the dermatomal spread of local anesthetic in TAP blocks administered, and test the hypothesis that TAP blocks decrease visual analog scale (VAS) scores. PATIENTS AND METHODS:After ethics committee approval and informed consent, 35 patients with body mass index >35 undergoing single-port sleeve gastrectomy (SPSG) were enrolled. All patients received balanced general anesthesia, followed by intravenous patient-controlled analgesia (IV-PCA; hydromorphone) postoperatively; all reported VAS >3 upon arrival to the recovery room. From the cohort of 35 patients having single-port laparoscopy (SPL), a sealed envelope method was used to randomly select ten patients to the TAP group and 25 patients to the control group. The ten patients in the TAP group received ultrasound-guided TAP blocks with 30 mL of 0.2% Ropivacaine injected bilaterally. The dermatomal distribution of the sensory block (by pinprick test) was recorded. VAS scores for the first 24 hours after surgery and opioid use were compared between the IV-PCA+TAP block and IV-PCA only groups. RESULTS: Sensory block ranged from T5-L1. Mean VAS pain scores decreased from 8 ± 2 to 4 ± 3 (P=0.04) within 30 minutes of TAP block administration. Compared with patients given IV-PCA only, significantly fewer patients who received TAP block had moderate or severe pain (VAS 4-10) after block administration at 6 hours and 12 hours post-surgery. However, cumulative consumption of hydromorphone at 24 hours after SPSGsurgery was similar for both groups. CONCLUSION: Ultrasound-guided TAP blocks in morbidly obese patients are feasible and result in satisfactory analgesia following SPSG in the immediate postoperative period.
KEYWORDS:analgesia, nerve blocks, postoperative pain, regional anesthesia, ultrasound
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849080/pdf/jpr-6-837.pdf
Efecto de la pregabalina oral en la premedicación sobre el dolor postoperatorio en el bypass gástrico laparoscópico
Effect of oral pregabalin premedication on post-operative pain in laparoscopic gastric bypass surgery.
Alimian M, Imani F, Faiz SH, Pournajafian A, Navadegi SF, Safari S.
Anesth Pain Med. 2012 Summer;2(1):12-6. doi: 10.5812/aapm.4300. Epub 2012 Jul 10.
Abstract
BACKGROUND:Post-operative pain and the administration of opioids to relieve it, is considered to be one of the important issues in surgery wards. This issue is even more significant in obese patients, because of the side effects of opioids. Pregabalin is an analog of gamma aminobutyric acid (GABA) which can be effective in dealing with post-operative pain. OBJECTIVES:This study will consider the effect of oral pregabalin in relieving the pain of obese patients after gastric bypass surgery. PATIENTS AND METHODS: In a double blind clinical trial, 60 candidates for laparoscopic gastric bypass surgery were enrolled in the study through convenience and non-random sequential sampling, into two groups; pregabalin group and control group. Inclusion criteria consisted of: morbid obesitywith a body mass index (BMI) > 35, age 18-50, American Society of Anesthesiologists (ASA) status I or II, and willingness to take part in the study. Patients in the pregabalin group received 300 mg of oral pregabalin on the morning of the surgery. Post-operative pain was controlled by the patient-controlled intravenous analgesia (PCIA) method, an AutoMed infusion pump containing 20 mg of morphine and normal saline (total volume 100 cc) was administered to all patients after surgery. Patients' level of pain were compared by considering their pain intensity on a visual analog scale (VAS), and the occurrence of nausea/vomiting from recovery, until 24 hours after surgery. RESULTS:A total of 60 patients were compared; 30 patients in each of the pregabalin and control groups. Both groups were similar in age and sex distribution. Mean pain intensity levels during the whole follow up were lower in the pregabalin group than in the control group, up to a maximum of 24 hours after the operation (P < 0.001). Incidence of nausea/vomiting was greater in the control group than in the pregabalin group (P < 0.001). CONCLUSIONS: The findings of this study indicate that oral pregabalin (300 mg dose) can alleviate patients' pain and nausea/vomiting and notably reduce adverse effects.
KEYWORDS:Gastric Bypass, Laparoscopy, Pain, Postoperative, Pregabalin
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821101/pdf/aapm-02-12.pdf
Aerosolización intraperitoneal de bupivacaína es segura y efectiva para controlar el dolor postoperatorio en bypass laparoscópico en Y de Roux
Intraperitoneal aerosolization of bupivacaine is a safe and effective method in controlling postoperative pain in laparoscopic Roux-en-Y gastric bypass.
Alkhamesi NA, Kane JM, Guske PJ, Wallace JW, Rantis PC.
J Pain Res. 2008 Dec 1;1:9-13.
Abstract
INTRODUCTION: Obesity is a worldwide problem and has grown in severity in the last few decades making bariatric surgery and, in particular, laparoscopic banding and Roux-en-Y gastric bypass efficacious and cost-effective procedures. The laparoscopic approach has been shown to offer significant healthcare benefits, of particular interests are reports of decreased postoperative pain resulting in a shorter hospital stay and an earlier return to normal activity. However, many patients still experience significant pain, including shoulder tip pain, that require strong analgesia including opiates during their early recovery period. The aims of this study were to establish the safe use of the aerosolization technique in bariatric surgery and to investigate the possible benefits in reducing postoperative pain. METHODS: In this study, fifty patients undergoing laparoscopic gastric bypass were recruited and divided into two groups; control (n = 25) and therapeutic (n = 25). The control group received intraperitoneal aerosolization of 10 mL of 0.9% normal saline while the therapeutic group received 10 mL of 0.5% bupivacaine. All the patients had standard preoperative, intraoperative, and postoperative care. Pain scores were carried out by the nursing staff in recovery and 6 h, 12 h and 24 h postoperatively using a standard 0-10 pain scoring scale. In addition, opiate consumption via patient-controlled analgesia (PCA) was recorded. RESULTS: Aerosolized bupivacaine reduced postoperative pain in comparison to normal saline (p < 0.05). However, PCA usage showed no statistically significant change from the control group. CONCLUSION: The aims of this study were achieved and we were able to establish the safe use of the aerosolization technique in bariatric surgery and its benefits in reducing postoperative pain.
KEYWORDS: Roux-en-Y gastric bypass, aerosolization, bupivacaine, intraperitoneal therapeutics, laparoscopy, local anesthetic
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004614/pdf/jpr-1-009.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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