Pethidine efficacy in achieving the ultrasound-guided oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy: A prospective study.

Caius Mihai Breazu,Lidia Ciobanu,Adrian Bartos,Petru Adrian Mircea,Raluca Bodea,Daniela Ionescu

doi:10.17305/bjbms.2016.1647

Abstract

Pethidine is a synthetic opioid with local anesthetic properties. Our goal was to evaluate the analgesic efficacy of pethidine for achieving the ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block in laparoscopic cholecystectomy. This prospective, double-blind study included 79 patients of physical status I and II according to American Society of Anesthesiologists, scheduled for elective laparoscopic cholecystectomy. The patients were randomly allocated into three groups, depending on the drug used to achieve preoperative bilateral OSTAP block: 1) OSTAP-Placebo (treated with normal saline); 2) OSTAP-Bupivacaine (treated with 0.25% bupivacaine); and 3) OSTAP-Pethidine (treated with 1% pethidine). The efficacy of pethidine in achieving the OSTAP block was analyzed using visual analog scale (VAS), intraoperative opioid dose, opioid consumption in post anesthesia care unit, and opioid consumption in the first 24 postoperative hours. The pain scores assessed by VAS at 0, 2, 4, 6, 12, and 24 hours were significantly lower in OSTAP-Pethidine than in OSTAP-Placebo group (p < 0.001). The mean intraoperative opioid consumption was significantly lower in OSTAP-Pethidine compared to OSTAP-Placebo group (150 versus 400 mg, p < 0.001), as well as the mean opioid consumption in the first 24 hours (20.4 versus 78 mg, p < 0.001). Comparing VAS assessment between OSTAP-Bupivacaine and OSTAP-Pethidine groups, statistically significant differences were observed only for the immediate postoperative pain assessment (0 hours), where lower values were observed in OSTAP-Pethidine group (p = 0.004). There were no statistically significant differences in the incidence of postoperative nausea and vomiting (p = 0.131) between the groups. The use of 1% pethidine can be an alternative to 0.25% bupivacaine in achieving OSTAP block for laparoscopic cholecystectomy.

Highlights

The laparoscopic cholecystectomy is a minimally invasive, widespread surgical procedure, associated with postoperative pain of moderate intensity in the early postoperative period
Based on the previous findings, in this study, we evaluated the efficacy of 1% pethidine in achieving the oblique subcostal transversus abdominis plane (OSTAP) block after laparoscopic cholecystectomy, and compared it with the results obtained for 0.25% bupivacaine and placebo
Intraoperative opioid consumption and opioid consumption at 24 hours were significantly lower in OSTAP-Pethidine and OSTAP-Bupivacaine groups compared to OSTAPPlacebo group (Table 4)

Summary

Introduction

The laparoscopic cholecystectomy is a minimally invasive, widespread surgical procedure, associated with postoperative pain of moderate intensity in the early postoperative period. There are several approaches to postoperative pain management after laparoscopic cholecystectomy, such as intravenous patient-controlled analgesia with opioids (IV-PCA), neuraxial blocks, intraperitoneal local anesthesia, and wound. Submitted: 04 September 2016/Accepted: 03 October 2016 infiltration All of these procedures are more or less effective and have specific side effects [5,6,7]. Hebbard et al [10] described the ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block, which is used to provide analgesia to the upper and lower abdomen. This technique has a lower rate of complications due to the direct ultrasound visualization. Different studies confirmed the analgesic efficacy of the OSTAP block and the postoperative opioid sparing effect after laparoscopic cholecystectomy [11,12]

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