Plane Block Research Articles

Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia.

Through bibliometric analysis, we aim to comprehensively understand the research dynamics in this field, reveal key scientific research achievements and breakthrough discoveries, and provide valuable reference and guidance for future research directions. Utilizing the Web of Science, we retrieved the literature pertaining to ultrasonics-guided regional anesthesiology (1994-2022). CiteSpace and VOSviewer were used for bibliometric and knowledge mapping analysis. Our examination encompassed publication trends, authorship patterns, institutional contributions, frequently occurring keywords, keyword clustering, and emerging terminology trends. Of the 570 papers reviewed, there was a rising trend in publications each year. The main keywords in regional anesthesia were ultrasound guidance, nerve, analgesia, and pain score. Key research areas were regional anesthesia, ultrasound guidance, approach, pain score, and plane block. The U.S. led in research. Stanford University, University of Toronto, and Cork University Hospital were central institutions. Chan V was the top author with 24 articles, while Marhofer P was the most cited at 150 times. Regional anesthesia and pain medicine were the predominant journal in both publications and citations. In conclusion, research in this field consistently grew yearly, and visualization showcased trends in ultrasound-guided regional anesthesia. These visuals provided key bibliometric insights, helping researchers further explore and understand this domain.

Evaluation of the effectiveness of artificial intelligence for ultrasound guided peripheral nerve and plane blocks in recognizing anatomical structures

BackgroundWe aimed to assess the accuracy of artificial intelligence (AI) based real-time anatomy identification for ultrasound-guided peripheral nerve and plane block in eight regions in this prospective observational study. MethodsAfter obtaining ethics committee approval and written informed consent from 40 healthy volunteers (20 men and 20 women, between 18 and 72 years old), an ultrasound device installed with AI software (Nerveblox, SmartAlfa, Turkey) were used to scan regions of the cervical plexus, brachial plexus, pectoralis (PECS), rectus sheet, femoralis, canalis adductorius, popliteal, and ESP by three anesthesiology trainees. During scanning by a trainee, once software indicates 100 % scan success of associated anatomic landmarks, both raw and labeled ultrasound images were saved, assessed, and validated using a 6-point scale between 0 and 5 by two expert validators. Evaluation scores of the validators for each block were compared according to demographics (gender, age, and BMI) and block type exists. ResultsThe scores were not different except ESP, femoralis, and cervical plexus regions between the experts. The mean scores of the experts for the PECS, popliteal and rectus sheath were significant between males and females (p < 0.05). In terms of BMI, significant differences in the scores were observed only in the canalis adductorius, brachial plexus, and ESP regions (p < 0.05). ConclusionsUltrasound guided AI-based anatomy identification was performed in commonly used eight block regions by the trainees where AI technology can successfully interpret the anatomical structures in real-time sonography which would be valuable in assisting anesthesiologists.

Recommendations for anesthesia management of hip and hip surgery: literature review

The authors analyzed studies on the issues of perioperative analgesia in hip and hip joint surgery. Based on the analysis, modern recommendations are presented regarding the choice of optimal anesthetic techniques for proximal femoral fractures and hip arthroplasty. Early surgical intervention in older patients contributes to the restoration of the supporting function of the limb, enables rapid rehabilitation, and reduces the risk of life-threatening complications. This requires pain relief for preoperative preparation and high-quality intraoperative and postoperative pain relief, allowing early rehabilitation of the patient. The review included materials from recent congresses, and webinars of the European Society of Regional Anesthesia Pain Treatment. According to many authors, ileofascial blockade is the method of choice for preoperative anesthesia for proximal femoral fractures. Variants of the blockades of the branches of the lumbar and sacral plexuses in various anatomical spaces and plane blocks are considered. In addition, recommendations of the PROSPECT group (Procedure Specific Postoperative Pain Management) on the use of various technologies in the perioperative period are considered based on data from multicenter randomized trials and meta-analyses in relation to a specific procedure. The effectiveness of new approaches to the branches of the lumbar plexus was also considered, for example, suprainguinal ileofascial blockade and blockade of the pericapsular nerves. Anesthesiologists have used relatively new and traditional tools available to reduce pain and speed up postoperative recovery for patients with injuries and undergoing surgery for the proximal femur. Although the effectiveness of not all of them is confirmed by evidence-based medicine, clinical practice shows a positive effect on their use.

Regional anesthesia techniques for cardiac surgery: where are we?

Inadequate pain relief after cardiac surgery results in decreased patient experience and satisfaction, increased opioid consumption with its associated adverse consequences, and reduced efficiency metrics. To mitigate this, regional analgesic techniques are an increasingly important part of the perioperative cardiac anesthesia care plan. The purpose of this review is to compare current regional anesthesia techniques, and the relative evidence supporting their efficacy and safety in cardiac surgery. Numerous novel plane blocks have been developed in recent years, with evidence of improved pain control after cardiac surgery. The current data supports the use of a variety of different regional anesthesia techniques to reduce acute pain after cardiac surgery. However, future randomized trials are needed to quantify and compare the efficacy and safety of different regional techniques for pain control after cardiac surgery.

Rationale for the use of TAP block technique for perioperative analgesia in laparoscopic cholecystectomy

Annotation. Acute postoperative pain is still a common unresolved health-care challenge even in highly developed countries. Insufficient postoperative pain control is associated not only with patients’ sufferings but also with increased incidence of complications (cardiovascular, thromboembolic, infectious, etc.), the development of chronic postoperative pain, delayed ambulation and discharge. Perioperative anesthesia is currently one of the main concerns in abdominal surgery. According to literature data, regional analgesia methods are widely used for anesthesia in perioperative period. Transversus abdominis plane (TAP) block proved to be a reliable regional technique of postoperative multimodal analgesia for anterior abdominal wall pain. Nowadays, ultrasound-guided TAP block techniques are considered to be a gold standard in many surgeries on anterolateral abdominal wall, producing consistent analgesia and having good safety profile. However, the quality of analgesia provided by TAP blocks under ultrasound guidance is different being influenced by the approach used. The choice between the variants of TAP block technique depends on the targeted region and the duration of nerve blockage. To date, the analgesic effect of anterior lateral abdominal wall blocks during laparoscopic cholecystectomy has not been sufficiently studied. The article provides the review of the latest advances in TAP block techniques as well as its standardized nomenclature, and suggests directions for future research. The aim was to analyze and substantiate the possibility of using regional anesthesia methods of the anterior abdominal wall by implementing the TAP-block type in the perioperative period during laparoscopic cholecystectomy. We have analyzed the current information and used the PubMed database. We have also analyzed the advantages of interstitial local anesthetic (TAP block), which primarily provides better control of pain in the anterior abdominal wall, and reduces the need for opiate and non-narcotic analgesics, the prescription of which may cause several side effects. There are many methods of the TAP-block, which to some extent depend on the pain localization in the anterior abdominal wall. For laparoscopic cholecystectomy, the most anatomically and theoretically justified is the oblique subcostal Tap-block. The use of regional techniques in laparoscopic cholecystectomy, namely the TAP-block, strategically fits into the concept of the accelerated recovery ERAS protocol, one of the purposes of which serves adequate control over the post-operative pain and early recovery.

New strategies for multimodal analgesia in patients with high-risk geriatric cancer in perioperative period.

12046 Background: Perioperative pain (POP) in high-risk geriatric patients with cancer (HRGCP) is an important issue. The purpose of this study was to optimize perioperative analgesia in HRGCP. Methods: This randomized study of the quality and effectiveness of perioperative analgesics included 115 HRGCP aged 64-88 years who underwent surgeries on the organs of the chest, abdomen and pelvis for various cancers. The patients were divided into 2 groups. Group 1 (n = 52): patient-controlled analgesia with morphine and nonsteroidal anti-inflammatory drugs (NSAIDs); group 2 (n = 63): ultrasound-guided bilateral transversus abdominis plane (TAP) block with ropivacaine. Intraoperative and perioperative analgesia was maintained with a continuous infusion of lidocaine, magnesium sulphate, microdoses of fentanyl and NSAIDs. Results and pain syndrome were assessed by monitoring the Efficacy Safety Score (ESS), personal and reactive anxiety, stress response (cortisol, insulin, lactate, glucose), rates of functional activity recovery, the need for opioid analgesics, frequency of postoperative nausea and vomiting (PONV). Results: Patients in group 2 showed a significant decrease in the perioperative need for opioid analgesics and significantly decreased POP. Analysis of variance of mean values revealed statistically lower scores of ESS, visual analogue scale and POP (p &lt; 0.05) during the first 24 hours of perioperative period in group 2 compared with group 1. Patient-controlled analgesia showed analgesic effect in 88.5% (p &lt; 0.05) cases. However, the effect was less pronounced, compared to multimodal analgesia, and did not reduce cognitive disorders. In group 2, opioid-sparing analgesic effect was 95.3% (p &lt; 0.05). Multimodal analgesia reduced the stress response (p &lt; 0.05) in perioperative period and did not cause cognitive dysfunction while reducing PONV episodes, unlike morphine. Despite the minimal doses of narcotic analgesics in group 2, multimodal analgesia provided safe analgesia and functional activity recovery in perioperative period with minimum negative effects of opioids. Conclusions: The strategy of multimodal analgesia based on a combination of intraoperative TAP block and infusions of lidocaine and microdoses of fentanyl can significantly improve the quality of analgesia in perioperative period.

Regional block pilot for microvascular free-flap breast reconstruction.

e18646 Background: With increasing focus on improving patient outcomes and decreasing narcotic use, healthcare has prioritized the use of multidisciplinary, multimodal, and evidence-based approaches to perioperative management through enhanced recovery after surgery (ERAS) pathways. Currently, microsurgical breast reconstruction with or without concurrent mastectomy commonly may employ regional anesthesia in the preoperative and intraoperative techniques. To optimize perioperative analgesia, an ERAS protocol was piloted at a quaternary care academic center implementing a pre-operative anesthesia placed regional block with preference for anterior quadratum lumborum blocks. Methods: A total of 161 patients were enrolled in this single center Continuous Quality Improvement (CQI) project. The project consisted of 72 baseline, 20 pilot, and 69 after pilot patients who underwent unilateral (n = 65) or bilateral (n = 96) deep inferior epigastric perforator (DIEP) flap reconstruction either immediately (n = 87) or delayed (n = 74) after mastectomy. In the 20 CQI pilot group, anesthesiologists pre-operatively placed bilateral anterior quadratus lumborum blocks (aQLB) under direct ultrasound guidance. After positively observed metrics, the official ERAS pathway was implemented into clinical practice, allowing for subsequent accrual of 69 additional patients. We compared this after pilot group to 72 baseline patients who underwent a surgeon-placed intraoperative transversus abdominus plane (TAP) block using liposomal bupivacaine. Statistics data was tracked using a dedicated clinical EMR dashboard. Baseline patients were matched to the after pilot cohort based on laterality and timing of DIEP flap reconstruction. Results: The ERAS pathway with anesthesia-placed aQLB was associated with lower post-operative daily opioid consumption from 27.2 MME to 10.2 MME. Average pain scores, post-anesthesia care unit (PACU) length of stay, hospital length of stay, as well as re-admissions and complications were not statistically different before and after the implementation of the ERAS pathway. Conclusions: Anesthesia placed pre-operative aQLB is a safe and effective opioid-reducing pain control modality for DIEP flap reconstruction with or without mastectomy. Prospective and controlled studies will be important for the precise impacts of aQLB in DIEP procedures in an ERAS protocol.[Table: see text]

Rescue acute pain treatment after renal artery embolization using erector spinae plane (ESP) block.

Rescue acute pain treatment after renal artery embolization using erector spinae plane (ESP) block.

A Comparison of effect of preemptive versus postoperative use of ultrasound-guided bilateral transversus abdominis plane (TAP) block on pain relief after laparoscopic cholecystectomy

Nowadays, there are various methods to manage pain after laparoscopic cholecystectomy. The aim of this study was to compare the effectof preemptive versus postoperative use of ultrasound-guided transversus abdominis plane (USG-TAP) block on pain relief after laparoscopic cholecystectomy. In this single-blinded randomized clinical trial, the patients who were candidates for laparoscopic cholecystectomy were randomly divided into the two groups (n = 38 per group). In the preemptive group (PG) after the induction of anesthesia and in the postoperative group (POG) after the end of surgery and before the extubation, bilateral ultrasound-guided transversus abdominis plane (TAP) block was performed on patients using 20 cc of ropivacaine 0.25%. Both groups received patient controlled IV analgesia (PCIA) containing Acetaminophen (20 mg/ml) plus ketorolac (0.6 mg/ml) as a standard postoperative analgesia and meperidine 20 mg q 4 h PRN for rescue analgesia. Using the numerical rating scales (NSR), the patients’ pain intensity was assessed at time of arrival to the PACU and in 2th, 4th, 8th, 12th, 24th h. Primary outcome of interest is NSR at rest and coughing in the PACU and in 2th, 4th, 8th, 12th, 24th h. Secondary outcomes of interests were the time to first post-surgical rescue analgesic and level of patients’ pain control satisfaction in the first 24 h. The USG-TAP block significantly decreased pain score in the POG compared to the PG, and also the pain was relieved at rest especially in 8 and 12 h (p value ≤ 0.05) after the surgery. Pain score after coughing during recovery at 2, 8 and 12 h after the operation were significantly decreased. (p value ≤ 0.05) The patient satisfaction scores in the POG were significantly higher in all times. There was a statistically significant difference between the two groups in terms of rate of postoperative nausea and vomiting (PONV), indicating that patients in the POG had significantly lower incidences of the PONV compared tothe PG. The time to first analgesic request was significantly shorterin the POG, which was statistically significant (p value = 0.089). There was no statistically significant difference between the two groups in terms of consumption of analgesics. The postoperative TAP block could offer better postoperative analgesia than preepmtive TAP block.

COMPARISON OF ULTRASOUND-GUIDED THORACIC PARAVERTEBRAL AND PECTORALIS INTERFASCIAL PLANE BLOCK FOR MODIFIED RADICAL MASTECTOMY

Aims and Objectives : To compare the efficacy of ultrasound-guided thoracic paravertebral block(TPVB) and ultrasound-guided pectoralis interfascial plane (PECS) block for Modified Radical Mastectomy (MRM). The primary objectives were to compare duration of post-operative analgesia and total post-operative analgesic consumption while the secondary objectives were to compare dermatomal spread, intraoperative anaesthesia requirement and patient satisfaction. Materials And Methods: Sixty female patients of American Society of Anaesthesiologists (ASA) physical status I and II, undergoing MRM under general anaesthesia, were randomly recruited to receive ultrasound-guided TPVB (Group T) or ultrasound-guided PECS block (Group P) with 25ml of 0.25% bupivacaine, in a prospective, observer-blinded, randomized study. Data was statistically analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Categorical variables were compared using the Chi-square test or Fishers exact probability test continuous variables compared using unpaired t-test or Mann-Whitney U test. Results: All demographic variables were comparable. Intraoperative fentanyl consumption was lower in patients who received PECS block (72.50+27.35) than those who received TPVB (104.17+46.92) (p=0.0023). NRS was comparable in both groups till 2 hours post operatively. However, from 4 hours onwards, till 18 hours the Numerical Rating Scale (NRS) was significantly higher in TPVB group. Dermatomal spread was more extensive and postoperative analgesia requirement was lower in Group P. Patient satisfaction was comparable in both groups. Conclusion: PECS block is associated with superior postoperative analgesia and reduced analgesic requirement. The cranial dermatomal spread was better and intraoperative opioid requirement was less with PECS block.

P127 ROBOTIC TRANSABDOMINAL RETRO-RECTUS HERNIA REPAIR VS. LAPAROSCOPIC INTRAPERITONEAL ONLAY MESH REPAIR: IMPROVING POSTOPERATIVE OUTCOMES

Abstract Aim “The optimal repair technique for small and medium-sized ventral hernias in obese patients remains unknown. We aimed to evaluate results after robotic-assisted laparoscopic transabdominal repair with retro-rectus mesh placement (rTARUP) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM).” Material and Methods “Retrospective cohort study of consecutive patients undergoing rTARUP or IPOM repair for small or medium-sized primary ventral and incisional hernias. The primary outcome was postoperative need for transverse abdominis plane (TAP) block or epidural catheter, and secondary outcomes were 30-day complications, and length of stay. All patients underwent elective surgery and were followed for 30 days postoperatively.” Results “A total of 27 patients (rTARUP) and 32 (IPOM) were included. Patients in the two groups were comparable in terms of age, sex, comorbidities, smoking status, body mass index (BMI), and type of hernia. The median BMI was 32.4 kg/m2 and the fascial defect area was comparable (rTARUP median 16.8 cm2 vs. IPOM 11.7 cm2, P = 0.303). The duration of surgery was longer in the rTARUP group (median 117.2 min. vs. 84.4, P = 0.003), whereas the postoperative need for TAP block or epidural analgesics was less in the rTARUP group compared with IPOM (n = 14 vs. n = 1, P = 0.002). There were no severe complications or reoperations in the two groups. The length of stay was shorter in the rTARUP group (median 0 vs. 1 days, P &amp;lt; 0.001).” Conclusions “rTARUP was associated with reduced postoperative analgesic requirement and shorter length of stay compared with laparoscopic IPOM.”

Rhomboid Intercostal Block for Analgesia of Multiple Rib Fractures in an Infant

Rhomboid intercostal block (RIB) is a novel plane block, which is thought to provide analgesia for both the anterior and the posterior hemithorax. Herein, we represent the successful usage of ultrasound-guided RIB on an infant patient to provide analgesia for multiple rib fractures and insertion of a chest tube. A 10-month-old, 8 kg, male infant was scheduled for insertion of a chest tube. The patient had right sided pneumothorax and multiple rib fractures from T4 to T8 after a car crush. Following induction of anaesthesia, he was placed in lateral decubitis position and RIB was performed with 8mL 0.125% bupivacaine. A paediatric epidural catheter was placed into the interfacial plane for post-operative intermittent local anaesthetic injection as a part of multimodal analgesia with administration of intravenous paracetamol 60 mg. The postoperative pain assessment was conducted with FLACC scale at the post-operative 10th minute, 30th minute, 1st, 2nd, 6th, 12th and 24th hours, and the Face, Legs, Activity, Cry, Consolability scale score was 2 at all time-points. Ultrasound-guided RIB provided effective analgesia for insertion of a chest tube and attenuation of pain due to multiple rib-fractures in our infant patient.

The Efficacy of Ultrasound-Guided Bilateral Transversus Abdominal Plane (TAP) Block in Decreasing the Pain After Laparoscopic Cholecystectomy: A Randomized Clinical Trial

Introduction: Pain after laparoscopic cholecystectomy is complex in nature and several methods are performed to control it. Transversus Abdominis Plane (TAP) block has been used for postoperative pain for some abdominal surgeries. This study was designed to determine the analgesic efficacy of bilateral TAP block for patients undergoing Laparoscopic Cholecystectomy. Methods: Forty-two patients were randomized into 2 groups. Group 1 received TAP block using bupivacaine 0.25% (n=21), and group 2 received TAP block using saline. Before extubation, blocks were performed bilaterally. Tramadol IV was given for breakthrough pain for the first 24 hours. Pain scores using the Visual Analog Scale (VAS) at 0, 1, 2, 4 ,8 ,12, 24 hour-intervals, number of patient demand for Tramadol and patient satisfaction were collected. Results: Patients in the control group have higher VAS scores both during rest and on movement. However, pain was significantly reduced only on the 2nd hour at rest and on the 1st to 4th hours on movement among patients who received Bupivacaine 0.25% on TAP block. Furthermore, there was no significant difference in the requirement for rescue analgesics (p=0.1160) and the satisfaction rate (p=0.2849) between the two groups. Conclusion: TAP block is safe and improved postoperative analgesia in patients receiving laparoscopic cholecystectomy. But its additional analgesic effect in the presence of a dynamic multimodal pain-control regimen is probably rather small and need further investigation in laparoscopic cholecystectomy.

A retrospective audit of pain assessment and management post-caesarean section at New Somerset Hospital in Cape Town, South Africa

BackgroundThe most common major surgical procedure performed worldwide is the caesarean section (CS). Effective pain management is a priority for women undergoing this procedure, to reduce the incidence of persistent pain (a risk factor for postpartum depression), as well as optimise maternal-neonatal bonding and the successful establishment of breastfeeding. Multimodal analgesia is the gold standard for post-CS analgesia. At present, no perioperative pain management protocols could be identified for the management of patients presenting for CS at regional hospitals in South Africa. This audit aimed to review the folders of patients who underwent CS, with particular reference to perioperative pain management guidelines for CS.MethodsA descriptive, retrospective, cross-sectional audit was conducted. Three hundred folders (10% of the annual number of caesarean procedures performed) from New Somerset Hospital, a regional hospital in Cape Town, South Africa were reviewed.ResultsThe women were a mean age of 30 years (standard deviation [s.d.]: 6.2). Median gravidity was 3 (interquartile range [IQR]: 2–3) and parity was 1 (IQR: 1–2); 52% had previously undergone a CS. In 93.3% cases, spinal anaesthesia was employed for CS. Pain assessment was poor, with only 55 (18%) patients having their pain assessed on the day of the operation. Analgesia was prescribed in over 98% of the patients, however, medication was only administered as prescribed in 32.6%. Non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed in < 5% of cases. None of the patients received a patient-controlled analgesia (PCA), transversus abdominis plane (TAP) block, or wound infusion catheter as supplementary strategies.ConclusionPain management for post-CS patient at this hospital is lacking. There is the need for the implementation of a structured assessment tool to improve administration of analgesics in these patients. In addition, the reasons for the omission of NSAIDs from the analgesia regimen requires investigation. Hospital requires post-CS pain protocols to guide management especially in resource-limited settings.

Purely ropivacaine-based TEA vs single TAP block in pain management after elective laparoscopic colon surgery within an upgraded institutional ERAS program

BackgroundThe aim of this study was to compare thoracic epidural analgesia (TEA) with transversus abdominis plane (TAP) block in post-operative pain management after laparoscopic colon surgery.MethodsOne hundred thirty-six patients undergoing laparoscopic colon resection randomly received either TEA or TAP with ropivacaine only. The primary endpoint was opioid requirement up to 48 h postoperatively. Intensity of pain, time to onset of bowel function, time to mobilization, postoperative complications, length of hospital stay, and patients’ satisfaction with pain management were also assessed.ResultsWe observed a significant decrease in opioid consumption on the day of surgery with TEA compared with TAP block (30 mg vs 14 mg, p < 0.001). On the first two postoperative days (POD), the balance shifted to opioid consumption being smaller in the TAP group: on POD 1 (15.2 mg vs 10.6 mg; p = 0.086) and on POD 2 (9.2 mg vs 4.6 mg; p = 0.021). There were no differences in postoperative nausea/vomiting or time to first postoperative bowel movement between the groups. No direct blockade-related complications were observed and the length of stay was similar between TEA and TAP groups.ConclusionTEA is more efficient for acute postoperative pain than TAP block on day of surgery, but not on the first two PODs. No differences in pain management-related complications were detected.

English

BACKGROUND Inguinal hernia is a frequently encountered surgical problem. General anaesthesia carries the risk of possible airway complications. Regional blocks improve acute post-operative pain, decrease post-operative visual analogue scale (VAS) score and patient can mobilise early. The purpose of this study was to compare the effectiveness of transversus abdominis plane (TAP) block vs. paravertebral (PVB) block for post-operative analgeia in inguinal hernia surgeries. METHODS We conducted a research on 64 patients of age &gt; 18 years with American society of Anaesthesiologists (ASA I – III) to undergo unilateral inguinal herniorrhaphy. Patients were randomized into two groups. Group T received TAP block in which 20 ml of 0.25 % bupivacaine was injected and Group P underwent PVB in which 5 ml of bupivacaine (0.25 %) at each segment from T10-L1 was injected slowly (total dose of 20 ml). Post-operative VAS score, time for first rescue analgesia, total diclofenac requirement, total anti-emetic requirement and complications if any was noted. RESULTS The demographic data of both the groups were comparable. Also, pre and postoperative heart rate, blood pressure, IV fluids, ephedrine use, operative time and complications were statistically insignificant. As compared to group T, group P had lower VAS score from 2nd – 12th hour which was statistically significant (P &lt; 0.05). Although more time is required to perform paravertebral block but the time for request of first rescue analgesia was quite prolonged in paravertebral block. Time of ambulation in group P was significantly lower than group T. CONCLUSIONS PVB requires more time to perform due to multiple site of injection, the comparison of both techniques in the present study revealed that PVB showed relatively higher efficacy in the management of post-operative pain, early ambulation and had significant reduction in dose requirement of additional analgesia (diclofenac) and antiemetics (ondansetron) over tap block. KEYWORDS Paravertebral Block, Transversus Abdominis Block, Inguinal Hernia

The effectiveness of peritibial fascial infiltration block for analgesia management after tibia fracture surgery: description of a novel plane block.

article: The effectiveness of peritibial fascial infiltration block for analgesia management after tibia fracture surgery: description of a novel plane block - Minerva Anestesiologica 2021 November;87(11):1269-71 - Minerva Medica - Journals

Effect of needle type on plane block spread in a cadaveric porcine model

IntroductionPlane blocks are an increasingly common type of regional anaesthesia technique in the perioperative period. Increased spread of local anaesthesia during plane blocks is thought to be related to an...

A COMPARATIVE STUDY OF CAUDAL BLOCK AND ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK WITH LEVOBUPIVACAINE AND DEXAMETHASONE AS ADDITIVE IN EXTRAPERITONEAL LOWER ABDOMINAL SURGERIES IN PEDIATRICS

Objective: The objective of the study was to evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block versus caudal block for post-operative analgesia with levobupivacaine and dexamethasone as additive in extraperitoneal lower abdominal surgeries in pediatrics as there is no available literature showing the same.&#x0D; Methods: This is a randomized control study carried out between two groups among 50 children (1–8 years of age), both sexes, posted for elective extraperitoneal lower abdominal surgeries after taking informed consent from parents. Fifty children were randomly allocated into two groups, 25 in each group. Caudal epidural (CE) group received general anesthesia and caudal block with 1 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. TAP group received general anesthesia and ultrasound-guided TAP block with 0.5 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. Data were collected by means of pre-designed format with pre-/post-operative assessment with standardized scores.&#x0D; Results: The mean age of the patients was 4.84 (SD=2.29). Mean face, legs, activity, cry, and consolability score was low and non-significant before shifting the patient (&lt;2 h post-operative [post-op]) in both the groups. Thereafter from 2 to 12 h, the mean score increased to 4.92 (SD=2.72) in the CE group and 2.92 (SD=2.17) in the TAP group and the difference was statistically significant at 2 h, 4 h, 6 h, and 12 h postoperatively. Mean time to rescue analgesia in the CE group was 4.96 h (SD=4.32) and 5.52 h (SD=7.53) in the TAP group and difference was statistically significant (p=0.000). Mean total rescue analgesic requirement for the CE and TAP groups was 298.40 mg (SD=170.70) and 111.40 mg (SD=138.81) and the difference was also significant. Post-operative complications such as urinary retention and motor blockade were seen in 28% of CE patients, while none of the patients experienced post-operative nausea/vomiting.&#x0D; Conclusions: Our study showed significant increase in duration of post-operative analgesia among TAP patients with reduced requirement of rescue analgesics and lesser post-operative complications as compared to CE patients

Comparing Intravenous Single Low Doses of Magnesium Sulphate versus Dexamethasone as Adjuvants to Ultrasound Guided Transversus Abdominis Plane (TAP) Block for Prolongation of Postcesarean Analgesia

Introduction: The TAP block is a regional anesthetic technique, which blocks neural afferents between T6 and L1, which provide anterior abdominal walls and therefore help to alleviate postoperative pain. Aim: The aim is to compare the efficacy of preoperative single low dose of intravenous MgSO4 versus intravenous dexamethasone as adjuvants to ultrasound guided TAP block for prolongation of postcesaren analgesia. Materials and Methods: A total 60 pregnant females were selected undergoing elective caesarean sections under general anesthesia with ultrasound-guided transversus abdominis plane (TAP) block done at the end of surgery. Patients were randomly and equally allocated into three groups of 20 patients each. The first group of patients were classified as magnesium sulphate group (M)who received 50 mg/Kg IV, the second group of patients were classified as dexamethasone group (D) who received 2 mg IV and the third group was classified as the placebo group (C) who received IV saline. Results: Comparison of the VAS at 6 and 12 hours postoperatively showed statistically significantly lower values in group (M) and group (D) compared to group (C) and also group (M) was significantly lower than group (D) as well. The time interval until first rescue analgesia (Nalbuphine) needed by the patients (VAS ≥ 50) was significantly longer in group (M) compared to group (D) and group (C) consecutively. Additionally, it was significantly longer in group (D) than in the control group(C). The total dose of rescue analgesia consumed during the first 24 hours postoperatively was significantly lower in groups (M) than in group (D) and both groups showed lesser doses compared to group (C) Conclusion: We concluded that both MgSO4 and dexamethasone could prolong the postoperative duration and analgesic efficiency provided by the TAP block in cesarean sections. This further reduced the demands for postoperative rescue analgesia, with MgSO4 found to be more efficient than IV dexamethasone. Clinical Trial Registration Number: NCT04223128