Transversalis Fascia Plane Block Research Articles

MATHEMATICAL PREDICTION OF CHANGES IN THE LEVELS OF CD40-CD40L TRANSMEMBRANE PROTEIN SYSTEM ACROSS DIFFERENT ANALGESIA TECHNIQUES IN CHILDREN

The impact of the CD40-CD40L on the development of non-communicable neurological conditions is determined by abnormal CD40 expression and may be detrimental to nervous tissue function. Pain is one of the earliest psychophysical functions to develop. Postoperative complications causing pain should be addressed immediately. Regional analgesia techniques can speed up children’s recovery and reduce the need for opioids. They can also lower the incidence of postoperative nausea and vomiting, respiratory complications, and postsurgical pain intensity.The aim of this study was to present a mathematical model that predicts changes in CD40-CD40L levels in children who underwent surgery under various analgesic modalities within the fi rst fi ve days postoperatively. The autoregressive probability model was used to predict the behavior of the experimental data function within 29 days after surgery.Material and Methods. The children were divided into three groups. Group I consisted of 33 children who underwent anterior abdominal wall surgery under general anesthesia with morphine. Group II comprised 27 children who underwent anterior abdominal wall surgery under general anesthesia with the transversalis fascia plane block (TFPB). Group III included 27 children who underwent anterior abdominal wall surgery under general anesthesia with the TFPB, combined with the quadratus lumborum block 4 (QLB-4) via a single injection. The serum CD40L levels were evaluated using the immunoenzymatic assay method. The autoregressive model method based on the Burg algorithm was used to predict the behavior of the experimental data function. To automate the calculation of predictions based on the Burg method, the ‘predict’ function in РТС MathCad Prime 7.0 software was used. All clinical and laboratory studies were conducted in accordance with the World Medical Association Declaration of Helsinki ‘Ethical Principles for Medical Research Involving Human Subjects’. The study is a fragment of the research project of the Department of Children Diseases of Postgraduate Medical Education Faculty, Ivano- Frankivsk National Medical University «Health Status and Adaption of Children from the Precarpathian Region with Somatic Diseases, Their Prevention» 2021-2026, state registration number 0121U111129.Results. On the fi fth day after surgery, the serum CD40-CD40L levels were highest in children who received conventional opioid analgesia. There was no signifi cant diff erence observed between children in the TFPB and TFPB+QLB groups. On the 29th day after surgery, the predicted CD40-CD40L levels were lowest in children who received conventional opioid analgesia combined with the TFPB+QLB.Conclusions. The fi ndings obtained confi rmed the positive eff ect of combined analgesia using opioids and regional nerve block TFPB+QLB in children who received anterior abdominal surgery on suppressing immune mechanisms of pain syndrome involving the CD40-CD40L signaling system.

Spinal Anestezi Altında Sezaryen Doğumda Postoperatif Analjezi için Transversalis Fasya Plan Bloğunun Transversus Abdominis Plan Bloğuyla Karşılaştırılması: Retrospektif Bir Çalışma

Objective: Transversalis fascia plane (TFP) and transversus abdominis plane (TAP) blocks are used for postoperative analgesia in many lower abdominal procedures such as cesarean section. This study aimed to retrospectively compare the postoperative effects of TFP and TAP blocks for postoperative multimodal analgesia in patients who underwent cesarean section under spinal anesthesia. Methods: We retrospectively searched electronic medical records to identify patients who underwent cesarean section under spinal anesthesia between November 2021 and June 2022. A total of 497 patients were identified, and 120 patients were included that meet our criteria in our analysis. The patients were divided into three groups: TFP, TAP, and control. Data were obtained from the files of the patients. Results: The block groups had significantly lower numeric rating scale (NRS) scores, less non-steroidal anti-inflammatory drug consumption, and lower complications than the control group. No opioid consumption was observed in the block groups. Although no non-steroidal anti-inflammatory drug consumption until the 4th hour and no opioid consumption until the 8th hour were observed in the control group, the need for additional analgesics increased as time passed. While the TFP group needed analgesics later than the TAP group, the NRS scores and total analgesic consumption were lower (p<0.001). Patient satisfaction was higher in the block groups than in the control group (p<0.001). Conclusion: Transversalis fascia plane and TAP blocks are effective as part of multimodal analgesia in cesarean section. The TFP block is superior to the TAP block in terms of pain scores, additional analgesic requirements, and patient satisfaction. Keywords: Cesarean section, postoperative pain, ultrasound-guided regional anesthesia, transversus abdominis plane block, transversalis fascia plane block

VARIOUS TYPES OF LOCOREGIONAL ANALGESIA IN PEDIATRIC PATIENTS

The regional blocks, as a part of multimodal analgesia, can improve pain managementin the postoperative period and reduce the rate of complications that arise when usinga single anesthesia regimen.The aim of the study – to compare the efficacy of various regional analgesia techniques.Materials and Methods. All patients were divided into two groups: Group I included31 children who underwent anterior abdominal wall surgery under general anesthesiawith the transversalis fascia plane block (TFPB); Group II comprised 32 children whounderwent anterior abdominal wall surgery under general anesthesia with the TFPB,combined with the quadratus lumborum block 4 (QLB-4) via a single injection.Results. In children of the I group, the pain intensity indicator on the visual analog scale(VAS) after one hour constituted 4.6±0.16 points, while in the children of the II group it was 3.5±0.15 (р<0.05). The assessment of pain intensity according to VAS in thedynamics of the postoperative period showed that children of group I 6 hours aftersurgery have 1.2 times higher pain indicators compared to children of group II (p<0.05),after 12 hours – by 1.7 times, after 24 hours – 1.6 times, after 36 hours – 1.5 times,and at discharge – 1.6 times (р<0.001). According to the results of the LIKERT scale,significantly higher pain indicators were established in children of group I after surgeryand at the time of discharge (10.12±0.15 and 5.45±0.22 compared to 5.93±0.19 and3.50±0 .15 in children of group II (p<0.001). The smallest volume of paracetamol usedfor pre-emptive and multimodal analgesia in children of group I was 95 ml, while inchildren of group II it was 40 ml. The largest volume, required by the children duringanalgesia was 220 mL and 150 mL in groups I and II, respectively.The mean time tocomplete the QLB-4 was 117.3±1.76 sec, while the TFPB was 121.8±3.56 sec (p =0.27).The duration of postoperative analgesia after performing the combined locoregionaltechnique was 32.56±0.5 hours, while when using the TFPB monoblock it was 22.9±0.57hours (p<0.001).Conclusions. The use of a combined block for regional analgesia during operations onthe anterior abdominal wall is accompanied by: a lower indicator of pain intensity in thepostoperative period (p<0.001); reducing the need to use «rescue doses of analgesics» inthe postoperative period (p<0.001); the spread of the sensory block at the level of T7-L2dermatomes; an increase in the duration of postoperative analgesia (p<0.001) comparedto the corresponding indicators when using the TFPB monoblock.

The analgesic effect of transversalis fascia plane block after caesarean section under spinal anaesthesia with intrathecal morphine: a randomised controlled trial.

We aimed to test whether bilateral injection of bupivacaine 0.25% in the transversalis fascia plane reduced 24 h opioid dose after singleton caesarean section, under spinal anaesthesia with intrathecal morphine, compared with saline 0.9% injectate. We allocated randomly 52 women to bilateral injection of 20 ml saline 0.9% on arrival in the post-anaesthesia care unit and 54 women to bilateral injection of 20 ml bupivacaine 0.25% (with adrenaline 2.5 μg.ml-1 ). Mean (SD) cumulative morphine equivalent opioid dose 24 h after saline injection was 32.3 (28.3) mg and 18.7 (20.2) mg after bupivacaine injection, a mean (95%CI) difference of 13.7 (4.1-23.2) mg (p = 0.006). Median (IQR [range]) time to first postoperative opioid dose was 3.0 (1.5-10.3 [0.0-57.4]) h after saline 0.9% and 8.2 (2.7-29.6 [0.2-55.4]) h after bupivacaine 0.25% (p = 0.054). Transversalis fascia plane with bupivacaine 0.25% with adrenaline reduced postoperative pain at rest during 48 h (0-10-point scale) by a mean (95%CI) of 0.9 (0.2-1.6) points (p = 0.013) and on movement by 1.2 (0.4-2.1) points (p = 0.004). We conclude that transversalis fascia plane bupivacaine 0.25% with adrenaline reduces pain and opioid dose after caesarean section compared with saline 0.9%.

MANAGEMENT OF CHRONIC POSTSURGICAL PAIN AND HYPERALGESIA IN CHILDREN AND ITS INFLUENCE ON COGNITIVE FUNCTIONING

Introduction. Persistent postsurgical pain (PPSP) or chronic postsurgical pain (CPSP) is recognized as a relevantpostoperative complication. Inadequate pain management in the early postoperative period may contribute to the development of hyperalgesia and the use of local anesthetics in regional anesthesia can help in its treatment and prevention.The aim of the study was to study the eff ectiveness of regional analgesia techniques in preventing PPSP and hyperalgesiain children after anterior abdominal wall surgery and to assess quality of life (QoL) using the Cognitive Functioning Scale.Material and Methods. The study included 87 children at the age of 7-18 years who underwent anterior abdominal wallsurgery with diff erent anesthetic techniques. Group I included 27 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block (TFPB), combined with the quadratus lumborum block 4 (QLB-4). Group II comprised 33 children who underwent anterior abdominal wall surgery under general anesthesia using fentanyl. Group III consisted of 27 children who underwent anterior abdominal wall surgery under general anesthesia using the TFPB. General anesthesia included either inhalation anesthesia or propofol infusion. The control group included 30 healthy children whose cognitive functioning was assessed. All clinical and laboratory studies were conducted in accordance with the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects”. According to the Law, prior to a subject’s participation in the study, a written informed consent form was signed by each subject (parents/adult guardians). The manuscript was approved by the Ethics Committee of the Communal Non- Profi t Enterprise “Ivano- Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”, as evidenced by an Excerpt from the Minute of the Committee Meeting No. 2 dated February 24, 2022.The results obtained were statistically processed using statistical measures of variation, correlation analysis, Student’s t-test.Diff erences were considered statistically signifi cant at p<0.05. The proportions were statistically compared by a z-test.The study is a fragment of the research project of the Department of Children Diseases of Postgraduate Medical EducationFaculty, Ivano- Frankivsk National Medical University “Health Status and Adaption of Children from the Precarpathian Regionwith Somatic Diseases, Their Prevention” (state registration number 0121U111129; 2021-2026).Results. A signifi cantly higher mechanical pain threshold was observed in children of Group I and Group III both three(226.422.2, 220.318.6, and 182.414.2 g/mm2, respectively, рІ-ІІ<0.05, рІІ-ІІІ<0.05) and six months (288.214.4, 276.414.8,and 174.216.4 g/mm2, respectively, рІ-ІІ<0.05, рІІ-ІІІ<0.05) after surgery.The surface area of hyperalgesia in children of Group I and Group III was signifi cantly smaller as compared to childrenof Group II three (68.69.4, 79.411.4, and 116.814.0 mm2, respectively, рІ-ІІ<0.05, рІІ-ІІІ<0.05) and six months (70.213.0,77.213.2, and 117.212.6 mm2, respectively, рІ-ІІ<0.05, рІІ-ІІІ<0.050) after surgery.The frequency of CPSP was higher in children of Group II (21%) as compared to children in Group I (4%) and Group III(11%). Additionally, assessing chronic pain with the DN4 questionnaire showed its signifi cantly lower level in children of Group Iand Group III as compared to Group II six months after surgery (5.46±0.42, 8.69±0.78, and 13.69±0.38 points, respectively,рІ-ІІ<0.05, рІІ-ІІІ<0.05, рІ-ІІІ<0.05). No statistically signifi cant diff erence in QoL assessment on the Cognitive Functioning Scale was observed on the 7th day following surgery; the QoL scores in all the groups were signifi cantly lower compared to the control group. Three months after surgery, QoL was signifi cantly lower in children of Group II (69.38±6.93 points) as compared to children of Group I (92.08±4.46 points, pІ-ІІ<0.001) and Group III (83.54±4.16 points, pІІ-ІІІ<0.01). Six months following surgery, the lowest QoL was diagnosed in children of Group II (72.08±6.64) as compared to those in Group І (94.17±4.36 points, p<0.001) and Group ІІІ (91.67±4.27, p<0.001).Conclusions.1. The use of general analgesia in combination with regional anesthesia techniques (TFPB or TFPB+QLB) was associatedwith a higher mechanical pain threshold and a smaller area of hyperalgesia around the postoperative wound three and six months after anterior abdominal wall surgery, compared to conventional anesthesia.2. In addition, combined use of regional (TFPB or QLB+TFPB) with general anesthesia demonstrated a lower frequencyof CPSP, a lower level of chronic pain, and a higher level of cognitive functioning in children throughout these time intervals.3. The results obtained provide a foundation for introducing these analgesia techniques (TFPB or TFPB+QLB) in pediatricpatients undergoing anterior abdominal wall surgery, with the aim of mitigating the eff ects of pain syndrome and improving their Qo L.

Comparison of ultrasound-guided transversalis fascia and posterior transversus abdominis plane block for postoperative analgesia following caesarean delivery: A double-blinded randomised controlled trial.

Posterior-transversus abdominus plane (TAP) block and transversalis fascia plane (TFP) block have been used for postoperative analgesia following caesarean delivery. We compared the analgesic efficacy of the TAP vs TFP plane blocks in patients undergoing elective caesarean delivery. We randomised 90 women undergoing caesarean delivery under spinal anaesthesia to receive either a posterior-TAP (Group-TAP), TFP (Group-TFP) or no block (Group-C) postoperatively. The primary objective was the postoperative analgesic requirements. Secondary objectives were duration of analgesia, pain scores and infra-umbilical sensory loss, which were recorded at specific intervals for 24 h. Statistical analysis was carried out using Statistical Package for Social Sciences version 16.0 software. The patients requiring one, two or nil rescue analgesics were comparable between the interventions and the control (P = 0.32). The duration of analgesia was longer in Group-TAP when compared to Group-C, 4.76 (1.2) vs. 6.89 (2.4); P < 0.001, whereas Group-TFP, 5.64 (2.1) h, was not significantly different from Group-C. The static pain score in Group-TAP was significantly less than that in Group-C at 4 h and beyond 12 h (P < 0.001), whereas Group-TFP was comparable with Group-C at all time points except at 4 h and 24 h (P = 0.002). Only Group-TAP demonstrated midline infraumbilical sensory loss. TAP and TFP blocks did not decrease the rescue analgesic requirement compared with the control group. The posterior-TAP block prolonged the duration of analgesia by 2 h, maintained the median static pain score at 0 beyond 12 h, and demonstrated sensory loss at the infraumbilical dermatomes.

Evaluation of the Effectiveness of Transversus Abdominis Plane Block and Transversalis Fascia Plane Block in Postoperative Analgesia in Pediatric Patients Undergoing Lower Abdominal and Genitourinary Surgery: A Retrospective Study

Evaluation of the Effectiveness of Transversus Abdominis Plane Block and Transversalis Fascia Plane Block in Postoperative Analgesia in Pediatric Patients Undergoing Lower Abdominal and Genitourinary Surgery: A Retrospective Study

Comparison of the Effectiveness of Ultrasound-guided Transversalis Fascia Plane Block (TFPB) and Transversus Abdominis Plane Block (TAPB) on Postoperative Pain in Caesarean Section: A Prospective Randomized Study

Comparison of the Effectiveness of Ultrasound-guided Transversalis Fascia Plane Block (TFPB) and Transversus Abdominis Plane Block (TAPB) on Postoperative Pain in Caesarean Section: A Prospective Randomized Study

PREVENTION OF HYPERALGESIA IN CHILDREN WHEN USING VARIOUS ANESTHESIA TECHNIQUES

Introduction. Opioid-induced hyperalgesia is characterized by a paradoxical response whereby a patient receiving opioids for pain management could actually become more sensitive to certain painful stimuli. Regional anesthesia can also impact central sensitization and reduce hyperalgesia after surgery.The objective of the study was to determine the method of preventing hyperalgesia in the early postoperative period when using different analgesic regimens in children after anterior abdominal wall surgery.Materials and Methods. The study included 87 children at the age of 7-18 years who underwent anterior abdominal wall surgery using different analgesic techniques. Group I included 33 children who underwent anterior abdominal wall surgery under general anesthesia using fentanyl. Group II comprised 27 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block (TFPB). Group III involved 27 children who underwent anterior abdominal wall surgery under general anesthesia using the TFPB, combined with the quadratus lumborum block 4 (QLB-4) via a single injection.All clinical and laboratory studies were conducted in accordance with the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects”. According to the Law, prior to a subject’s participation in the study, a written informed consent form was signed by each subject (parents/adult guardians). The manuscript was approved by the Ethics Committee of the Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”, as evidenced by an Excerpt from the Minute of the Committee Meeting No. 2 dated February 24, 2022.The results obtained were statistically processed using statistical measures of variation, correlation analysis, Student’s t-test. Differences were considered statistically significant at p&lt;0.05. The proportions were statistically compared by a z-test.The study is a fragment of the research project of the Department of Children Diseases of Postgraduate Medical Education Faculty, Ivano-Frankivsk National Medical University “Health Status and Adaption of Children from the Pre-Сarpathian Region with Somatic Diseases, Their Prevention” 2021-2026, state registration number 0121U111129; the author is a co-researcher.Results. In most (48.5 %) patients of Group I, the response to stimulation occurred only when applying pressure forces of 8 and 10 g, while the motor response was observed to stimulation with a pressure force of 8 g, with the FLACC scale score of 5.1±0.3, indicating insufficient pain threshold and potential development of opioid-induced hyperalgesia in the early postoperative period. In patients of Group II and Group III, the response to stimulation occurred when applying a pressure force of 8 g and the FLACC scale scores were 2.9±0.27 and 2.4±0.32, respectively (p&lt;0.05).Conclusions. The results obtained confirmed the benefits of using regional anesthesia techniques in combination with conventional analgesia.

Efficacy of regional analgesia in prevention of chronic postsurgical pain in children on the PEDSQL General Well-Being Scale and Pediatric Pain Questionnaire

Introduction. In pediatrics, regional anesthesia is one of the most valuable and safest means of perioperative pain management and chronic pain prevention. Pediatric Quality of Life Inventory 3.0 General Well-Being Scale and Pediatric Pain Questionnaire allow for assessing the impact of pain on children and their families via studying changes in Quality of Life scores for the scales of Present Pain and Worst Pain, General Well-Being and General Health. Purpose - to assess the impact of regional analgesia on the prevention of chronic postsurgical pain using PedsQL™ 3.0 questionnaires. Materials and methods. Following the inclusion and exclusion criteria, a total of 80 children were enrolled in the study. Among them, there were 60 children who underwent anterior abdominal wall surgery with various types of anesthetic management and were treated at the surgical department of a Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”. All patients were divided into 4 groups. The Group 0, the control group, included 20 children who had no surgical pathology and met inclusion criteria. The Group I comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block combined with the quadratus lumborum block-4 via a single injection. The Group II included 20 children who underwent anterior abdominal wall surgery under general anesthesia using morphine. The Group III comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block. Results. The prevalence of chronic pain syndrome in children who received conventional analgesia was the highest - 19.81±0.21%. Children who underwent conventional analgesia, while staying in the surgical department, had significantly higher the Face, Legs, Activity, Cry, Consolability scale and Visual Analogue Scale scores as compared to those who received other forms of regional analgesia. Discussion. Three and six months after surgery, in patients who received conventional analgesia, quality of life significantly reduced (p&lt;0.001) on the scales of General Well-Being, General Health, Present Pain, and Worst Pain. This shows the need for using effective minimally invasive regional analgesia techniques in the perioperative period. Conclusions. Chronic pain syndrome reduces quality of life in children by reducing their general well-being and general health due to high indicators of present and worst pain. Regional analgesia techniques are a priority for the prevention of chronic pain syndrome. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Ultrasound-guided transversalis fascia plane block versus lateral quadratus lumborum plane block for analgesia after inguinal herniotomy in children: a randomized controlled non-inferiority study

BackgroundSurgical repair of inguinal hernia is one of the most common day case surgeries in the pediatric population. This study compared the postoperative analgesic effects of transversalis fascia plane block (TFB) versus quadratus lumborum block (QLB) in children scheduled for open unilateral inguinal herniotomy.MethodsIn this prospective, randomized, double-blind, controlled non-inferiority study, 76 eligible patients were recruited. Patients were randomly allocated to either the TFB or QLB group. The primary outcome measure was the proportion of patients who needed rescue analgesia during the first postoperative 12 h. The secondary outcomes were, the time needed to perform the block, the postoperative FLACC score, intraoperative heart rate (HR) and mean arterial pressure (MAP).ResultsThe proportion of patients who required a rescue analgesic was comparable (p = 1.000) between the TFB group (7/34, 20.5%) and the QLB group (6/34, 17.6%). The median [Q1-Q3] time needed to perform the block (min) was significantly longer (p < 0.001) in the QLB group (5[5]) compared with the TFB group. The postoperative FLACC pain scale was comparable between the two groups at all-time points of assessment. There is no difference regarding the heart rate and mean arterial blood pressure values at the time points that the values were recorded. (P > 0.005).ConclusionsBoth TFB and QLB similarly provide good postoperative analgesia by reducing the proportion of patients who required rescue analgesia, pain scores and analgesic consumption. Moreover, TFB is technically easier than QLB.

CHANGES IN THE INDICATORS OF ABDOMINAL ARTERIAL CIRCULATION WHEN APPLYING VARIOUS ANESTHETIC TECHNIQUES IN CHILDREN

Intra-abdominal hypertension and abdominal compartment syndrome result from increased intra-abdominal pressure. In addition, intra-abdominal hypertension has been reported to be an independent risk factor for pediatric intensive care unit mortality.The study aimed to compare the efficacy and the effect of various anesthetic techniques using regional anesthesia on the indicators of abdominal arterial circulation in anterior abdominal wall surgery in children.Materials and Methods. The study included 90 children at the age of 7-18 years. All children underwent anterior abdominal wall surgery under general anesthesia and were divided into 3 groups: Group I included 30 children who underwent anterior abdominal wall surgery under general anesthesia using morphine; Group II comprised 30 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block combined with the quadratus lumborum block 4 via a single injection; Group III included 30 children who underwent anterior abdominal wall surgery under general anesthesia using the TFPB.The manuscript was approved by the Ethics Committee of the Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”, as evidenced by an Excerpt from the Minute of the Committee Meeting No. 2 dated February 24, 2022.The results obtained were statistically processed using statistical measures of variation, correlation analysis, Student’s t-test. Differences were considered statistically significant at p&lt;0.05. The proportions were statistically compared by using a z-test.The study is a fragment of the research project of the Department of Children Diseases of Postgraduate Medical Education Faculty, Ivano-Frankivsk National Medical University “Health Status and Adaption of Children from the Precarpathian Region with Somatic Diseases, Their Prevention” 2021-2026, state registration number 0121U111129; the author is a co-researcher.Results and Discussion. The analysis of acute pain on the selected scales found significantly higher indicators of acute pain on the FLACC scale in the group of conventional anesthesia (Group I, p&lt;0.001) as compared to Group II, where the TFPB in combination with the QLB-4 was used. The analysis of the Likert scale responses found that, over the course of treatment, there was a significant reduction in pain indicators among patients of Group II as compared to those in Group I and Group III (p&lt;0.001). High pain intensity in children who received conventional anesthesia led to a prolonged length of hospital stay and increased IAP (FLACC scale (rx,y=0.38±0.16, р=0.02).Conclusions. A combination of regional anesthesia techniques and conventional anesthesia leads to a reduction in IAP, and increase in APP, a decrease in the resistance index in the superior mesenteric artery and shortens the length of hospital stay as compared to conventional anesthesia management.

Efficacy of transversalis fascia plane block as a novel ındication for varicocelectomy surgery: prospective randomized controlled study

BackgroundVaricocele occurs as a result of dilatation of the pampiniform plexus in the spermatic veins. In this study, our primary aim was to evaluate the effect of Transversalis Fascia Plane Block (TFPB) on pain scores in the postoperative period in patients undergoing varicocelectomy surgery, and our secondary aim was to evaluate the effect of TFPB on analgesic consumption.MethodsThe study was initiated following local ethics committee approval, and sixty ASA I-II patients > 18y scheduled to undergo varicocelectomy and who consented to participation were enrolled. Before the procedure, the patients were randomly assigned two groups: Transversalis Fascia Plan block group (Group TFPB) or surgical incision site infiltration group (Group I).All surgeries were carried out under general anesthesia, and microsurgery using the subinguinal approach. After surgical suturing, TFPB and local infiltration blocks were applied prior to termination of anesthesia.For each block, 20 mL of 0.25% bupivacaine was utilized. Patients' demographic information, passive and active VAS ratings after surgery, usage of non steroidal anti-inflammatory medications and rescue analgesia, and the requirement for rescue analgesia, were recorded.ResultsA total of 60 patients were included in the study. In terms of demographic data, there was no difference between the groups. At all hours, there was a statistically significant decrease in favor of Group TFPB in terms of active and passive VAS scores (p < 0.001), non steroidal anti-inflammatory analgesic use (p < 0.05), and tramadol requirement (p < 0.001).ConclusionThis study has shown that TFPB can provide a more effective analgesia when compared to surgical site infiltration.

Ultrasound-guided transversalis fascia plane block for postoperative analgesia: A systematic review and meta-analysis.

Ultrasound-guided transversalis fascia plane block (TFPB) has been used for providing postoperative analgesia after various lower abdominal surgeries like iliac crest bone harvesting, inguinal hernia repair, caesarean section and appendicectomy. After registering the protocol in PROSPERO, various databases like PubMed/Medline, Ovid, CENTRAL and clinicaltrials.gov were searched for randomized controlled trials and observational, comparative studies till October 2022. The risk of bias (RoB-2) scale was used to assess the quality of evidence. The database searched identified 149 articles. Out of these, 8 studies were identified for qualitative analysis and 3 studies were TFPB was compared to control in patients undergoing caesarean section were selected for quantitative analysis. At 12 hours, pain scores were significantly less in TFPB group when compared to control on movement with no heterogeneity. At other times, the pain scores were comparable. 24-hr opioid consumption was significantly less in TFPB group when compared to control with significant heterogeneity. Time to rescue analgesia was significantly less in TFPB group when compared to control with significant heterogeneity. Number of patients requiring rescue analgesia were significantly less in TFPB group when compared to control with no heterogeneity. Postoperative nausea/vomiting (PONV) was significantly less in TFPB group when compared to control with minimal heterogeneity. In conclusion, TFPB is a safe block which provides opioid-sparing postoperative analgesia and a delayed time to rescue analgesia with no significant difference in pain scores and lesser PONV postoperatively when compared to control in patients undergoing caesarean section.

Elevated serum TLR4 level as a potential marker for postsurgical chronic pain in pediatric patients with different approaches to analgesia.

IntroductionThe perioperative period of any surgery is accompanied by immune suppression. The level of Toll-like receptor 4 (TLR4) is known to increase in inflammation and after nerve injury and contributes to the development of neuropathic pain. The interaction of TLRs in response to the effect of opioids results in paradoxical hyperalgesia. Regional anesthesia techniques are the standard of care for perioperative pain management in children.AimThe aim of the study was to determine and evaluate the indicators of TLR4 for different methods of pain relief in anesthetic management of hernia repair in children and their effect on pain chronification.Materials and methodsThere were examined 60 children with inguinal hernia during 2020–2022. Children were divided into 3 groups: Group I included 20 children who underwent surgery under general anesthesia using the block of the anterior abdominal wall—transversalis fascia plane block (TFPB), combined with the quadratus lumborum block (QLB-4) via a single intramuscular injection; Group II included 20 children who underwent surgery under general anesthesia using the TFPB; Group III comprised 20 children who underwent surgery under general anesthesia using opioid analgesics. The levels of TLR4 were evaluated at a discharge from the hospital, 3 and 6 months after surgery.ResultsThere was no difference in age and body weight among all groups. In Group II, boys prevailed. In Group III, the length of hospital stay was the longest (3.28 ± 0.24 days, p < 0.05, t = 4.09) as compared to children of Group II and Group I (3.0 ± 0.30 (p < 0.05, t = 2.647) and 2.1 ± 0.16 days, respectively). While staying in the surgical department, children of Group III demonstrated significantly higher FLACC and VAS scores. The prevalence of chronic pain was the highest among children of Group III (35%) as compared to those in Group II and Group I (20 and 15%, respectively). The highest increase in the level of TLR4 was found in the group of opioid analgesia on the third and sixth months after surgery (68.86 + 10.31 pg/ml and 143.15 + 18.77 pg/ml (p < 0.05, t = 6.33), respectively) as compared to patients who received regional anesthesia.ConclusionsThere were confirmed the following advantages of the transversalis fascia plane block combined with the quadratus lumborum block (QLB + TFPB) via a single intramuscular injection: ease of use; adequate perioperative pain control as evidenced by the FLACC and VAS pain assessment scales; reduced perioperative use of opioid analgesics; shortening the length of hospital stay.

Analgesic effects of different concentrations of ropivacaine in transversalis fascia plane block during laparotomy

ObjectiveTo explore the analgesic effects of different concentrations of ropivacaine in transversalis fascia plane (TFP) block during laparotomy.MethodsNinety patients who underwent laparotomy admitted to our hospital from March 2019 to March 2020 were selected as the study subjects and were divided equally into a low concentration group, a medium concentration group, and a high concentration group according to the randomized grouping method. The low concentration group adopted 0.4% ropivacaine 40 ml, the medium concentration group was given 0.5% ropivacaine 40 ml, and the high concentration group was given 0.6% ropivacaine 40 ml. The hemodynamic indexes and the incidence of adverse reactions in the two groups were compared. The Numerical Rating Scale (NRS) was used to assess the postoperative pain in the three groups, the Bruggrmann comfort scale (BCS) was used to assess the comfort level in the three groups, and the Mini-mental State Examination (MMSE) was used to evaluate the postoperative cognitive function of the three groups of patients.ResultsThe mean artery pressure (MAP) and heart rate (HR) levels at T1 and T2 were significantly lower in the medium concentration group than in the other two groups (P < 0.05). The low concentration group had a significantly higher NRS score at T2 than the medium concentration group and the high concentration group (P < 0.05). A significantly higher BCS score was observed in the high concentration group than the other two groups (P < 0.05). There were significantly higher Ramsay scores and MMSE scores in the medium concentration group than in the low concentration and high concentration groups (P < 0.05). The overall incidence of adverse reactions of the high concentration group was significantly higher than that of the low concentration group (P < 0.05), but showed similar results with the medium concentration group.ConclusionThe medium concentration group exhibits a better analgesic effect than the low concentration group and higher safety than the high concentration group. Therefore, the use of medium concentration ropivacaine in TFP block may provide a referential basis for clinical treatment.

Ultrasound-guided transversalis fascia plane block versus wound infiltration for both acute and chronic post-caesarean pain management - A randomised controlled trial.

Background and Aims:Ultrasound-guided transversalis fascia plane block (USG-guided TFPB) has recently been evaluated for post-caesarean acute pain management. We compared it with standard wound infiltration for both acute and chronic post-caesarean pain management.Methods:All patients undergoing caesarean section (CS) under subarachnoid block were included and randomised. Patients in group C received standard wound infiltration (20 ml of 0.375% ropivacaine) and group-T received bilateral USG-guided TFPB (20 ml of 0.375% ropivacaine) at the end of the surgery. Acute pain assessed using numeric rating scale (NRS), time to first request of analgesia and total rescue analgesic consumption in 24 hours. The incidence of chronic persistent post-surgical pain (CPSP), neuropathic pain component and quality of life (QoL) were assessed. Fisher’s exact test, Chi-square test, unpaired Student’s t-test and Mann-Whitney U test were used.Results:Sixty patients were included with 30 in each group. NRS score on rest at 6th and 24th hour and on active movement at 1st hour was significantly decreased in group T. The “time to first request of analgesia” was statistically higher in group T, that is, 10.77 ± 1.39 h versus 6.30 ± 1.60 h. Five (16.6%) and two (6.6%) patients in groups C and T, respectively, required rescue analgesia in first 24 hours. 30% (n = 6) and 10% (n = 2) patients in groups C and T, respectively, developed CPSP. The neuropathic pain component was significantly reduced and QoL was significantly improved in group T.Conclusion:TFPB is efficacious for management of both acute and chronic post-caesarean pain management.

Efficacy of ultrasound-guided transversalis fascia plane block in pediatric ureteroneocystostomy surgery.

Efficacy of ultrasound-guided transversalis fascia plane block in pediatric ureteroneocystostomy surgery.

The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials.

ObjectiveCesarean section (CS) is one of the most frequently performed major surgical interventions. Local anesthetic techniques, a universal component of perioperative multimodal analgesia, are reportedly effective in reducing pain scores and opioid requirements. However, the optimal local anesthetic technique for postoperative CS pain remains unclear.MethodsSix databases were searched, and a Bayesian network meta-analysis was performed. The outcomes included cumulative morphine consumption and pain scores at four time points, time to first analgesic request, postoperative nausea and vomiting, pruritus, and sedation.ResultsSixty-eight studies with 5039 pregnant women were included. Six local anesthetic techniques were involved, including transversus abdominis plane block (TAPB), ilioinguinal and iliohypogastric nerve block, quadratus lumborum blocks, transversalis fascia plane block, erector spinae block, and wound infiltration. Compared to inactive controls, TAPB reduced cumulative morphine consumption at 6, 12, 24, and 48 h, pain scores at 6, 12, and 24 h (with the exception of 24 h at rest), the risk of postoperative nausea and vomiting, and sedation. Compared with inactive controls, ilioinguinal and iliohypogastric nerve block reduced cumulative morphine consumption at 6 and 24 h and pain scores at 6, 12, and 24 h during movement. Compared with inactive controls, quadratus lumborum blocks reduced cumulative morphine consumption at 24 and 48 h and pain scores at 6 and 12 h and lengthened the time to first analgesic request. Compared with inactive controls, wound infiltration reduced cumulative morphine consumption at 12 and 24 h, pain scores at 12 and 24 h during movement, and risk of sedation. Compared with inactive controls, erector spinae block reduced pain scores at 6 and 12 h. Transversalis fascia plane block was found to have similar outcomes to inactive controls.ConclusionTAPB is the most comprehensive local anesthetic technique for postoperative CS analgesia in the absence of intrathecal morphine.

Ultrasound-guided transversalis fascia plane block versus transmuscular quadratus lumborum block for post-operative analgesia in inguinal hernia repair.

BackgroundInguinal hernia repair is one of the most commonly performed surgical procedures. Regional blocks might provide excellent analgesia and reduce complications in the postoperative period. We aimed to compare the postoperative analgesic effect of the ultrasound-guided transversalis fascia (TF) plane block versus the transmuscular quadratus lumborum (QL) block in patients undergoing unilateral inguinal hernia repair.MethodsFifty patients enrolled in this comparative study and were randomly assigned into two equal groups. One group received an ultrasound-guided QL block. In comparison, the other group received an ultrasound-guided TF plane block. The primary outcome was the patient-assessed resting, and movement-induced pain on the numeric pain rating scale (NRS) measured at 30 minutes postoperatively. Secondary outcomes included the percentage of patients receiving rescue analgesia in the first postoperative day, ease of performance of the technique, and incidence of adverse effects.ResultsThere were no statistically significant differences in NRS at rest and with movement between the groups over the first 24 hours postoperatively. The proportion of patients that received postoperative rescue analgesics during the first 30 minutes postoperatively was 4% (n = 1) in the QL group compared to 12% (n = 3) in the TF group. However, the mean performance time of the TF block was shorter than that of the QL block, and the performance of the TF block appeared easier technically.ConclusionsThe ultrasound-guided TF plane block could be as effective as the QL block in lowering pain scores and decreasing opioid consumption following non-recurrent inguinal herniorrhaphy.