Clinical Trial Of Ultrasound-guided Transversus Abdominis Plane(TAP) Block For Postoperative Analgesia Of Abdominal Sugery

Part 1 Analgesic efficacy of adding dexamethasone to the transversus abdominis plane block after laparoscopic cholecystectomy—a randomized and control studyObjective Ultrasound-guided transversus abdominis plane(TAP)block is an adjunct therapy to provide effective postoperative analgesia in abdominal surgical procedures;dexamethasone is a supplement agent that can improve the efficacy of local anesthetic in previous reports.However,information about its additive effect is limited.This study was aimed to compare the analgesic efficiency using ultrasound-guided TAP block with and without perineural dexamethasone for patients who underwent laparoscopic cholecystectomy.Methods Sixty patients who underwent laparoscopic cholecystectomy were randomly divided into three groups: group I,control group;group ?,TAP block group;and group ?,TAP + perineural dexamethasone supplement.The requirement of additional analgesic and the first-time request of rescue-analgesia were recorded after operation and the numerical rating scale(NRS)was evaluated at specific intervals.Results Compared to group I,the first-time requirement of rescue-analgesia in groups ? and ? was significantly delayed(P ? 0.01).Compared with those in group I,patients in groups ? and ? were associated with lower NRS pain scores(P ? 0.01)and less postoperative paracoxib consumption(P ? 0.01).There was no significant difference in the variables mentioned above between groups ? and ?(P > 0.05).Conclusion Perineural dexamethasone has no additive/synergistic effect with subcostal TAP block on analgesic efficacy for the patients undergoing laparoscopic cholecystectomy.Part 2 Analgesic efficacy of trocar sites local anesthetic infiltration with and without transversus abdominis plane block after laparoscopic hysterectomy: a randomized and control trialObjective In gynecologic laparoscopic procedures,both the transversus abdominis plane(TAP)block and local analgesic(LA)infiltration of trocar insertion sites were suggested as components of multimodal approach for postoperative analgesia,and their effects were controversial;up to now,there is limited data for outcome of combination of these 2 approaches and either regimen alone.The aim of this prospective study was to compare the analgesic efficiency of trocar sites LA infiltration with and without TAP block.Methods Seventy-one women who underwent laparoscopic hysterectomy were randomly divided into 2 groups: the TAP group(n = 35,performed with TAP block after tracheal intubation)and the control group(n = 36).All subjects had trocar sites LA infiltration before closure of trocar incision and were managed with multimodal analgesia postoperatively.NRS was used to evaluate the pain relief and to record additional analgesic usage;other outcomes such as length of stay,adverse effects,and satisfaction scores were also assessed.Results The 2 groups had comparable demographic information.Patients in the TAP group had significantly lower NRS compared with those in the control group(P ? 0.05);reduced postoperative analgesics requirement was also shown(parecoxib requirement of 60-80 mg: 11 cases vs.34 cases,P ? 0.01;sufentanil supplementation: 3 case vs.10 cases,P ? 0.05).In addition,satisfaction scores were significantly satisfactory in the TAP block group(Z = 1.61,P ? 0.01)and comparable results were shown in length of stay and adverse effects between the 2 groups(P > 0.05).Conclusion After laparoscopic hysterectomy,conjunction of TAP block and trocar sites LA infiltration may be a better analgesic regimen compared to the latter alone.Part 3 Analgesic efficiency of different concentration of ropivacaine applied in transversus abdominis plane block after laparoscopic cholecystectomy-A randomized and control studyObjective As component of multimodal analgesia,ultrasound-guided subcostal transversus abdominis plane block(TAP)has been used for postoperative analgesia in patients undergoing the laparoscopic cholecystectomy(LC),and is thought of good clinical outcome.Also,as widely used local anesthetic(LA),ropicacaine has been used in different concentration for TAP block.However,there is short of clinical standard for its effectively minimum dose and concentration.In this study,based on previous research,different concentration of ropivacaine is adopted to compare their analgesic efficacy,overall rehabilitation,and relative adverse effects after LC.Methods 60 patients schedured to undergo the LC were divided into two groups according to the computer generation,they were recivieing the bilateral TAP block in different concentration(Group R 0.25% / Group R 0.375%).Total intravenous anesthesia(TIVA)was adopted to all patients,and target controlled infusion(TCI)ran through the anesthetic induction and intraoperative maintance.Between the period of stable vital signs of tracheal intubation and surgical incision,a skilled anesthesiologist performed the bilateral subcostal TAP block under ultrasound guidance.Till the needle tip reached the TAP,based on dose of 0.5ml per kilogram,different concentration of ropivacaine was injected into the plane after gentle aspiration.After operation,all patients were given sulfentanil to maintain the pain relief.In case of complaining of pain in postanesthetic care unit and surgical ward,the patient was injected additional analgesic,from parocoxib to sulfentanil.Afterwards,the following aspects were recorded to all patients: the first time to receive the additional analgesic,total dose of opioids and paroxib during the perioperative time,scores of numeric rating scale(NRS)at different intervals,and relative adverse effects.Results For patients receiving the the bilateral TAP block at different concentration of ropivacaine,there is no evident difference in analgesic efficacy and relative adverse effects(P > 0.05).Conclusion After LC,based on dose of 0.5ml per kilogram,analgesic efficiency of ropivacaine is comparable by two different concentration.Thus the lower concentration of ropivacaine is recommended in order to performe the safer TAP block.Part 4 Analgesia Efficacy of continous transversus abdominis plane block and plasma ropivacaine concentrations after transabdominal hysterectomy – a randomized and control studyObjective To investigate the effects of transversus abdominis plane block on postoperative analgesia and recovery in patients undergoing transabdominal hysterectomy(TAH)and detect the venous plasma concentrations of ropivacaine at the period of continuous TAP infusion.Methods 40 patients undergoing TAH with general anesthesia were randomly divided into two groups: 21 patients received ultrasound-guided bilateral transversus abdominis plane(TAP)block and continuous infusion through catheters(CTAP group)after operation,and 19 patients received patient-controlled intravenous analgesia(PCIA,PCIA group).A TAP infusion of 0.2% ropivacaine was administered for 72 h after operation.Data collection included morphine consumption,pain scores,and plasma ropivacaine levels during this period;recovery time of bowel function,length of hospital stay and patient satisfaction were also evaluated.Results Patients in the CTAP group had the lower VAS compared to the patients in the PCIA group(P ? 0.05),with the reduced consumption of additional morphine posoperatively(P = 0.03).Beside that,recovery time of bowel function,incidence of postoperative nausea and vomiting(PONV),and the Satisfaction score also had statistically different between the two grous(P ? 0.05).There was no subject going through the neurological symptoms attributed to LA toxicity in the CTAP group.plasma ropivacaine concentration rose up rapidly after the initial bolus of the TAP block,Thereafter,there is a second phase of more gradual increase in total plasma ropivacaine concentration.The mean peak total ropivacaine for TAP infusions was 2.56mg/L(SD 0.35),which was reached at the 48 h time point.The scope of total plasma ropivacaine concentrations was 0.93-3.20mg/L.The mean(SD)peak plasma concentration of unbound ropivacaine for infusions was 0.065mg/L(SD 0.023),which occurred at the 24 h time point.Conclusion After TAH,continuous TAP block can alleviate the postoperative pain,reduce opioid consumption and the incidence of PONV,shorten the period of intestinal function recovery,and increase satisfaction of patients.As the potential of high plasma concentrations from a bilateral infusion technique,attention should be paid to individualized dosing project.Further studies related to safety and efficacy of this technique are justified.