Postoperative Analgesic Efficiency Of Ultrasound Guided Transversus Abdominis Plane Block Using Different Concentrations Of Bupivacaine In Inguinal Hernia Repair

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Download or read book Comparison Of Ultrasound Guided Transversus Abdominis Plane Block And Quadratus Lumborum Block For Postoperative Pain In Cesarean Section written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Comparison of ultrasound guided transversus abdominis plane block and quadratus lumborum block for postoperative pain in cesarean section: A prospective, randomized-controlled studyU Caglayan1, C Yilmaz1, D Karasu1, SE Ozgunay1, F Ata1, S Cansabuncu11 University of Health Sciences Bursa Yuksek Ihtisas Training and Education Hospital Departmentt of Anesthesiology and Reanimation, Bursa,TurkeyIntroductionNeuroaxial anesthesia methods are preferred In cesarean section. General anesthesia is performed when the regional anesthesia is contraindicated or when the patient does not want regional anesthesia. Effective analgesia after cesarean section is important for faster recovery and prevention complications.Transversus abdominis plane block (TAP) and Quadratus lumborum block (QL) are used for postoperative analgesia in lower and upper abdominal surgeons (1-4). However, studies comparing the analgesic efficacy of truncal blocks after cesarean section under general anesthesia are inadequate.The aim of this study is to compare the postoperative analgesic efficacy of TAP Block and QL Block administered by ultrasound (US) guidance under the general anesthesia for cesarean section.Materials and MethodsThe study protocol was approved by the Local Ethics Committee and Australian New Zealand Clinical Trials Registry (Ref: ACTRN12617000842369). A written informed consent was obtained from each patient. The study was carried out in accordance with The Code of Ethics of the Declaration of Helsinki. 99 pregnant women aged 18-49 years who refused or contraindicated to regional anesthesia were included in study. In this prospective, randomized, and double blinded study, patients that scheduled for elective cesarean section, were randomly allocated in two groups (Group TAP n=49, Group QL n=50). Standard monitorization and general anesthesia was performed. After surgery was completed, TAP or lateral QL Block (QL1 Block) was applied bilaterally with US guidance.All patients received tenoxicam (20 mg) iv as a multimodal analgesic component. Patient-controlled analgesia (PCA) pump was used for all patients (no loading dose, 25 mg tramadol bolus, 20 minutes of lock out time). The severity of postoperative pain was measured by VAS scale (0=no pain, 10=the worst possible pain). Patients were asked to score the pain at different times after the operation, both at rest and during coughing, 0. 2. 6. 12. and 24 h later. ResultsDemographics, intraoperative hemodynamic changes, duration of surgery and intraoperative fentanyl consumption were similar in both groups (p>0,05). Duration of anesthesia was statistically longer in the Group QL (p=0.044). Primary Outcomes Total tramadol consumption was 227u00b197 mg in Group TAP and 166u00b1101 mg in Group QL (p=0.003). However, no significant difference was found statistically regarding to demand of rescue analgesics (p=0.876). First analgesic administration with PCA was later in Group QL (0,43u00b10,76h vs 1,74u00b12,36 h, p0,001). VAS scores at rest and movement were found in Table 1-2.Secondary OutcomestThere was no statistically significant difference between groups in terms of postoperative side effects (p 0,05). Patient satisfaction in Group QL was significantly higher (p = 0.013).Table 1: Resting VAS scores according to groups VAStGroup TAP (n=49)tGroup QL (n=50)tp0th h#t2,65 u00b11,01t2,00u00b10,96t0,001*2nd h#t1,53u00b10,64t1,18 u00b10,69t0,011*6th h#t1,35 u00b10,72t0,94u00b10,62t0,003*12th h#t1,57 u00b10,76t1,30u00b10,78t0,08524th h#t0,94u00b10,45t0,70u00b10,54t0,022*VAS: Visual Analog scale #: Meanu00b1Standard Deviation, *p