The Effect of Ultrasound-guided TAPB on Pain Management after Total Abdominal Hysterectomy
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background:Incisional pain is particularly troublesome after hysterectomy. A method called transversus abdominis plane block (TAPB) has shown promise in managing postoperative pain. In this study, we evaluated the analgesic efficacy of ultrasound-guided TAPB after hysterectomy at different time points and at each time point separately for 48 hours.Methods:Forty-two patients (ASA I, II) who were electively chosen to undergo total abdominal hysterectomy were divided into 2 groups, control (group C) and intervention (group I). Twenty-one patients underwent TAPB (group I) and 21 patients received only the standard treatment with a fentanyl pump (group C). Both groups received standard general anesthesia. For patients in group I, following the surgery and before emergence from anesthesia, 0.5 mg/kg of ropivacaine 0.2% (about 20 cc) was injected bilaterally between the internal oblique and transverse abdominis muscles using sonography. Pain scores using the Visual Analogue Scale (VAS) and drug consumption were measured at 2, 6, 12, 24, and 48 hours after TAPB.Results:There were no significant differences in demographics between the two groups. VAS scores appeared to be lower in group I, although there was no interaction with time when we compared mean VAS measurements at different time points between group I and group C (P ＞ 0.05). The amount of fentanyl flow was consistently higher in group C, but when we compared the two groups at each time point separately, the observed difference was not statistically significant (P ＜ 0.053). The incidence of vomiting was 10% in group I and 28% in group C. There were no complaints of itching, and sedation score was 0 to 3. There were no complications. Conclusions:This study showed that TAPB did not result in a statistically significant decrease in VAS scores at different time points. TAPB did lead to decreased fentanyl flow, but when we compared the two groups at each time point separately, the observed difference was not statistically significant.
Abstract
Background:Incisional pain is particularly troublesome after hysterectomy. A method called transversus abdominis plane block (TAPB) has shown promise in managing postoperative pain. In this study, we evaluated the analgesic efficacy of ultrasound-guided TAPB after hysterectomy at different time points and at each time point separately for 48 hours.Methods:Forty-two patients (ASA I, II) who were electively chosen to undergo total abdominal hysterectomy were divided into 2 groups, control (group C) and intervention (group I). Twenty-one patients underwent TAPB (group I) and 21 patients received only the standard treatment with a fentanyl pump (group C). Both groups received standard general anesthesia. For patients in group I, following the surgery and before emergence from anesthesia, 0.5 mg/kg of ropivacaine 0.2% (about 20 cc) was injected bilaterally between the internal oblique and transverse abdominis muscles using sonography. Pain scores using the Visual Analogue Scale (VAS) and drug consumption were measured at 2, 6, 12, 24, and 48 hours after TAPB.Results:There were no significant differences in demographics between the two groups. VAS scores appeared to be lower in group I, although there was no interaction with time when we compared mean VAS measurements at different time points between group I and group C (P ＞ 0.05). The amount of fentanyl flow was consistently higher in group C, but when we compared the two groups at each time point separately, the observed difference was not statistically significant (P ＜ 0.053). The incidence of vomiting was 10% in group I and 28% in group C. There were no complaints of itching, and sedation score was 0 to 3. There were no complications. Conclusions:This study showed that TAPB did not result in a statistically significant decrease in VAS scores at different time points. TAPB did lead to decreased fentanyl flow, but when we compared the two groups at each time point separately, the observed difference was not statistically significant.
참고문헌 (18)
- Stanley G, "Dose requirements, efficacy and side effects of morphine and pethidine delivered by patient-controlled analgesia after gynaecological surgery", Br J Anaesth, 76, pp.484~486 (1996)
- Woodhouse A, "The effect of duration of dose delivery with patient-controlled analgesia on the incidence of nausea and vomiting after hysterectomy", Br J Clin Pharmacol, 45, pp.57~62 (1998)
- Ng A, "The analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine after total abdominal hysterectomy", Anesth Analg, 95, pp.158~162 (2002)
- Netter FH, "Back and spinal cord, In Atlas of human anatomy", pp.145~155 (1989), Ciba-Geigy Corporation
- McDonnell JG, "The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial", Anesth Analg, 104, pp.193~197 (2007)
- McDonnell JG, "The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial", Anesth Analg, 106, pp.186~191 (2008)
- O'Donnell BD, "The transversus abdominis plane (TAP) block in open retropubic prostatectomy", Reg Anesth Pain Med, 31, pp.91~ (2006)
- Carney J, "The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy", Anesth Analg, 107, pp.2056~2060 (2008)
- Shibata Y, "Transversus abdominis plane block", Anesth Analg, 105, pp.883~ (2007)
- McDonnell JG, "Transversus abdominis plane block: a cadaveric and radiological evaluation", Reg Anesth Pain Med, 32, pp.399~404 (2007)
- Russon K, "Ultrasound-guided transversus abdominal plane block, In Ultrasound guided regional anesthesia and pain medicine", pp.93~96 (2010), Lippincott Williams & Wilkins Health
- Rafi AN, "Abdominal field block: a new approach via the lumbar triangle", Anaesthesia, 56, pp.1024~1026 (2001)
- Hebbard P, "Subcostal transversus abdominis plane block under ultrasound guidance", Anesth Analg, 106, pp.674~675 (2008)
- Niraj G, "Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery", Anaesthesia, 66, pp.465~471 (2011)
- Mokini Z, "Transverse abdominal plexus block, In The flying publisher guide to ultrasound blocks for the anterior abdominal wall: principles and implementation for adult and pediatric surgery", pp.35~ (2011), Flying Publisher
- Kanazi GE, "The analgesic efficacy of subarachnoid morphine in comparison with ultrasound-guided transversus abdominis plane block after cesarean delivery: a randomized controlled trial", Anesth Analg, 111, pp.475~481 (2010)
- Belavy D, "Ultrasoundguided transversus abdominis plane block for analgesia after caesarean delivery", Br J Anaesth, 103, pp.726~730 (2009)
- El Bayoumy R, "Trans-abdominal plane (TAP) block analgesia in day case laparoscopic cholecystectomy - a prospective study: 14AP12-6", Eur J Anaesth, 27, pp.222~ (2010)