Article

Transversus abdominis plane block reduces postoperative pain intensity and analgesic consumption in elective cesarean delivery under general anesthesia

Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran.
Journal of Anesthesia (Impact Factor: 1.18). 02/2012; 26(3):334-8. DOI: 10.1007/s00540-012-1336-3
Source: PubMed

ABSTRACT

It is reported that following abdominal surgery, transversus abdominis plane (TAP) block can reduce postoperative pain. The primary outcome of this study was the evaluation of the efficacy of TAP block on pain intensity following cesarean delivery with Pfannenstiel incision.
Fifty pregnant women were randomized blindly to receive either a TAP block with 15 ml 0.25% bupivacaine in both sides (group T, n = 25) or no blockade (group C, n = 25) at the end of the surgery, which was performed with a Pfannenstiel incision under general anesthesia. The pain intensity in the patients was assessed by a blinded investigator at the time of discharge from recovery and at 6, 12, and 24 h postoperatively, with a visual analogue scale (VAS) for pain.
The women in the TAP block group had significantly lower VAS pain scores at rest and during coughing and consumed significantly less tramadol than the women in group C [50 mg (0-150) vs. 250 mg (0-400), P = 0.001]. There was a significantly longer time to the first request for analgesic in the TAP block group [210 min (0-300) vs. 30 min (10-180) in group C, P = 0.0001].
Two-sided TAP block with 0.25% bupivacaine in parturients who undergo cesarean section with a Pfannenstiel incision under general anesthesia can decrease postoperative pain and analgesic consumption. The time to the first analgesic rescue was longer in the parturients who received the TAP block.

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    • "Randomized double - blind trial 5 Eslamian et al . , 2012 26 50 Bilateral TAP in cesarean with general anesthesia TAP vs . no TAP VAS pain score at rest and in movement in the first 24 h"
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    ABSTRACT: Justificativa O bloqueio do plano transverso abdominal (TAP) é um bloqueio da parede abdominal que se difundiu rapidamente na prática clínica como parte de analgesia multimodal em cirurgia abdominal. A técnica ecoguiada permitiu reduzir as possíveis complicações, assim como as novas abordagens, que, de acordo com as descrições feitas e os estudos prospectivos, permitiram usar o TAP em vários procedimentos cirúrgicos; no entanto, os resultados obtidos em ensaios clínicos randomizados (ECR) são inconsistentes. Objetivos Revisão sistemática para determinar a eficácia analgésica do TAP ecoguiado em diversos procedimentos cirúrgicos, assim como determinar as indicações de acordo com abordagens e sua influência. Métodos Foi feita uma pesquisa no PubMed e outra livre e foram encontrados 28 ECR em que intervenção com o TAP ecoguiado era feita e se comparava sua eficácia analgésica com outra técnica em humanos adultos, publicados entre 2007 e outubro de 2013 com escore de Jadad > 1, em inglês ou espanhol, de acordo com os critérios de inclusão para esta revisão. Todos os ECR foram analisados de forma independente pelos autores. Conclusões O TAP mostrou ser uma técnica eficaz em cirurgia colorretal, cesárea, colecistectomia, histerectomia, apendicectomia, nefrectomia em doador, prostatectomia retropúbica e cirurgia bariátrica. No entanto, os dados encontrados nos ECR são inconclusivos, de modo que mais ECR bem desenhados são necessários e com poder estatístico suficiente na comparação de diferentes abordagens, drogas, doses e volumes para uma mesma intervenção, a fim de resolver os temas da atualidade e seu impacto na prática clínica habitual.
    Full-text · Article · Oct 2014
    • "Intravenous dexmedetomidine has been particularly beneficial because of its opioid sparing effect and the lack of respiratory depression.[45] Transversus abdominis plane block has shown to reduce the postoperative pain intensity and analgesic consumption after elective caesarean delivery in non-obese parturients.[46] However, further trials are warranted before its use in parturients with OSA. "
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    ABSTRACT: Obstructive sleep apnea (OSA) is characterized by upper airway collapse and obstruction during sleep. It is estimated to affect nearly 5% of the general female population. Obesity is often associated with OSA. The physiological changes associated with pregnancy may increase the severity of OSA with a higher risk of maternal and fetal morbidity. However, very few parturients are diagnosed during pregnancy. These undiagnosed parturients pose great challenge to the attending anaesthesiologist during the perioperative period. Parturients at risk should be screened for OSA, and if diagnosed, treated. This review describes the anaesthetic concerns in obese parturients at risk for OSA presenting to the labor and delivery unit.
    No preview · Article · Oct 2012 · Journal of Anaesthesiology Clinical Pharmacology
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    ABSTRACT: La césarienne concerne un grand nombre de patientes et de structures de soins. Grâce aux évolutions de la technique chirurgicale et du blocage efficace des afférences grâce à l’emploi de l’anesthésie locorégionale, l’agression tissulaire que représente la césarienne est bien moins importante qu’il y a quelques années encore. On peut même aujourd’hui considérer la césarienne comme une intervention chirurgicale mineure. Plus que dans d’autres domaines de la chirurgie, la restauration rapide de l’état physiologique est primordiale en raison de la création des liens mèreenfant. Pour restaurer le fonctionnement physiologique et accélérer le retour rapide à une vie normale, plusieurs actions sont possibles et méritent d’être mises en place rapidement dans toutes les structures. La limitation des soins invasifs (sonde urinaire, perfusion intraveineuse) représente le premier moyen simple. Ceci se traduit par une reprise précoce des boissons et de l’alimentation, tout en assurant une analgésie multimodale adéquate afin de réduire le recours aux antalgiques morphiniques et donc leurs effets secondaires. Prévenir de façon simple et efficace les hémorragies du postpartum grâce à l’administration d’une dose unique d’un ocytocique de longue durée d’action participe à la stratégie visant à raccourcir la durée du maintien de la voie veineuse.
    No preview · Article · Sep 2012 · Revue de médecine périnatale
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