Search Results (43)

Introduction: The management of peri-operative pain significantly impacts the post-operative recovery following kidney transplant. For decades, regional blocks have been utilized for post-operative pain management following abdominal surgery. The data on the routine use of regional blocks peri-operatively during kidney transplants are limited. We aim to review our current clinical practice of peri-operative use of regional blocks during kidney transplants and management of peri-operative pain up to 24 h. Methods: A consecutive series of 100 patients who underwent kidney transplant was reviewed. All demographic data including patient’s age, gender, race, and body mass index were collected. Pre-transplant co-morbidities were summarized for all patients and included the American Society of Anesthesiologists (ASA) score. Patients were divided into two groups based on whether they received a transversus abdominis plane (TAP) block. Group A consisted of patients who received an ultrasound-guided TAP block, while Group B included patients who did not receive any form of TAP block. The intra-operative and post-operative use of analgesia was recorded for up to 24 h post kidney transplant. All peri-operative complications were reviewed. The chi-square test and Fisher’s exact test was used to compare symptoms (nausea, vomiting, and pruritus) between the two groups. Similarly, the use of analgesia was also compared. Results: A total of 100 patients were identified and equally distributed between the two groups [Group A = 50 (TAP block), Group B = 50 (non-TAP block)]. There was a statistically significant reduction in the use of intraoperative fentanyl (p = 0.04) in Group A. There was no difference in the post-operative use of hydromorphone (p = 0.665), oxycodone (p = 0.75), and acetaminophen (p = 0.64) up to 24 h after the kidney transplant procedure. There was no difference between post-operative nausea (p = 0.766), vomiting (p = 0.436), and pruritus. There were no complications recorded secondary to the use of regional blocks in Group A. Conclusions: The use of regional anesthesia in kidney transplant recipients is a safe approach without complications. The study concluded that regional blocks decrease the use of intra-operative opioids. However, there was no difference in the use of post-operative requirements for analgesia or side effects up to 24 h after kidney transplant. Full article

Background/Objectives: Laparoscopic appendectomy (LsA) is a standard acute surgical procedure typically performed under general anesthesia (GA). However, GA is associated with side effects such as hemodynamic instability and postoperative nausea/vomiting. Regional anesthesia (RA) has gained attention as an effective alternative in such surgeries, as it reduces surgical stress responses, provides adequate postoperative analgesia, and promotes early mobilization. This study evaluates the effectiveness of the combined use of spinal anesthesia (SA) and transversus abdominis plane block (TAPB) in LsA procedures. Methods: This retrospective observational study included 220 patients who underwent LsA between 2020 and 2023. Patients were divided into two groups: Group 1 (n = 110) received bilateral TAPB, and Group 2 (n = 110) received unilateral TAPB, both under SA. Postoperative pain was assessed using the Visual Analog Scale (VAS), and outcomes such as time to first analgesic requirement, analgesic consumption, and patient satisfaction were recorded. Results: This study evaluated the effects of SA combined with TAPB in LsA. Bilateral TAPB significantly prolonged the time to first analgesic request (13.7 vs. 12.1 h; p = 0.001) and reduced analgesic requirements (p = 0.008) compared to unilateral TAPB. VAS scores were significantly lower in Group 1 at the 9th and 12th hours postoperatively (p = 0.003 and p = 0.039). Although overall satisfaction scores were similar, a higher proportion of patients in Group 1 reported being “very satisfied” or “excellent” (55.5% vs. 42.7%). Conclusions: The combination of spinal anesthesia and bilateral TAPB is a safe and effective anesthetic strategy for LsA. Compared to unilateral TAPB, it offers superior postoperative analgesia and improved patient satisfaction. Full article

Background and Objectives: Extensive research has demonstrated that various approaches to the quadratus lumborum (QL) block offer superior postoperative analgesia compared to the transversus abdominis plane (TAP) block, particularly in reducing opioid consumption. This study aims to compare postoperative analgesia between the blocks in laparoscopic colorectal surgery. Materials and Methods: A retrospective analysis was performed on patients with elective colorectal surgeries who received bilateral US TAP blocks in the supine position or US anterior QL block in the lateral position at the end of the surgery and before extubating, with Ropivacaine 0.25%. Total opioid consumption and time to first intravenous analgesic were noted. Results: Between January 2020 and December 2024, 410 patients underwent elective laparoscopic colorectal oncology surgery under general anesthesia, with peripheral nerve blocks. Of these, we analyzed 116 patients with localized diseases who underwent elective surgeries and who did not require conversion to classical surgery and received either QL or TAP blocks. A total of 62 patients underwent QL block and 54 received TAP block. For the primary outcome, in the QL group, significantly fewer opioids were used than in the TAP group (p < 0.001), and time to first rescue analgesic was prolonged in the QL group at 16 h (IQR 14–18) compared to the TAP group, where the requirement occurred earlier at 8 h (IQR 8–8) postoperatively (p < 0.001). Conclusions: Postoperative bilateral US anterior QL block reduced morphine consumption and improved time to rescue analgesia and LOS compared with midaxillary line bilateral US TAP block. Full article

Effective postoperative pain management is crucial for optimizing recovery and clinical outcomes in living donor kidney transplantation (LDKT). This retrospective study compared the efficacy and safety of transversus abdominis plane (TAP) block and local wound infiltration (LWI) for postoperative analgesia. A total of 524 LDKT recipients, matched through propensity scoring, were analyzed (262 per group). Pain intensity was assessed using the visual analog scale (VAS) at multiple postoperative time points, while opioid consumption was evaluated based on intravenous patient-controlled analgesia (IV-PCA) usage and rescue fentanyl doses. The TAP block group had significantly lower VAS pain scores at 1, 4, and 8 h postoperatively (p < 0.001) and required fewer opioids, as evidenced by reduced IV-PCA usage (55.9 ± 10.2 mL vs. 69.7 ± 18.2 mL; p < 0.001) and lower rescue fentanyl doses (67.7 ± 30.6 µg vs. 119.1 ± 71.8 µg; p < 0.001). Despite these differences in analgesic efficacy, no significant differences were observed between the groups in terms of postoperative nausea and vomiting or complications such as systemic toxicity and nerve injury. These findings suggest that the TAP block provides more effective early postoperative pain relief and reduces opioid requirements without increasing adverse events. Given its favorable safety profile and effectiveness, the TAP block is a valuable component of multimodal analgesia in LDKT recipients, supporting enhanced recovery while minimizing opioid-related complications. Full article

Background and goal of study: The aim of this double-blind randomized study was to investigate the efficacy of dexmedetomidine as an adjuvant to the local anesthetic in transversus abdominis plane (TAP) block for unilateral inguinal hernioplasty. Materials and Methods: Eighty eligible patients were randomly allocated into ultrasound-guided TAP block with either dexmedetomidine 0.5 mcg/kg diluted to a volume of 2 mL and ropivacaine 0.5% 25 mL (DR group) or ropivacaine 0.5% 25 mL and normal saline 2 mL (R group). The primary endpoint of this study was the numeric rating scale (NRS) score during coughing 24 h postoperatively. Secondary parameters were also evaluated. Results: Patients in the RD group demonstrated significantly less pain at rest three, six and 12 h postoperatively as compared to patients in the R group (p = 0.002, 0.032 and 0.049, respectively). Significant differences between the two groups were also demonstrated for NRS scores during coughing at 3, 6 and 12 h postoperatively (p = 0.013, 0.035 and 0.042, respectively). Additionally, the RD group demonstrated lower intraoperative remifentanil consumption (p < 0.001), lower PACU morphine requirement (p = 0.012) and lower overall PCA morphine requirement postoperatively (p < 0.001). Sedation scores, the incidence of hypotension, bradycardia and the occurrence of postoperative nausea and vomiting were no different between the two groups. Finally, the incidence of chronic pain at 6 months was significantly lower in the RD group compared to the R group (5.55% vs. 25%, p = 0.049). Conclusions: Dexmedetomidine as an adjuvant to ropivacaine reduces postoperative pain scores, has opioid-sparing effects and is associated with a favorable effect on chronic pain without side effects in patients subjected to TAP block for inguinal hernia repair. Full article

Laparoscopic surgery reduces tissue trauma and accelerates recovery, but postoperative pain remains a concern. Opioids are effective but have adverse effects, highlighting the need for multimodal analgesia. Nefopam, a non-opioid analgesic, provides pain relief without respiratory depression or dependence. This study aims to investigate the efficacy of intravenous nefopam combined with a transversus abdominis plane (TAP) block in living liver donors undergoing laparoscopic hepatectomy. This retrospective cohort analysis was conducted on 452 adult living donors who underwent laparoscopic hepatectomy with a TAP block between August 2013 and August 2018 at a single tertiary medical center. After propensity score matching, 296 patients were included, with 148 in the nefopam group and 148 in the non-nefopam group. The primary outcomes assessed were pain scores using the Numeric Rating Scale (NRS) at 1, 4, 8, 12, and 24 h postoperatively, opioid consumption, postoperative nausea and vomiting, and nefopam-related adverse effects. Nefopam significantly reduced NRS at 1, 4, and 8 h postoperatively (p < 0.001) and decreased fentanyl use in the post-anesthesia care unit (26.0 ± 32.2 μg vs. 60.5 ± 37.9 μg, p < 0.001) and total intravenous patient-controlled analgesia volume (p < 0.001). The incidence of postoperative nausea and vomiting and severe opioid-related complications did not differ between groups. Nefopam-related side effects were mild and self-limiting. Nefopam combined with a TAP block effectively reduces postoperative pain and opioid consumption in living liver donors, supporting its role in multimodal analgesia. Further research is needed to explore its broader applications. Full article

Background/Objectives: Ropivacaine is primarily metabolized by the liver. High doses of ropivacaine, combined with altered pharmacokinetics due to hepatectomy, raise concerns about potential drug toxicity. We investigated the impact of LMH (laparoscopic major hepatectomy) on the pharmacokinetics of high-dose ropivacaine. Methods: Ten patients undergoing LMH received a BD-TAP (bilateral dual transversus abdominis plane) block with a high dose of ropivacaine (3 mg·kg⁻¹ in 60 mL). Plasma concentrations of total and free ropivacaine and AAG (alpha-1 acid glycoprotein) levels were measured. Liver volumes were calculated using three-dimensional liver reconstruction technology. Results: The peak total ropivacaine concentration occurred 45 min after the block, reaching 2031.5 (876.0) ng·mL⁻¹, with a tendency to exceed the toxicity threshold in patients with a CFLV (cut functional liver volume) exceeding 199.24 mL or a CFLV/TFLV (total functional liver volume) ratio surpassing 18.61%. The peak free ropivacaine concentration, 111.5 (31.3) ng·mL⁻¹, was observed 90 min after the block, potentially exceeding the toxicity threshold when CFLV exceeded 452.33 mL or the CFLV/TFLV ratio was greater than 42.16%. Plasma AAG levels increased approximately 1.5 times within 24 h, from 1519.7 (422.6) μg·mL⁻¹ preoperatively to 2253.6 (460.4) μg·mL⁻¹ postoperatively, effectively reducing the toxicity risk associated with free ropivacaine. Conclusions: Preoperative administration of high-dose ropivacaine can be safely utilized in patients undergoing major hepatectomy. The increased plasma AAG concentration due to surgical stress reduces free ropivacaine levels, enhancing patient tolerance to the drug. The CFLV and CFLV/TFLV ratio may be supplementary indicators for predicting ropivacaine toxicity. Full article

Background/Objectives: Due to post-surgical discomfort in kidney transplant recipients and donors as well as opioids’ multiple side effects, alternative analgesic methods are required in renal transplant surgeries. This study aimed to evaluate the analgesic effect of the transversus abdominis plane (TAP) block versus no-block controls in kidney transplantation patients. Methods: We conducted a meta-analysis with a trial sequential analysis (TSA) of randomized controlled trials (RCTs). We searched for relevant articles in PubMed, Scopus, and the Cochrane Library published before December 2023. Protocol registration: doi.org/10.17605/OSF.IO/PMZJ4. Results: A total of 11 RCTs were included in the meta-analysis. The TAP block group had lower pain intensity on postoperative day 1 (mean difference, MD = −0.65 [−0.88, −0.42]; p < 0.00001) than the control group. However, the heterogeneity among the included studies was considerable (I² = 93%). Subgroup meta-analysis and TSA revealed a significant pain reduction at 24 h postoperatively in donors (MD = −0.70 [−1.16, −0.24]; p = 0.003); heterogeneity was substantial (I² = 67%). The TAP block group also had lower overall morphine consumption within 24 h (MD = −4.82 [−7.87, −1.77]; p = 0.002) and cumulative 24 h morphine use (MD = −14.13 [−23.64, −4.63]; p = 0.004); however, heterogeneity was considerable (I² = 98% in both cases). The time to first analgesia (hours) was significantly longer in the TAP block group (MD = 5.92 h [3.63, 8.22]; p < 0.00001, n = 3). There was no significant difference between the groups in postoperative nausea and vomiting (risk ratio, RR = 0.91 [0.49, 1.71]; p = 0.78). Conclusions: TAP block can lower pain intensity and reduce morphine consumption on the first postoperative day in patients undergoing renal transplantation. Pain reduction is especially notable in the subgroup of donors, but the benefits reported are minimum and certainly not clinically relevant. Larger, well-powered RCTs are warranted to confirm these results and evaluate the effect of TAP block in the subgroup of recipients. Full article

Background: Effective pain management is essential to early extubation and recovery in living donor liver transplantation (LDLT). The subcostal transversus abdominis plane (TAP) block has emerged as a potential strategy to address postoperative pain while reducing opioid consumption. This study evaluated the effectiveness of the TAP block in facilitating early extubation in the OR and examined its impact on re-intubation rates, postoperative fentanyl requirements, and pain intensity upon ICU admission to determine its role in perioperative pain management. Methods: This retrospective cohort study included adult patients who underwent LDLT for hepatocellular carcinoma within the Milan criteria. Propensity score matching was performed to compare outcomes between patients who received the subcostal TAP block and those who did not. The primary outcome was the rate of successful extubation in the operating room (OR). Secondary outcomes included re-intubation rates, postoperative fentanyl requirements, and peak numeric rating scale (NRS) pain scores upon ICU admission. Results: The subcostal TAP block was associated with a significantly higher rate of successful OR extubation compared with no TAP block. Multivariable analysis revealed that the TAP block independently increased the likelihood of successful extubation. Patients receiving the TAP block required less fentanyl for pain management and demonstrated lower peak NRS pain scores upon ICU admission. No complications related to the TAP block were observed, underscoring its safety in this high-risk population. Conclusions: The subcostal TAP block facilitates early OR extubation by effectively managing postoperative pain and reducing opioid requirements, promoting smoother recovery without increasing adverse events. These findings support its inclusion in multimodal analgesia protocols for optimizing perioperative outcomes in LDLT patients. Full article

Background and Objectives: Kidney transplantation (KT) is an important treatment modality for renal failure. However, moderate-to-severe pain often occurs in KT recipients. Multimodal analgesia using combined analgesic measures has been recommended to enhance postoperative recovery. This retrospective study explored the additional analgesic efficacy of paracetamol and nefopam infusions in living-donor KT recipients who received a transversus abdominis plane (TAP) block. Materials and Methods: Consecutive living-donor KT recipients at our institute between January 2020 and March 2022 were divided into groups that received a TAP block with paracetamol and nefopam infusions (Group TA) or a TAP block without analgesics (Group T) during surgery. Following propensity-score (PS) matching, 103 patients were included in each group. Postoperative pain intensity assessed using the visual analog scale (VAS), opioid consumption via patient-controlled analgesia (PCA) devices over 24 h, and postoperative outcomes were compared between the two groups. Results: VAS pain intensity at rest was lower in group TA than in group T at 1 and 6 h after surgery [1 h: 29 (15–41) vs. 41 (29–51) mm, p < 0.001; 6 h: 32 (23–43) vs. 40 (32–54) mm, p < 0.001]. The VAS pain intensity during coughing was lower in group TA [1 h: 46 (30–58) vs. 59 (48–69) mm, p < 0.001; 6 h: 51 (40–63) vs. 60 (45–71) mm, p < 0.001]. Moreover, PCA consumptions during the first 6 h and between 6–24 h post-surgery was significantly lower in group TA. Other postoperative outcomes did not differ between the two groups. Conclusions: Multimodal analgesia with intraoperative paracetamol and nefopam infusions improved postoperative pain control in living-donor KT recipients who received a preoperative TAP block. Our findings demonstrate the efficacy of paracetamol and nefopam infusions in KT recipients. Full article

Background/Objectives: Current literature has demonstrated the benefits of transversus abdominis plane (TAP) blocks for reducing postoperative pain and opioid consumption for an array of surgical procedures. Some randomized controlled trials and retrospective studies have compared ultrasound guidance TAP blocks completed by anesthesiologists (US-TAP) to laparoscopic guidance TAP blocks completed by surgeons (LAP-TAP). However, the findings of these studies have not been consolidated to improve recommendations and patient outcomes. Our objective is to consolidate and summarize current literature regarding the efficacy of TAP blocks for postoperative pain control and opioid consumption when performed with ultrasound guidance (US-TAP, compared to laparoscopic guidance (LAP-TAP). Methods: We performed a systematic review and meta-analysis of RCTs and retrospective studies to evaluate US-TAP versus LAP-TAP blocks for postoperative pain control and opioid consumption. We searched PubMed/MEDLINE, CINAHL, Cochrane, and Web of Science databases for all articles meeting the search criteria until the time of article extraction in February 2024. The primary outcome variables were postoperative pain scores and opioid consumption. The secondary outcome variables were complications, time taken to perform the block, length of stay (LOS) in the hospital, and cost of performing the block. Results: Of the 1673 articles initially identified, 18 studies met the inclusion criteria for evaluation. Of the included studies, 88.9% and 77.8% found no significant difference in postoperative pain scores or opioid consumption, respectively, between US-TAP and LAP-TAP groups. Six studies (33.3%) found that LAP-TAP was faster to perform than US-TAP. Meta-analysis demonstrated no statistically significant differences in postoperative pain scores or opioid consumption between groups but showed that block times were significantly longer in the US-TAP group. Conclusions: US-TAP and LAP-TAP blocks may be equivocal in terms of reducing postoperative pain and opioid consumption. LAP-TAPs may be less time-consuming and more cost-effective and viable alternatives to US-TAP blocks in the perioperative setting. Full article

Background/Objectives: Esophagectomy is a key component of esophageal cancer treatment, with minimally invasive esophagectomy (MIE) increasingly replacing open esophagectomy (OE). Effective postoperative pain management can be achieved through various analgesic modalities. This study compares the efficacy of thoracic epidural anesthesia (TEA) with non-TEA methods in managing postoperative pain following MIE. Methods: A retrospective review was conducted on 110 patients who underwent MIE between 2018 and 2023. 1. TEA vs. 2. intravenous patient-controlled analgesia (PCA) alone vs. 3. transversus abdominis plane (TAP) catheter with PCA vs. 4. single-shot TAP block with paravertebral catheter (PVB) in combination with PCA were compared. The primary outcome was postoperative pain within the first 72 h, assessed using the numeric rating scale. Secondary outcomes included postoperative surgical complications (Clavien–Dindo classification (CDC)), patient satisfaction, and duration of induction and emergence, among others. Results: The incidence of an NRS > 3 during movement was 47.1%, 51%, 60.1%, and 48.3% for TEA, PCA alone, TAP + PCA, and PVB + PCA, respectively. For pain at rest, the rates were 8.3%, 4.3%, 11.2%, and 5%, respectively. High surgical complication rates were observed across all groups (CDC IIIa-V 31.6% overall), with patient satisfaction similarly high, regardless of the analgesic modality used (85% satisfied or very satisfied). No differences in the other secondary outcomes were observed. Conclusions: PVB combined with PCA offered analgesic efficacy and patient satisfaction comparable to TEA in managing postoperative pain following MIE. Full article

Background/Objectives: Abdominoplasties are prevalent surgical procedures for improving lower abdominal contours, necessitating effective pain management. Insufficient management can increase opioid usage, dependency risks, and adverse effects. This review investigates various strategies in abdominoplasty pain management, aiming to reduce opioid dependence and improve patient care. Methods: A comprehensive systematic literature search (MEDLINE, Cochrane, PubMed, Web of Science, EMBASE) was conducted, spanning from their inception to January 2024, using keywords such as ‘abdominoplasty’ and ‘postoperative pain management’. Included studies focused on nonopioid interventions in adults, encompassing various study designs. Non-English publications and those not meeting outcome criteria were excluded. Bias in studies was assessed using specific tools for randomized and non-randomized trials. Results: Thirty-five studies, published between 2005 and 2024, were included, involving 3636 patients with an average age of 41.8. Key findings highlighted the effectiveness of transversus abdominis plane blocks in reducing opioid use and pain. Pain pump catheters also showed promise in improving pain management and reducing opioid dependency. Local anesthetics demonstrated varying degrees of efficacy, while other alternatives like ketamine and NSAIDs successfully reduced postoperative pain and opioid requirements. The bias assessment of the RCTs revealed “low” and “some concerns” ratings, indicating a need for more detailed methodology reporting and management of missing data. The cohort studies generally attained “moderate” risks of bias, primarily due to confounding variables and outcome data reporting. Conclusions: Nonopioid analgesics show potential in postoperative pain management for abdominoplasties, but further research is needed to confirm their effectiveness and optimize patient care. Full article

Laparoscopic cholecystectomy (LC) is the gold standard of treatments for symptomatic gallstone disease. The aim of this study is to determine if postoperative opiate use is reduced with transversus abdominus plane (TAP) and rectus sheath (RS) regional anaesthetic blocks compared to port site local anaesthetic (LA) infiltration. A prospective, randomised cohort study was conducted of adult patients who underwent an emergency LC between 25 April 2022 and 25 May 2023. An amount of 40 mL of 0.375% ropivacaine was infiltrated as either TAP and RS blocks or to port sites. Patient demographics, operative data, and postoperative opioid use were collected from the medical record. In total, 138 patients were enrolled in this study: 73 patients allocated to the LA to port sites cohort (52.9%) and 65 patients in the TAP and RS cohort (43.5%). The most common indication for surgery was acute cholecystitis. The average amount of opiate analgesia use was 115.2 mg in the LA group compared to 61.2 mg in the TAP and RS group (p < 0.05). Optimisation of postoperative pain allows for early recovery, improved patient satisfaction, and improved cost-effectiveness for the health service. With a trend towards multimodal analgesia, the uptake of TAP and RS regional anaesthesia may help to achieve this goal. Full article

Background: The transversus abdominis plane (TAP) block is providing effective postoperative analgesia in patients undergoing cesarean section (CS). This study aims to evaluate and compare the effects on pain levels of bupivacaine alone versus bupivacaine combined with dexmedetomidine and bupivacaine combined with dexamethasone in ultrasound-guided TAP block for postoperative pain after CS. Material and Method: In this randomized controlled trial, 120 patients with American Society of Anesthesiologists (ASA) physical status I and II scheduled for elective cesarean section under spinal anesthesia were randomly divided into three groups. At the end of the surgery, an ultrasound-guided TAP block was performed on all patients: bupivacaine 0.5% (Group B), bupivacaine 0.5% + dexmedetomidine (1 µg/kg) (Group BD), and bupivacaine 0.5% + dexamethasone (4 mg) (Group BDx). Postoperatively, all patients were evaluated at 0, 1, 4, 8, 16, and 24 h for visual analog scores VASs, tramadol consumption, complications, and patient satisfaction. A p value of < 0.05 is statistically significant. Results: At 0 h, VASs in the sitting and supine positions were significantly higher in the BDx group (0.85 ± 1.61 and 0.85 ± 1.36, respectively) compared to the B group (0.05 ± 0.32 in both positions) and the BD group (0.15 ± 0.48 in both positions) (p = 0.005 and p = 0.001, respectively). At the 24th hour, VASs in the sitting and supine positions were significantly lower in the BDx group (1.7 ± 1.2 and 1.43 ± 1.05) compared to the B group (2.3 ± 0.68 and 2.2 ± 0.72) and the BD group (2.57 ± 1.01 and 2.28 ± 0.78) (p = 0.005 and p = 0.001, respectively). At 0 h, the tramadol requirement was highest in the BDx group at 12.5%, while it was not required in the B and BD groups (p = 0.005). At 0 h, the rate of nausea and vomiting was highest in the BDx group at 17.5%, compared to 2.5% in the BD group and 0% in the B group (p = 0.003). Patient satisfaction scores were higher in the dexamethasone group compared to the other groups. This was significant between Group B and Group BDx (p = 0.009 < 0.05). Conclusions: Adding dexmedetomidine or dexamethasone to bupivacaine in ultrasound-guided TAP blocks reduces postoperative pain and increases patient satisfaction after cesarean sections. Dexamethasone, due to its delayed onset but extended duration, achieves lower pain scores and higher satisfaction. Further research is necessary to confirm these findings. Full article