Introduction: The main objective of this study is to compare TAP block with subfascial wound infiltration in the prevention of acute and chronic postoperative pain after surgical repair of inguinal hernia. Materials and methods: This is a prospective randomized study. After approval by the local ethics committee and obtaining informed patients consent, ASA I or ASA II patients proposed for a simple inguinal hernia cure are included. Patients were randomized into two groups: Subfascial cicatricial infiltration with 0.5% bupivacaine (20 ml) during wall closure (Group 1); a TAP block (by the technique of two projections) with 0.5% bupivacaine (20 ml) on the operated side (Group 2). Postoperative analgesia is provided by systematic Paracetamol and Nefopam and morphine titration. Apart from demographic parameters and ASA class, the postoperative pain intensity at rest and at coughing, the morphine consumption and the secondary effects were compared. Patients’ satisfaction and postoperative chronic pain at 3 and 6 months were also analyzed. Results: Concerning demographic parameters, ASA class and secondary effects, we didn’t find any meaningful difference. However, there was a significant reduction of postoperative pain in the TAP group whether at rest as coughing. Gr 1 patients asked for more morphine consumption and they were less satisfied and accused more chronic pain. Conclusion: This study shows that the TAP block is as simple and effective technique in reducing acute postoperative pain and preventing chronic pain after inguinal hernia surgery. This technique seems well tolerated and more effective than a single subfascial infiltration injection.
Backgrounds/Aims The main objective of this study is to compare the ventilatory effects of AFVC and PC modes with the VC mode in laparoscopic surgery of the gall bladder. Methods Thirty-five patients programmed for laparoscopic cholecystectomy were included. Four times were defined for all patients. The parameters studied were recorded ten minutes after anesthetic induction; and this is the time T1. The time T2 fits to 10 min after induction of pneumoperitoneum. Then, the ventilator mode was changed from VC mode to AFVC mode. Ten minutes later, the variables were scored; it was the time T3. The ventilator mode was then changed to a PC mode. The set pressure was adjusted in order to obtain the same Vt as at the time T2. The time T4 was 10 minutes after switching to PC mode. Results The Vte were increased, compared to time T2, during the AFVC and PC modes. The induction of pneumoperitoneum with CO 2 induced a rise of P ET CO 2 between T1 and T2. These had been accompanied by a significant rise in airway pressures. The change from VC mode to AFVC mode resulted in lower Prpeak and Prtray elevation without impacting dynamic compliance. Conclusions AFVC mode appears safe for patients in laparoscopic surgery. Its use, compared with VC, is associated with a decrease in Prpeak without effects on the Cdyn, oxygenation, capnia and hemodynamic parameters. We conclude that is no necessary to change ventlatory modes to improve ventilation conditions in non-obese patients.
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