Background: The transversus abdominis plane block (TAP block), a regional block, provides effective analgesia after lower abdominal surgeries. The objective of this study was to assess whether transversus abdominis plane block is effective as part of multimodal pain management following Cesarean section. Materials and Method: Totally, 60 ASA I and II parturients for Cesarean section via Pfannenstiel incision under spinal anesthesia were randomly allocated to either the TAP block group or the control. The TAP block group received a landmark-orientated, bilateral TAP block with 0.25% levobupivacain 17,5ml each side in the triangle of Petit. Postoperative pain treatment followed the same protocole for both groups with 1gram paracetamol intravenously and received patrient-controlled analgesia with intravenous morphine. The time to first request of analgesic, morphine consumption, visual analogue scale (VAS) pain scores and side effects were scored at 2, 4, 6, 8, 12 h postoperatively. Results: The time to first request of analgesic was longer, morphine consumption was lower in TAP group than in the control (p < 0.05). Visual analogue scale (VAS) pain scores at rest and on mouvement were similar in two groups at 2h, but lower in TAP group from 4h (p < 0.05). No severe adverse effects were detected in two groups. Conclusion: TAP block prolonged the time to fisrt request of analgesic and reduced morphine consumption, the VAS pain scores significantly both at rest and on mouvement. Therefore, TAP block is feasible and effective as part of a multimodal analgesia regimen after Caesarean section. Key words: Caesarean section, multimodal pain management, transversus abdominis plane block
Background: Effective postoperative pain relief is the cornerstone of enhanced postoperative recovery. Pain after laparoscopic surgery can be caused by many factors such as the trocar incision associated, the incision in the abdominal wall and manipulations in the peritoneal cavity. Therefore, it is necessary to apply multimodal analgesia. The research question is whether the pain after laparoscopic surgery is low level. Objective: To evaluate the effectiveness of multimodal analgesia using paracetamol combined with intravenous ketorolac and morphine rescue compared with intravenous paracetamol alone and morphine rescue after laparoscopic major surgery. Materials and methods: In a randomized controlled clinical trial, 70 patients aged 18 years and older, classified ASA I - III, undergoing laparoscopic surgery were randomly divided into two groups. The Para-Keto group received intravenous ketorolac and paracetamol, the Para group received intravenously paracetamol and both groups received patient-controlled intravenous morphine. VAS pain scores at rest, on movement, morphine consumption in 48 hours, flatus time, time to sit up, patient satisfaction and side effects. Results: The Para-Keto group had lower pain scores at rest and on movementand shorter flatus, sitting up time than the Para group (p < 0.05). “Very satisfied” in the Para-Keto group was statistically significantly higher than the Para group (71.4% vs 28.6%). The level of satisfaction in the Para group accounted for 60.0%, the average satisfaction rate accounted for 11.4%. The average total amount of morphine used in 48 hours in the Para-Keto group was significantly lower than that in the Para group (p < 0.05). The rates of itching, vomiting and nausea in the two groups were low and did not differ statistically between the two groups. No patient experienced respiratory depression. Conclusions: Multimodal analgesia by using paracetamol combined with intravenous ketorolac and rescue with intravenous morphine after laparoscopic major surgery was better than paracetamol combined with morphine rescue after laparoscopic surgery. Laparoscopic surgery still have severe pain and needed additional pain killer Key words: Laparoscopic surgery, multimodal analgesia.
Background: Both laryngeal mask airway I-gel and Supreme have been available for clinical use, but there was no comparison between two devices. This study was designed to compare the efficacy and complications of the laryngeal mask airway I-gel and Supreme in children undergoing general anesthesia for lower abdominal surgery. Methods: One hundred and twenty children were randomly assigned to either the I-gel or the Supreme group (60 children in each group). All patients of the two groups received the same protocol of general anesthesia. Evaluation criteria included successful mask insertion rate, ease of insertion, insertion time, and number of adjustments needed during anesthesia maintenace and postoperative complications. Results: There were no differences in the demographic data between the two groups. The success rate of insertion in the first attempt of the I-gel group was 94.8% and the Supreme group (98.3%) (p>0.05). According to ease of placement, grade 1 (very easy) ratios of Supreme, and I-gel were 40% and 3.3%, respectively (p<0.01). The insertion time of the I-gel was longer than that of Supreme (p < 0.05). The rate of airway manipulations during anesthesia maintenance of Supreme, and I-gel group were 5% and 11.7%, respectively (p > 0.05). The most common complication was cough, with the rate of 17% in I-gel group and 5% in Supreme group (p<0.05). There were no differences in other complications between both groups. Conclusions: Both I-gel and Supreme provided a satisfactory airway during general anesthesia in children. Insertion of Supreme was significantly easier and more rapid than insertion of I-gel, and the incidence of cough after surgery was significantly lower with Supreme than I-gel. Key words: Laryngeal mask airway, I-gel, Supreme, children
Background: Abdominal surgery is a type of surgery with a high percentage in general surgery department. After this surgery, pain is severe and multimodal analgesia is recommended. The objective of this study was to evaluate the effectiveness of epidural analgesia with intravenous bupivacaine-fentanyl plus paracetamol compared with ketorolac plus paracetamol and intravenous morphine as rescue. Materials and methods: In a randomized controlled clinical trial, 70 patients aged 18 years or older, ASA I - III, with an indication for open abdominal surgery were randomly divided into two treatment groups. The PCEA group received bupivacaine 0.1% + fentanyl 2mcg/ml and intravenous paracetamol, the IV-PCA group received ketorolac and paracetamol combined with intravenous morphine as rescue. VAS scores at rest and on movement, patient satisfaction, side effects. Results: VAS scores at rest and on movement in both groups were less than 4 in the first 48 hours postoperatively and in the PCEA group lower than the IV-PCA group (p < 0.05). The level of very satisfied in the PCEA group was statistically significantly higher than in the IV-PCA group (71.4% versus 22.9%). Satisfaction level in group IV-PCA accounted for 71.4%. Side effects of the two groups were low rate and mild. Conclusion: Multimodal analgesia by using epidural bupivacaine - fentanyl combined with intravenous paracetamol was more effective than ketorolac combined with intravenous paracetamol and rescue by intravenous morphine after open abdominal surgery. In cases where epidural analgesia is not applied, intravenous multimodal analgesia also provides good analgesia. Key words: open abdominal surgery, multimodal analgesia, epidural, intravenous.
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