A Dose-Ranging Study of the Effect of Transversus Abdominis Block on Postoperative Quality of Recovery and Analgesia After Outpatient Laparoscopy

Oliveira, Gildàsio S. De; Fitzgerald, Paul C.; Marcus, R-Jay; Ahmad, Shireen; McCarthy, Robert J.

doi:10.1213/ane.0b013e3182303a1a

Cited by 93 publications

(53 citation statements)

References 23 publications

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“…In addition, a similar trend toward a reduction in pain burden and opioid consumption was also detected in the TAP infiltration group compared to saline. The inverse relationship between postoperative opioid consumption and quality of recovery in the subjects in this study support our previous findings of reduced opioid use and improved postoperative recovery [16,23,25] . Our results suggest that the TAP infiltration may be a clinically significant multimodal strategy to reduce pain and improve quality of postsurgical recovery in patients undergoing laparoscopic gastric band surgery.…”

Section: Discussionsupporting

confidence: 91%

“…A sample size of 23 subjects per group was estimated to achieve 80% power to detect a 10 point difference in the aggregated QoR-40 score for the 2 study groups to be compared assuming an overall standard deviation of 12 points similar what was observed in a previous investigation [25] . To account for drop-outs 50 subjects were planned to be recruited and randomized.…”

Section: Discussionmentioning

confidence: 99%

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Transversus abdominis plane infiltration for laparoscopic gastric banding: A pilot study

Oliveira

Fitzgerald

Ahmad

et al. 2014

WJGS

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AIM:To estimate an effect size for the transversus abdominis plane (TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS:The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40 (QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. RESULTS:Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range (IQR)] of 175.5 (170-189) compared to 170 (160-175) in the control group (P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median (IQR) of 7.5 (2.5-11.5) mg iv morphine equivalents compared to 13 (7-21.5) in the control group (P = 0.07). Correlation analysis (Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores, -0.49 (P = 0.03). CONCLUSION:The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.© 2014 Baishideng Publishing Group co., Limited. All rights reserved.Key words: Transversus abdominis plane; Infiltration; Gastric band; Pain; Recovery Core tip: In this current randomized, double blinded, placebo controlled pilot study we estimated the effect of a transversus abdominis plane block on postoperative quality of recovery in morbidly obese patients undergoing laparoscopic gastric band surgery. Postoperative opioid consumption was inversely correlated to quality of recovery in this surgical population. The transversus abdominis plane block seems to be an effective strategy to improve quality of recovery in those patients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Transversus abdominis plane infiltration for laparoscopic gastric banding: A pilot study

Oliveira

Fitzgerald

Ahmad

et al. 2014

WJGS

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“…40 Regional anesthesiologists and researchers should recognize the opportunity to apply their skills in the personalization of pain medicine and measure outcomes that are important to patients. 41,42 CONCLUSIONS Ultrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted. Before we become overtaken with enthusiasm for these new techniques, we need to go back to basics by deepening our understanding of fascial tissue anatomy and structure and determine the precise targets for needle placement.…”

Section: Future Research Directionsmentioning

confidence: 99%

Interfascial Plane Blocks

Elsharkawy

Pawa

Mariano

2018

Regional Anesthesia and Pain Medicine

158

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Ultrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted. Before becoming overtaken with enthusiasm for these new techniques, a deeper understanding of fascial tissue anatomy and structure, as well as precise targets for needle placement, is required. Many factors may influence the ultimate spread and quality of resulting interfascial plane blocks, and these must be understood in order to best integrate these techniques into contemporary perioperative pain management protocols.

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“…7,8 Several studies have shown this block to be safe and effective. [9][10][11][12] Furthermore, the control of postoperative pain using nonopioid medication has repeatedly been shown to benefit patients in terms of morbidity and mortality. 13 Currently, spine surgeons frequently perform a preoperative field infiltration for lumbar surgery with a total dose of anesthetic similar to that of the TAP block 14 ; however, the efficacy of this approach has not been well studied.…”

Section: Résumémentioning

confidence: 99%