First Experience With Rectus Sheath Block for Postoperative Analgesia After Pancreas Transplant: A Retrospective Observational Study

Hausken, John; Rydenfelt, Kristina; Horneland, Rune; Ullensvang, Kyrre; Kjøsen, Gisle; Tønnessen, Tor Inge; Haugaa, Håkon

doi:10.1016/j.transproceed.2019.01.065

Cited by 13 publications

(14 citation statements)

References 24 publications

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“…Additionally, when comparing the 7 day LOS of our post-protocol group to the prior pancreas studies by Hausken and Yeap, there was an 11 and 7 day LOS in those studies respectively. 13,14 Additionally, in the prior pain management studies in both liver and kidney transplant, no study found a decreased LOS following the implementation of a pain management protocol. [18][19][20]22 Yeap and colleagues reported return of bowel function at 2.5 days post-pancreas transplant which is similar to the reported 3 days the post-protocol group despite that group receiving significantly less opioids.…”

Section: Discussionmentioning

confidence: 99%

“…Due to this anastomosis, there is an additional motivation to reduce opioid use to optimize the return of bowel function and reduce post‐operative nausea and vomiting. The current data on pain management post‐pancreas transplant focuses on intravenous (IV) opioids, transversus abdominis plane (TAP) blocks, thoracic epidural analgesia, and/or rectus sheath blocks 13,14 . Pain management with primarily oral therapy, as well as discharge and outpatient opioid use following pancreas transplantation are inadequately addressed in the current literature.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a multidisciplinary, multimodal pain management protocol following pancreas transplantation

Lindner

Lakhani

Cooper

et al. 2022

Clinical Transplantation

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Introduction: Patients undergoing solid-organ transplantation demonstrate pain arising from both the surgical intervention and pre-existing comorbidities. High levels of opioid use both pre-and post-transplant are associated with unfavorable transplant outcomes. Patient education, multimodal therapy, and discharge planning have all been demonstrated to reduce opioid use after transplant.Methods: This is a single-center, retrospective study analyzing patients before and after implementation of a multimodal, multidisciplinary pain management protocol.Morphine milligram equivalents (MMEs) use during the index transplant hospitalization and the need for opioids at discharge was compared between the pre-and post-protocol groups.Results: A total of 52 patients were included in the study, 31 in the pre and 21 in the post-protocol groups. Inpatient MME use was reduced from 135.5 to 67.5 MMEs after protocol implementation. Additionally, the number of patients discharged on opioids following transplant decreased from 90.3% to 47.6%. Pain scores, length of stay (LOS), and return of bowel function was not different between groups. Conclusion:The implementation of a multimodal, multidisciplinary pain management protocol significantly decreased opioid use during the post-surgical hospitalization and in the 6 months following transplantation. A combination of non-opioid analgesics, patient education, and discharge planning can be beneficial elements in pancreas transplant pain management.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of a multidisciplinary, multimodal pain management protocol following pancreas transplantation

Lindner

Lakhani

Cooper

et al. 2022

Clinical Transplantation

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“…SPK patients may also have end-stage renal disease (ESRD), limiting their ability to take certain opioids due to the accumulation of metabolites [101]. Pancreas transplant recipients often require increased anticoagulation due to the risk of allograft thrombosis, sometimes limiting the epidural options available [102][103][104]. Epidural analgesia is also known to increase the LOS while only providing superior pain control on the day of surgery in pancreatic surgery [105].…”

Section: Analgesiamentioning

confidence: 99%

“…New analgesic options include transversus abdominis plane (TAP), rectus sheath and quadratus lumborum blocks with an infusion of local anaesthetic [106][107][108][109][110]. Hausken et al showed that a rectus sheath block could provide equivalent analgesia to thoracic epidural analgesia in pancreas transplantation [104]. In a double-blind RCT comparing IV morphine PCA (patient controlled analgesia) vs. IV morphine PCA with TAP block vs. IV morphine with TAP block and dexmedetomidine in renal transplant patients, Yang [111] et al found that both TAP block groups had reduced pain, decreased morphine consumption and decreased nausea and vomiting compared to the IV morphine PCA group.…”

Section: Analgesiamentioning

confidence: 99%

Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review

Elango

Papalois

2021

JCM

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Enhanced recovery after surgery (ERAS) initially started in the early 2000s as a series of protocols to improve the perioperative care of surgical patients. They aimed to increase patient satisfaction while reducing postoperative complications and postoperative length of stay. Despite these protocols being widely adopted in many fields of surgery, they are yet to be adopted in pancreatic transplantation: a high-risk surgery with often prolonged length of postoperative stay and high rate of complications. We have analysed the literature in pancreatic and transplantation surgery to identify the necessary preoperative, intra-operative and postoperative components of an ERAS pathway in pancreas transplantation.

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“…Rectus sheath catheters have been compared with thoracic epidural analgesia (TEA). One retrospective observational study for pancreas transplant found there was no significant difference in rescue analgesia and the technique was preferred due to their anticoagulation regimen [17]. Another observational study found equivalent pain scores and faster time to mobilization in the rectus sheath group [18].…”

Section: Laparotomymentioning

confidence: 99%

Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a Technical Description and Evidence Review

Uppal

Sancheti

Kalagara

2019

Curr Anesthesiol Rep

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Purpose of Review This article aims to review the anatomy relevant to the ultrasound techniques of the transversus abdominis plane (TAP) block and rectus sheath block (RSB). We discuss their analgesic efficacy for various surgical procedures, both as single shot and as a continuous infusion via catheters. Recent Findings RSB provides superior analgesia to local infiltration and has an opioid-sparing effect for umbilical surgery, laparotomy, and laparoscopic surgery. There is no high-quality evidence comparing RSB with epidural analgesia. Intermittent bolus through catheters appears to be more effective than continuous infusion for prolonged analgesia. Similarly, ultrasoundguided TAP block provides postoperative analgesic benefit after abdominal laparotomy or laparoscopy and cesarean delivery when long-acting neuraxial opioids are not used or contraindicated. Adding adjuvant such as dexamethasone and dexmedetomidine to local anesthetic prolongs the duration of TAP and RSB blocks and improves their efficacy. Summary Use of ultrasound guidance makes the RSB and TAP blocks more reliable. Single-shot infiltration is useful for less extensive surgical procedures, while catheters are a useful alternative when thoracic epidural analgesia is contraindicated.

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First Experience With Rectus Sheath Block for Postoperative Analgesia After Pancreas Transplant: A Retrospective Observational Study

Cited by 13 publications

References 24 publications

Evaluation of a multidisciplinary, multimodal pain management protocol following pancreas transplantation

Evaluation of a multidisciplinary, multimodal pain management protocol following pancreas transplantation

Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review

Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a Technical Description and Evidence Review

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