<p>Ultrasound-Guided Unilateral Transversus Abdominis Plane Combined with Rectus Sheath Block versus Subarachnoid Anesthesia in Patients Undergoing Peritoneal Dialysis Catheter Surgery: A Randomized Prospective Controlled Trial</p>

Abstract

Background Peritoneal dialysis catheter placement can be performed under general anesthesia, local anesthesia or subarachnoid anesthesia (SA). Recently, studies have reported the successful placement of peritoneal dialysis catheters using a transversus abdominis plane (TAP) block and rectus sheath (RS) block. This study compared the TAP + RS block with SA for patients undergoing peritoneal dialysis catheter placement. Methods Sixty patients were randomly divided into two groups, with 30 receiving unilateral ultrasound-guided TAP + RS block anesthesia and 30 receiving SA. The demographic characteristics, anesthesia efficacy, indicators related to anesthesia or operation, hemodynamic index, postoperative pain numeric rating score (NRS), postoperative recovery indicators, complications related to anesthesia or surgery, and dosage of sedative or analgesic medication were analyzed. Results Anesthesia operation time was significantly shorter in the TAP + RS block group than in the SA group ( P <0.001), while there was no significant difference in success rates (TAP + RS 93.33% [95% confidence interval, 95% CI, 83.9–102.8%] vs SA 100.00% [95% CI, 100–100%], P =0.472). Two patients in the TAP + RS group needed extra analgesia, although the dermatome pinprick sensation test gave negative results for all patients. Patients who received the TAP + RS block expressed significantly less pain on movement or at rest at 4 h and 8 h postoperative. Fewer patients needed rescue analgesia with tramadol in the postoperative period in the TAP + RS block group than in the SA group ( P <0.05). The intraoperative MAP was more stable ( P <0.05) in the TAP + RS group compared to the SA group. Conclusion The TAP + RS block is a safe, effective method for use as the principal anesthesia technique in PD catheter placement. Compared to SA, it has the advantages of less influence on hemodynamics and a better postoperative analgesic effect.

Conscious sedation anesthesia using different doses of remifentanil combined with dexmedetomidine for peritoneal dialysis catheter implantation

“…Surgery was combined with dexmedetomidine, a highly effective and specific α-2 receptor agonist; however, the pharmacokinetic parameters in patients with ESRD were similar to those in patients with normal renal function [ 4 ]. The combination of the two drugs could reduce the total doses of dexmedetomidine and remifentanil.…”

“…General anesthesia yields a good analgesic effect; however, it is associated with high risk in patients with ESRD [ 3 ]. Regional blockade anesthesia, such as transverse abdominal block, has fewer side effects during PD catheter implantation [ 4 , 5 ]. However, the technique of regional blockade anesthesia is relatively complex.…”

Bilateral Ultrasound-Guided Rectus Sheath Block for Anesthesia of Midline Laparotomy

“…When regional anesthetic techniques such as TAP+RS block are used, several studies have shown that opioid consumption is reduced postoperatively (12) . Li et al (13) pointed out that patients who received TAP +RS block anesthesia had more stable intraoperative hemodynamics and required less vasoactive drugs. The TAP+RS block is safe for patients with end-stage renal disease because it does not affect sympathetic nerves.…”

Combination of Rectus Sheath Block and Subcostal Transversus Abdominis Plane Block as the Sole Anesthesia for an Open Gastrostomy in a High-risk Patient

“…In our opinion, right RSB and left sTAPB were a suitable combination for this patient, as they helped overcome somatic pain from both the midline and left part of the abdomen incisions while minimizing LA volume. The combination of RSB and TAPB as the sole anesthesia has also been evident for peritoneal dialysis catheter placement surgery 10 . However, a different technique of TAPB was used, which was different from this reported case.…”