Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols

Simpson, Joanna C; Bao, Xiaodong; Agarwala, Aalok V.

doi:10.1055/s-0038-1676477

Cited by 139 publications

(106 citation statements)

References 67 publications

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“…If the symptoms are severe, patients may have postoperative delirium, myocardial ischemia and other serious complications. If the pain cannot be controlled in a timely fashion, acute pain can transform into chronic pain, which distresses the patient, affects wound healing, reduces the quality of life of the patient, and prolongs his or her length of hospital stay [23,24]. Therefore, adequate postoperative analgesia has important clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: a systematic review and meta-analysis of randomized controlled trials

et al. 2020

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Background: Abdominal surgery is common and is associated with severe postoperative pain. The transverse abdominal plane (TAP) block is considered an effective means for pain control in such cases. The quadratus lumborum (QL) block is another option for the management of postoperative pain. The aim of this study was to conduct a meta-analysis and thereby evaluate the efficacy and safety of QL blocks and TAP blocks for pain management after abdominal surgery. Methods: We comprehensively searched PubMed, EMBASE, EBSCO, the Cochrane Library, Web of Science and CNKI for randomized controlled trials (RCTs) that compared QL blocks and TAP blocks for pain management in patients undergoing abdominal surgery. All of the data were screened and evaluated by two researchers. RevMan5.3 was adopted for the meta-analysis. Results: A total of 8 RCTs involving 564 patients were included. The meta-analysis showed statistically significant differences between the two groups with respect to postoperative pain scores at 2 h (standardized mean difference [Std.MD] = − 1.76; 95% confidence interval [CI] = − 2.63 to − 0.89; p < .001), 4 h (Std.MD =-0.77; 95% CI =-1.36 to − 0.18; p = .01),6 h (Std.MD =-1.24; 95% CI =-2.31 to − 0.17; p = .02),12 h (Std.MD =-0.70; 95% CI =-1.27 to − 0.13; p = .02) and 24 h (Std.MD =-0.65; 95% CI =-1.29 to − 0.02; p = .04); postoperative morphine consumption at 24 h (Std.MD =-1.39; 95% CI =-1.83 to − 0.95; p < .001); and duration of postoperative analgesia (Std.MD = 2.30; 95% CI = 1.85 to 2.75; p < .001). There was no statistically significant difference between the two groups with regard to the incidence of postoperative nausea and vomiting (PONV) (RR = 0.55;95% CI = 0.27 to 1.14;p = 0.11).

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Section: Discussionmentioning

confidence: 99%

Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: a systematic review and meta-analysis of randomized controlled trials

et al. 2020

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“…If the symptoms are severe, patients may have postoperative delirium, myocardial ischemia and other serious complications. If the pain cannot be eliminated in time, acute pain will be transformed into chronic pain, which will make the patient uneasy, affect wound healing, reduce the quality of life of the patient, and prolong his or her hospitalization time [21,22]. Therefore, good postoperative analgesia has important clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: A systematic review and meta-analysis of randomized controlled trials

Liu

Song

Chen

et al. 2019

Preprint

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Background Abdominal surgery is common and associated with severe postoperative pain. Transverse abdominal plane (TAP) block is considered an effective means for pain control in such cases. Quadratus lumborum (QL) block is another option for the management of postoperative pain. The aim of this study was to conduct a meta-analysis and thereby evaluate the efficacy and safety of QL block and TAP block for pain management after abdominal surgery. Methods We comprehensively searched PubMed, Embase, EBSCO, the Cochrane Library, Web of Science and CNKI for randomized controlled trials (RCTs) that compared QL block and TAP block for pain management in patients undergoing abdominal surgery. All of the data were screened and evaluated by two researchers. RevMan5.3 was applied to perform the meta-analysis. Results A total of 8 RCTs involving564 patients were included. The meta-analysis showed statistically significant differences between the two groups with respect to postoperative pain scores at 2 hours (standardized mean difference [Std.MD]=-1.76; 95% confidence interval [CI]=-2.63 to -0.89; p<.001), 4 hours (Std.MD=-0.77; 95% CI=-1.36 to -0.18; p=.01),6 hours (Std.MD=-1.24; 95% CI=-2.31 to -0.17; p=.02),12 hours (Std.MD=-0.70; 95% CI=-1.27 to -0.13; p=.02) and 24hours (Std.MD=-0.65; 95% CI=-1.29 to -0.02; p=.04) ; postoperative opioid consumption at 24 h (Std.MD=-1.39; 95% CI=-1.83 to -0.95; p<.001); and duration of postoperative analgesia (Std.MD=2.30; 95% CI=1.85 to 2.75; p<.001). There was no statistically significant difference between the two groups regarding postoperative nausea and vomiting (PONV) incidence (RR=0.55; 95% CI=0.27 to 1.14; p=.11). Conclusion QL block provides better pain management with less opioid consumption than TAP block after abdominal surgery. In addition, there are no differences between TAP block and QL block with respect to PONV.

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“…Moreover, excessive use of opioid can lead to extended recovery from anesthesia, nausea and vomiting, ileus, and lengthened hospital stay. 5 Thus, it is still challenging for surgeons and anesthesiologists to provide effective pain control during the perioperative period. Multimodal analgesia in an ERAS program involves using two or more non-opioid medications to both minimize pain and minimize opioid use after surgery.…”

Section: Challenges In Postoperative Pain Control In Laparoscopic Hepmentioning

confidence: 99%

<p>The Safety and Efficacy of Ultrasound-Guided Bilateral Dual Transversus Abdominis Plane (BD-TAP) Block in ERAS Program of Laparoscopic Hepatectomy: A Prospective, Randomized, Controlled, Blinded, Clinical Study</p>

Zhang¹,

Liu²,

Zhou³

et al. 2020

DDDT

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Purpose: Postoperative pain management for patients undergoing hepatic resection is still a challenge due to the risk of perioperative liver dysfunction. The transversus abdominis plane (TAP) block is a promising regional analgesic technique. However, the correct guidelines regarding the dose and regimen of local anesthetics in patients undergoing hepatic resection have yet to be established completely. This study aimed to evaluate the safety and efficacy of ultrasound-guided BD-TAP block with a large dose of ropivacaine in laparoscopic hepatectomy. Patients and Methods: This prospective, blinded, randomized, controlled study was conducted with 50 patients who were scheduled for selective laparoscopic hepatectomy. Patients who received a BD-TAP block (3 mg/kg of ropivacaine diluted to 60 mL) with general anesthesia were categorized into the BD-TAP block group (n = 25), and those who received general anesthesia were categorized into the control group (n = 25). The primary outcomes were consumption of sufentanil within 48 hours post-operation and plasma ropivacaine concentration. The secondary outcomes were the severity of pain (at rest and upon coughing), nausea and/or vomiting, and quality of recovery. Results: Compared with the control group, the patients in BD-TAP block group had a significant reduction of postoperative sufentanil consumption at 2 hours (P = 0.019), 24 hours (P = 0.001), and 48 hours (P = 0.001), and the visual analog scale (VAS) scores on coughing were significantly lower at postoperative 2 hours (P = 0.004). There were no statistically significant differences in postoperative nausea and/or vomiting, flatus, catheter removal, off-bed activity, liver function, or postoperative hospital stay. The mean peak total ropivacaine concentration was 1,067.85 ng/mL, which occurred 1 hour after administering the block, and mean free ropivacaine concentration was 52.32 ng/mL. The highest individual peak plasma concentration was 2,360.90 ng/mL at 45 min postinjection, and the free ropivacaine concentration was 139.29 ng/mL. Conclusion: Ultrasound-guided BD-TAP block provides effective postoperative analgesia after laparoscopic hepatectomy. This study also confirms that ultrasound-guided BD-TAP blocks with 3 mg/kg ropivacaine during laparoscopic hepatectomy almost never results in the plasma ropivacaine concentrations associated with neurotoxicity.

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Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols

Cited by 139 publications

References 67 publications

Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: a systematic review and meta-analysis of randomized controlled trials

Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: a systematic review and meta-analysis of randomized controlled trials

Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: A systematic review and meta-analysis of randomized controlled trials

<p>The Safety and Efficacy of Ultrasound-Guided Bilateral Dual Transversus Abdominis Plane (BD-TAP) Block in ERAS Program of Laparoscopic Hepatectomy: A Prospective, Randomized, Controlled, Blinded, Clinical Study</p>

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