Systemic lidocaine versus ultrasound-guided transversus abdominis plane block for postoperative analgesia: A comparative randomised study in bariatric surgical patients

Gupta, Chandan; Valecha, Umesh Kumar; Singh, Shri Prakash; Varshney, Manu

doi:10.4103/ija.ija_430_19

Cited by 11 publications

(11 citation statements)

References 7 publications

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“…In studies comparing TAP versus non-TAP, the TAP group had a significantly longer time to first opioid use, compared to the non-TAP group (38). However, when compared with placebo, or infiltration, there were no differences observed between the 2 groups (5,38,42).…”

Section: Opioid Sparing Effect Of Tapmentioning

confidence: 94%

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Benefits of Transversus Abdominis Plane Block on Postoperative Analgesia after Bariatric Surgery: A Systematic Review and Meta-Analysis

2021

Pain Phys

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BACKGROUND: Patients undergoing bariatric surgery present unique analgesic challenges, including poorly controlled pain, increased prevalence of obstructive sleep apnea, and opioid-induced respiratory depression. The transversus abdominis plane (TAP) has been demonstrated to be a safe and effective component of multimodal analgesia for a variety of abdominal surgeries. OBJECTIVE: To determine the benefits of the TAP block on postoperative analgesia and recovery in patients undergoing bariatric surgery. STUDY DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized studies. METHODS: We conducted a comprehensive search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to April 2020 for studies using TAP block in bariatric surgeries and reporting postoperative pain, opioid consumption, and recovery-related outcomes. Primary outcomes included postoperative pain scores, opioid consumption, and recovery-related outcomes (e.g., length of stay, time to ambulation). Outcomes were pooled using random effects model and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CI). RESULTS: Twenty-one studies (15 RCTs [n = 1410] and 6 nonrandomized studies [n = 1959]) were included. Among RCTs, the TAP block group required fewer opioid rescues (RR 0.28; 95% CI 0.18 to 0.42, P < 0.001) (moderate quality); reduced total opioid use over 24 hours (MD –8.33; 95% CI –14.78 to –1.89, P = 0.01); decreased time to ambulation (MD –1.12 hours; 95% CI –1.50 to –0.73, P < 0.001) (high quality); and had significantly lower pain scores at 6 hours (MD –1.52; 95% CI –1.90 to –1.13, P < 0.01) and 12 hours (MD –0.95; 95% CI –1.34 to –0.56, P < 0.001) on a 0-10 pain scale (moderate quality). No difference was observed for nausea and vomiting, or hospital length of stay. Meta-analyzed outcomes from observational studies supported these results, suggesting decreased postoperative pain and opioid consumption. LIMITATIONS: Studies varied with respect to type of surgery and components of comparator multimodal analgesia, likely contributing to heterogeneity. Subgroup analyses by type of comparator group were conducted to address these differences. We were unable to extract data from all trials included due to variability in outcomes reporting, such as non-opioid drugs for postoperative pain management or invalid dosages. Pain-related outcomes may be affected by operative differences leading to variation in visceral pain. Observational studies have their inherent limitations, such as confounding due to lack of participant randomization and intervention blinding, potentially affecting subjective outcomes, such as pain scores, as well as provider-dependent outcomes, such as hospital length of stay. Lastly, there was significant variation of TAP block technique across all studies. CONCLUSION: TAP block is an effective, safe modality that can be performed under anesthesia. It decreases pain, opioid use, and time to ambulation after bariatric surgeries and should be considered in multimodal analgesia for enhanced recovery in this high-risk surgical population. KEY WORDS: Analgesia, bariatric surgery, enhanced recovery after surgery, multimodal analgesia, opioid-sparing analgesia, pain, postoperative, regional block, transversus abdominis plane block

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Section: Opioid Sparing Effect Of Tapmentioning

confidence: 94%

“…Out of 92 potentially relevant citations, 15 randomized studies (5,(23)(24)(25)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)) and 6 non-randomized studies (47)(48)(49)(50)(51)(52) were selected (Fig. 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

Benefits of Transversus Abdominis Plane Block on Postoperative Analgesia after Bariatric Surgery: A Systematic Review and Meta-Analysis

2021

Pain Phys

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“…In these surgical procedures, lidocaine infusion has been shown to reduce postoperative pain, opioid requirements, ileus duration, and incidence of postoperative nausea and vomiting (PONV) and PND, and shorten hospital stays. IV infusion of lidocaine has been shown to enhance the quality of early recovery after laparoscopic bariatric and upper airway surgery [ 13 , 17 , 42 , 43 ]. However, a single study showed that IV lidocaine significantly decreased postoperative opioid consumption, but when used after bariatric surgery, it was clinically irrelevant [ 44 ].…”

Section: Hypothesismentioning

confidence: 99%

Intravenous Infusion of Lidocaine Can Accelerate Postoperative Early Recovery in Patients Undergoing Surgery for Obstructive Sleep Apnea

2021

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Obstructive sleep apnea (OSA) is defined by intermittent and recurrent episodes of partial or complete obstruction of the upper airway during sleep. Intermittent and recurrent hypoxia/reoxygenation is the main pathophysiological mechanism of OSA. Its consequences include systemic inflammation, activation of the sympathetic nervous system, and release of oxygen free radicals. Infusion of intravenous (IV) lidocaine has anti-inflammatory, antihyperalgesic, and analgesic properties, supporting its use as an anesthetic adjuvant. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress, as well as postoperative pain and/or analgesic requirements. Because of the high prevalence of OSA in obese patients, the use of opioids to manage postoperative pain in that population is often accompanied by the development of adverse respiratory events, such as hypoventilation and hypoxemia. IV infusion of lidocaine has been shown to enhance the quality of early recovery after laparoscopic bariatric and upper airway surgery. However, limited evidence exists regarding its use in patients undergoing surgery for OSA. In addition, whether IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA remains unknown. Therefore, we hypothesized that IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA. Perioperative infusion also may be a promising analgesic adjunct to enhanced recovery after surgery (ERAS) protocols.

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“…1 2 In recent years, regional anaesthesia has been increasingly used as a component of multimodal analgesia following the laparoscopic surgery. 3 4 Hebbard et al 5 described oblique abdominal transversus abdominis plane (OSTAP) block in 2010, which can provide effective analgesia for laparoscopic surgery. 6 7 However, considering that OSTAP block only blocks the intercostal nerve and its lateral/anterior branches, visceral pain has not been relieved.…”

Section: Introductionmentioning

confidence: 99%

Transmuscular quadratus lumborum block versus oblique subcostal transversus abdominis plane block for analgesia in laparoscopic hysterectomy: a randomised single-blind trial

et al. 2021

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ObjectiveThe transmuscular quadratus lumborum (TQL) block and the oblique subcostal transversus abdominis plane (OSTAP) block both contribute to multimodal analgesia after laparoscopic surgery. The objective of this study was to compare the analgesic effects of the TQL block versus OSTAP block after laparoscopic hysterectomy.DesignProspective single-centre randomised single-blind trial.SettingUniversity-affiliated hospital.ParticipantsPatients aged between 18 and 65 years scheduled for laparoscopic hysterectomy.InterventionsPatients were randomised into two groups (1:1 ratio) and received bilateral TQL block or bilateral OSTAP block with 0.375% ropivacaine 20 mL on each side before surgery.Primary and secondary outcome measuresThe primary outcome measure was the cumulative morphine dose in the first 24 hours. The secondary outcome measures were the morphine consumption at each time interval after surgery, the time from the end of surgery to the first need for morphine, the Numerical Rating Scale (NRS) scores for visceral and incisional pain intensity, and the incidence of adverse events.ResultsThe cumulative morphine dose was significantly lower in the TQL group than in the OSTAP group (17.2 (12.5) vs 26.1 (13.3) mg, p=0.010). Compared with the OSTAP group, the morphine doses from 6 to 12, 12 to 18, and 18 to 24 hours were significantly lower, the time of first need for morphine was significantly longer and the NRS scores for visceral pain intensity were significantly lower in the TQL group.ConclusionCompared with the OSTAP block, the TQL block reduced morphine consumption and provided better visceral pain relief with a longer duration of effect after laparoscopic hysterectomy.Trial registration numberChinese Clinical Trial Registry (ChiCTR1800017995); pre-results.

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Systemic lidocaine versus ultrasound-guided transversus abdominis plane block for postoperative analgesia: A comparative randomised study in bariatric surgical patients

Cited by 11 publications

References 7 publications

Benefits of Transversus Abdominis Plane Block on Postoperative Analgesia after Bariatric Surgery: A Systematic Review and Meta-Analysis

Benefits of Transversus Abdominis Plane Block on Postoperative Analgesia after Bariatric Surgery: A Systematic Review and Meta-Analysis

Intravenous Infusion of Lidocaine Can Accelerate Postoperative Early Recovery in Patients Undergoing Surgery for Obstructive Sleep Apnea

Transmuscular quadratus lumborum block versus oblique subcostal transversus abdominis plane block for analgesia in laparoscopic hysterectomy: a randomised single-blind trial

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