The additional analgesic effects of transverse abdominis plane block in patients receiving low-dose intrathecal morphine for minimally invasive colorectal surgery: a randomized, single-blinded study

Han, Sang-Ick; Lee, Chul Seung; Bae, Jung Hoon; Yoon, Mi Ran; Lee, Do Sang; Lee, Yoon Suk; Al-Sawat, Abdullah; Shim, Jung Ho; Hong, Sang Hyun; Lee, In Kyu

doi:10.4174/astr.2021.101.4.221

Cited by 7 publications

(5 citation statements)

References 28 publications

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“…Compared with wound infiltration, three studies did not find superior analgesia with TAP blocks 72–74 . Han et al demonstrated that TAP blocks did not show additional analgesic effects when superimposed on intrathecal morphine 75 . When compared with thoracic epidural analgesia, one study showed less early morphine consumption in the epidural than in the TAP group, 58 whereas no difference was detected in two other studies 59,60 .…”

Section: Resultsmentioning

confidence: 99%

“…Some studies had more than two relevant study arms. These were separately listed for each relevant comparison, making the sum of studies in the following listing higher than the number of studies included: seven studies investigating adjuvant systemic analgesics, 39–45 three studies investigating varying degrees of neuromuscular blockade, 46–48 seven studies investigating intravenous lidocaine, 43,49–54 six studies investigating epidural analgesia, 55–60 four studies investigating spinal opioids, 55,61–63 twenty-eight studies investigating truncal nerve blocks, 53,58–60,64–87 seven studies investigating wound infiltration, 54,57,72–74,88,89 four studies investigating intraperitoneal local anaesthetics (IPLA) 90–93 and seventeen studies investigating surgical techniques 94–110 . Supplemental Table 1, http://links.lww.com/EJA/A901 lists the summary of key results from studies evaluating systemic analgesics, systemic analgesic adjuncts, regional analgesia and surgical procedures used to support the recommended interventions in patients after laparoscopic colectomy.…”

Section: Resultsmentioning

confidence: 99%

“…[72][73][74] Han et al demonstrated that TAP blocks did not show additional analgesic effects when superimposed on intrathecal morphine. 75 When compared with thoracic epidural analgesia, one study showed less early morphine consumption in the epidural than in the TAP group, 58 whereas no difference was detected in two other studies. 59,60 Hamada et al 76 showed that the addition of dextran to levobupivacaine could prolong analgesic effects of TAP blocks in a setting without adequate baseline analgesia.…”

Section: Truncal Blocksmentioning

confidence: 99%

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PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

Lirk,

Badaoui,

Stuempflen

et al. 2024

European Journal of Anaesthesiology

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Colorectal cancer is the second most common cancer diagnosed in women and third most common in men. Laparoscopic resection has become the standard surgical technique worldwide given its notable benefits, mainly the shorter length of stay and less postoperative pain. The aim of this systematic review was to evaluate the current literature on postoperative pain management following laparoscopic colorectal surgery and update previous procedure-specific pain management recommendations. The primary outcomes were postoperative pain scores and opioid requirements. We also considered study quality, clinical relevance of trial design, and a comprehensive risk–benefit assessment of the analgesic intervention. We performed a literature search to identify randomised controlled studies (RCTs) published before January 2022. Seventy-two studies were included in the present analysis. Through the established PROSPECT process, we recommend basic analgesia (paracetamol for rectal surgery, and paracetamol with either a nonsteroidal anti-inflammatory drug or cyclo-oxygenase-2-specific inhibitor for colonic surgery) and wound infiltration as first-line interventions. No consensus could be achieved either for the use of intrathecal morphine or intravenous lidocaine; no recommendation can be made for these interventions. However, intravenous lidocaine may be considered when basic analgesia cannot be provided.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Truncal Blocksmentioning

confidence: 99%

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PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

Lirk,

Badaoui,

Stuempflen

et al. 2024

European Journal of Anaesthesiology

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“…Clinical studies have attested to its ability to provide superior analgesia, reduce dependency on opioids, and subsequently improve prognostic outcomes for patients who have undergone colorectal surgeries [ 120 – 123 ]. This technique is particularly beneficial in the context of laparoscopic colorectal surgeries, where it has been shown to efficiently attenuate visceral pain better than ultrasound or laparoscopy-guided transversus abdominis plane (TAP) blocks, without concomitantly escalating postoperative complications such as ileus or prolonged hospitalization [ 124 – 126 ]. Moreover, when compared with epidural analgesia, intrathecal analgesia has been linked with a faster resumption of normal activities and shorter postoperative hospital stays following laparoscopic colorectal procedures [ 127 , 128 ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Multimodal Analgesia Strategy for Enhanced Recovery After Surgery in Elderly Colorectal Cancer Patients

Huang,

Zhang,

Wang

et al. 2024

Pain Ther

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Enhanced Recovery After Surgery (ERAS) protocols have substantially proven their merit in diminishing recuperation durations and mitigating postoperative adverse events in geriatric populations undergoing colorectal cancer procedures. Despite this, the pivotal aspect of postoperative pain control has not garnered the commensurate attention it deserves. Typically, employing a multimodal analgesia regimen that weaves together nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, and nerve blocks stands paramount in curtailing surgical complications and facilitating reduced convalescence within hospital confines. Nevertheless, this integrative pain strategy is not devoid of pitfalls; the specter of organ dysfunction looms over the geriatric cohort, rooted in the abuse of analgesics or the complex interplay of polypharmacy. Revolutionary research is delving into alternative delivery and release modalities, seeking to allay the inadvertent consequences of analgesia and thereby potentially elevating postoperative outcomes for the elderly post-colorectal cancer surgery populace. This review examines the dual aspects of multimodal analgesia regimens by comparing their established benefits with potential limitations and offers insight into the evolving strategies of drug administration and release.

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“…Traditional anesthetic drugs, such as midazolam, exert analgesic effects by acting on the gamma-am-Effect of transversus abdominis plane block combined with low-dose dexmedetomidine on elderly patients undergoing laparoscopic colectomy inobutyric acid system, but they suppress the immune function. Nevertheless, anesthetic drugs have a more serious impact on the central nervous system of elderly patients, with a higher risk of postoperative delirium [5][6][7][8][9]. Delirium is a common clinical syndrome of acute temporary disturbance of neurological function, manifested as consciousness and cognitive dysfunction [10].…”

Section: Introductionmentioning

confidence: 99%

Effect of transversus abdominis plane block combined with low-dose dexmedetomidine on elderly patients undergoing laparoscopic colectomy.

Zhang¹,

Hao²

2023

Videosurgery and Other Miniinvasive Techniques

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Introduction Colon cancer is a common malignancy, for which surgery is currently the preferred therapy. Aim To assess the effect of transversus abdominis plane block (TAPB) combined with low-dose dexmedetomidine on elderly patients undergoing laparoscopic colectomy. Material and methods Sixty-two elderly patients undergoing laparoscopic colectomy between March 2021 and March 2022 were randomly selected and equally divided into Group A (low-dose dexmedetomidine) and Group B (TAPB + low-dose dexmedetomidine) by the randomized double-blind method. The treatment outcomes were compared. Results The resting and active Visual Analogue Scale and Pittsburgh Sleep Quality Index scores were lower in Group B than those in Group A at 6 h, 1 day, 2 days and 3 days after operation (p < 0.05). The two groups had no significant differences in the levels of cluster of differentiation 4+ (CD4+), CD8+ and free Cor, CD4+/CD8+ ratio and NK cell level before anesthesia (p > 0.05). At 24 h after the operation, the level of CD4+, CD4+/CD8+ ratio and NK cell level were higher in Group B than those in Group A, and the levels of CD8+ and free Cor were lower in Group B (p < 0.05). Group B had higher partial pressure of oxygen ((45.52 ±11.14) mm Hg) and pH (7.42 ±0.06) (p < 0.05) and lower partial pressure of carbon dioxide ((4.05 ±0.32) mm Hg) than those of Group A (p < 0.05). Conclusions TAPB combined with low-dose dexmedetomidine can exert better anesthetic, analgesic and sedative effects, and ameliorate stress responses.

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The additional analgesic effects of transverse abdominis plane block in patients receiving low-dose intrathecal morphine for minimally invasive colorectal surgery: a randomized, single-blinded study

Cited by 7 publications

References 28 publications

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

Postoperative Multimodal Analgesia Strategy for Enhanced Recovery After Surgery in Elderly Colorectal Cancer Patients

Effect of transversus abdominis plane block combined with low-dose dexmedetomidine on elderly patients undergoing laparoscopic colectomy.

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