The Role of Preoperative and Postoperative Transversus Abdominis Plane and Rectus Sheath Block in Patients Undergoing Total Laparoscopic Hysterectomy

Yagi, Katsumi; Adachi, K.; Tanaka, Eriko; Toda, Asuka; Miyoshi, Yukari; Funada, Rina; Yamamoto, Yoshimitsu

doi:10.1016/j.jopan.2020.02.014

Cited by 2 publications

(16 citation statements)

References 15 publications

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“…Animal studies have shown that preemptive analgesia can prevent the development of central hypersensitivity after nociceptive demands and reduce postoperative pain [13,14]. Previous studies in patients undergoing laparoscopic surgery have also suggested that pre-RSB provides preemptive analgesia [3,4,6]. Although the concept of preemptive analgesia remains controversial [7,9], it is supported by the results of the present study.…”

Section: Discussionsupporting

confidence: 76%

“…Although some reports have suggested that pre-RSB is more effective for postoperative analgesia than post-RSB, we could not nd any reports concluding that post-RSB is more effective [3,4,6]. We presumed that pre-RSB functioned as "preemptive analgesia" in the present and previous studies.…”

Section: Discussioncontrasting

confidence: 52%

“…The Kaplan-Meier curve was roughly parallel and showed that the ratio of analgesia-free patients changed approximately 2 h after surgery, suggesting that the intergroup differences in analgesia requests in the present study were earlier than those in previous studies. In previous studies, analgesia requests were only compared at xed points, such as 1, 12, and 24 h after surgery, and differences in requests were examined only at these points [3,4,6]. However, the curves in the present study provide a clearer picture of the differences in the changes between the two groups over time.…”

Section: Discussionmentioning

confidence: 86%

“…Yagi et al published a prospective observational cohort study of patients undergoing abdominal wall (transverse abdominal plane [TAP]) and RSB in total laparoscopic hysterectomy. They showed that nonsteroidal in ammatory drug usage in women who underwent a preoperative TAP and RS block was signi cantly lower than that in women who received a postoperative block within the rst 12 h, with both groups receiving 40 mL of 0.25% ropivacaine in total (pre-versus post-, 54.4% versus 75.0%; P = 007) [4]. Jeong et al reported a single-center randomized controlled trial (RCT) on the use of RSB in laparoscopic cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

“…We estimated the sample size based on the expected incidence of postoperative usage of analgesic agents, as suggested in previous studies [4]. Assuming that the baseline incidence of the usage of analgesic agents after anesthesia was 75% in the control group and considering a 20% reduction in the incidence in the pre-RSB group to be clinically important, we estimated that 99 patients would be required to demonstrate this difference (two-sided alpha level of 0.05, power of 0.8).…”

Section: Sample Sizementioning

confidence: 99%

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Preoperative versus postoperative rectus sheath block for acute postoperative pain relief: a retrospective cohort study

Nakazawa

Fukushima

Shoji

et al. 2023

Preprint

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Background Although rectus sheath block (RSB) is routinely used in laparoscopic surgeries to reduce mid-abdominal pain, it is unclear whether RSB should be performed before or after surgery. In this study, we investigated the optimal timing for RSB in patients undergoing laparoscopic surgery. Methods This retrospective cohort study analyzed patients who underwent RSB during laparoscopic procedures at our hospital between January 2013 and December 2018. The primary outcome was the first analgesia request within 24 h after the end of anesthesia. The patients were divided into preoperative RSB (pre-RSB) and postoperative RSB (post-RSB) groups. A multivariable Cox proportional hazards regression model was used to analyze analgesia requests in the unmatched and propensity-score (PS)-matched patient populations. Results We analyzed the findings for 609 of 14284 patients (pre-RSB group, 227 patients; post-RSB group, 382 patients). After PS matching, 97 patients were assigned to both groups. Although the time from extubation to the first analgesic request was not significantly different between the two groups (322 versus 294 min, P = 0.57), the patients in the pre-RSB group showed a lower risk of postoperative first analgesic administration after PS matching (adjusted hazard ratio, 0.71; 95% confidence interval, 0.53–0.95; P = 0.023). Conclusions Among patients undergoing laparoscopic surgery, the pre-RSB group tended to show a longer time to the first analgesic request. Patients in the pre-RSB group showed a lower risk of analgesic administration within 24 h than those in the post-RSB group. Thus, it may be preferable to perform RSB preoperatively. Trial registration: This study was registered with the University Hospital Medical Information Network-Individual Case Data Repository (UMIN000047494).

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Section: Discussionsupporting

confidence: 76%

Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Sample Sizementioning

confidence: 99%

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Preoperative versus postoperative rectus sheath block for acute postoperative pain relief: a retrospective cohort study

Nakazawa

Fukushima

Shoji

et al. 2023

Preprint

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Preoperative versus postoperative ultrasound-guided rectus sheath block for acute postoperative pain relief after laparoscopy: A retrospective cohort study

Nakazawa,

Fukushima,

Shoji

et al. 2024

Medicine

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Although rectus sheath block (RSB) is routinely used in laparoscopic surgeries to reduce mid-abdominal pain, whether RSB should be performed before or after surgery remains unclear. Herein, the optimal timing for RSB in patients undergoing laparoscopic surgery was investigated. This retrospective cohort study analyzed the data of patients who underwent RSB during laparoscopic procedures at our hospital between January 2013 and December 2018. The primary outcome was the time to rescue analgesia within 24 hours postanesthesia. The patients were divided into preoperative (pre-) and postoperative (post-) RSB groups. A multivariable Cox proportional hazards regression model was used to analyze the time to rescue analgesia in the unmatched and propensity score (PS)-matched patient populations. In total, 609/14,284 patients were included (pre-RSB group, 227 patients; post-RSB group, 382 patients). After PS matching, 97 patients were assigned to both groups. Although the time from extubation to the first analgesic request was not significantly different between the 2 groups (322 vs 294 minutes, P = .57), the patients in the pre-RSB group showed a lower risk of postoperative first analgesic administration after PS matching (adjusted hazard ratio, 0.71; 95% confidence interval, 0.53–0.95; P = .023). Among patients undergoing laparoscopic surgery, those in the pre-RSB group tended to have a longer time to the first analgesic request and had a lower risk of analgesic administration within the first 24 hours than those in the post-RSB group. Thus, performing RSB preoperatively may be preferable.

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The Role of Preoperative and Postoperative Transversus Abdominis Plane and Rectus Sheath Block in Patients Undergoing Total Laparoscopic Hysterectomy

Cited by 2 publications

References 15 publications

Preoperative versus postoperative rectus sheath block for acute postoperative pain relief: a retrospective cohort study

Preoperative versus postoperative rectus sheath block for acute postoperative pain relief: a retrospective cohort study

Preoperative versus postoperative ultrasound-guided rectus sheath block for acute postoperative pain relief after laparoscopy: A retrospective cohort study

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