Truncal regional nerve blocks in clinical anesthesia practice

Urits, Ivan; Ostling, Peter S; Novitch, Matthew B.; Burns, James C.; Charipova, Karina; Gress, Kyle; Kaye, Rachel; Eng, Matthew R.; Cornett, Elyse M.; Kaye, Alan D.

doi:10.1016/j.bpa.2019.07.013

Cited by 45 publications

(34 citation statements)

References 76 publications

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“…Compared with TAP blocks, the QL block, which is a regional variation of the TAP block, has been suggested to be a more reliable approach for pain after abdominal surgery. QL blocks result in more extensive sensory blocks than TAP blocks (T10-L3vs.T10-T12, [11]).…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…The transversus abdominis plane (TAP) block has shown promise in minimizing reliance on opioids following inpatient laparoscopic surgery [3,26]. The TAP block provides analgesia to the anterior abdominal wall through infiltration of local anesthesia between the transversus abdominis and internal oblique muscles [3].…”

Section: Regional Anesthesiamentioning

confidence: 99%

“…The paravertebral block (PVB) is a type of chest wall block that is considered the gold standard for regional anesthesia for breast surgery [3,26]. Use of PVB in conjunction with general anesthesia has been demonstrated to result in decreased pain ratings, decreased postoperative opioid consumption, and overall improved recovery compared to use of general anesthesia alone.…”

Section: Regional Anesthesiamentioning

confidence: 99%

“…The major risk of PVB is pneumothorax, but rates are exceedingly low especially with widespread use of ultrasound guidance [ 3 ]. Fascial blocks such as the pectoralis, serratus, and erector spinae blocks represent new alternatives to PVB that have been shown to reduce opioid consumption following breast surgery [ 3 , 26 , 27 ]. To date, studies supporting their use in same-day surgery have been small and more data is needed to support their quality and safety compared to PVB [ 3 ].…”

Section: Reviewmentioning

confidence: 99%

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Maximization of Non-Opioid Multimodal Analgesia in Ambulatory Surgery Centers

Charipova¹,

Gress²,

Urits³

et al. 2020

Cureus

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Ambulatory surgery centers aid the healthcare system by not only providing a cost-effective option for delivery of care but also by helping to reduce overwhelming case volumes at inpatient facilities. While outpatient protocols have been designed for an increasing number of surgical procedures, the inpatient to outpatient transition of surgery remains limited by both procedure type and patient comorbidities. This limitation stems in part from the heavy emphasis on accelerated discharge following outpatient procedures, given that prolonged recovery time is associated with delayed turnover and increased nursing care demands. Since its inception, enhanced recovery after surgery (ERAS) has aimed to primarily reduce the disruption of physiologic homeostasis that occurs secondary to surgery. More recently, the aim of ERAS has evolved to help transition inpatient procedures to outpatient settings and may even be useful in more emergent cases. It should be noted, however, that outpatient surgery even in combination with ERAS is not the best option for all patients, and the use of ERAS protocols should be complemented with predictive assessments of patient risk. Beyond augmenting the efficiency of outpatient surgery, ERAS protocols, when used in eligible patients and especially when combined with regional anesthetic techniques, are effective in delivering opioid-sparing pain management while increasing overall outcomes and patient satisfaction rates.

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“…The goal of multimodal analgesia, especially for chronic pain patients who may use a daily pain regimen, is to take advantage of multiple receptors involved in pain production [3]. Therapy should be catered not only to individual patients but also to the type of surgery-use of gabapentin in combination with a paravertebral block that has been efficacious for breast surgery but cannot be recommended universally [15,20].…”

Section: Recommendations For Managementmentioning

confidence: 99%

Management of Patients With Chronic Pain in Ambulatory Surgery Centers

Charipova¹,

Gress²,

Urits³

et al. 2020

Cureus

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In the setting of increasingly streamlined surgical techniques and perioperative care, the United States healthcare system is seeing a steady rise in the number of procedures being carried out at ambulatory surgery centers. Concurrently, awareness and diagnosis of both chronic pain conditions and substance use disorders have also improved in recent years. As a result of these two shifts, the demographic characteristics of patients undergoing procedures at ambulatory surgery centers are actively evolving. Chronic pain and substance use disorders are difficult to manage in both the outpatient and inpatient settings and present unique challenges in the context of perioperative planning. Both conditions are associated with worsened postoperative outcomes, including refractory pain, decreased functional status, increased length of stay, increased readmission rates, and increased economic costs. There has been a recent movement to include a preoperative risk stratification calculation for these patients, followed by the implementation of enhanced recovery after surgery (ERAS) protocols in these patient cohorts. Taking a step further, patients benefit when standard ERAS protocols are augmented by integrating designated pain specialists into the ambulatory surgery team. This multimodal and multidisciplinary approach must be assessed in the context of the human and financial resources of a given institution and surgery center, but has been shown to improve the quality and safety of perioperative care effectively.

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Truncal regional nerve blocks in clinical anesthesia practice

Cited by 45 publications

References 76 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

Maximization of Non-Opioid Multimodal Analgesia in Ambulatory Surgery Centers

Management of Patients With Chronic Pain in Ambulatory Surgery Centers

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