Ultrasound-guided left lateral transversus abdominis plane block combined with rectus sheath block in peritoneal dialysis catheter placement

Abstract

This study assessed the utility of ultrasound-guided lateral transversus abdominis plane (TAP) block combined with rectus sheath (RS) block for peritoneal dialysis catheter placement surgery. Thirty consecutive patients with end-stage renal disease scheduled to have peritoneal dialysis catheter placement received a left lateral TAP block combined with RS block performed under ultrasound guidance. The TAP and RS blocks were, respectively, conducted with 15 ml of 0.5% ropivacaine and 10 ml of 0.5% ropivacaine. Pain intensity was evaluated by verbal rating scale during operation, and the degree of patient and surgeon satisfaction was qualified by a categorical scale. Twenty-nine patients received successful blocks without any other adjuvant anesthetic drugs. One patient required rescue analgesia with lidocaine infiltration. No complications related to regional anesthesia were noted. Ultrasound-guided left lateral TAP block combined with RS block can serve as the primary anesthetic modality for peritoneal dialysis catheter placement surgery.

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“…Regional anesthesia became popular because of its satisfactory anesthetic effect and negligible systemic effects, especially for patients with significant comorbidities. Previous studies have shown that TAP and RS blockades can provide effective analgesia during PD catheter placement, and they have been shown to be an ideal anesthetic option for patients with ESRD [ 2 , 3 , 13 ]. However, ultrasound-guided TAP and RS blockades with ropivacaine individually cannot relieve the pain of PD catheter insertion and anxiety caused by the procedure that result in perioperative OS.…”

“…At present, this surgical technique remains the most widely used method in clinical practice in China; it is accurate and reliable, involves few complications, and is suitable for the majority of patients who intend to undergo PD. It has been reported in the literature that ultrasound-guided transversus abdominis plane (TAP) and rectus sheath (RS) blockades can be used for open surgical PD catheter insertion [ 2 ]. However, because of the lack of sedation and visceral analgesia, propofol and sufentanil consumption were increased during surgery; without satisfactory sedation and visceral analgesia, the surgical process may be affected [ 3 ].…”

<p>Ultrasound-Guided Unilateral Transversus Abdominis Plane Combined with Rectus Sheath Block versus Subarachnoid Anesthesia in Patients Undergoing Peritoneal Dialysis Catheter Surgery: A Randomized Prospective Controlled Trial</p>

“…Over the past few years, some scholars had tried to apply the TAP block in PD catheter placement. 7 , 8 , 16 - 20 In some reports, the TAP block was applied alone with a success rate of 87.50% (n=24), 91.7% (n=60) or 95% (n=20). 7 , 8 , 18 However, the additional use of anesthetic drugs was needed to achieve a better analgesia or sedation effect.…”

“… 20 Wei Dai et al applied this combination of blocks for open PD catheter insertion with a 96.67% (n=30) success rate. 16 They combined the two blocking methods to make it more suitable for PD catheter insertion, but they did not compare this type of anesthesia with other methods. In our setting, the TAP + RS block group achieved a 93.33% (n=30) success rate, similar to the SA group, while also taking less time to perform.…”

“…14 , 15 Although studies have shown that the TAP block, either with or without the RS block, can be used for PD catheter placement, thus far none have compared this method with SA. 7 , 8 , 16 - 20 Hence, the primary objective of this study is to test the efficacy of the TAP + RS block as a principal anesthesia method for PD catheter surgery compared to SA. The secondary objective is to analyze the intraoperative hemodynamics and postoperative analgesic efficiency.…”