Which G-tube to use in pullers? Assessment of pull pressures on silicone skin models to determine optimal catheter choice for patients with recurrent pulled gastrostomy tubes

Abstract

performed. Data obtained included age; sex; ASA physical classification score; Mallampati score; indication; type of anesthesia; and pain levels pre-procedure, immediate (0-2 hours) post-procedure, and 24-hour post-procedure via a verbal numerical scale or visual analog scale. Patient requirement for post-procedural narcotic analgesia was also evaluated. Patients unresponsive to stimuli were excluded. Results: Ninety-eight patients underwent successful percutaneous gastrostomy tube placement. Eleven patients (11%) received regional anesthesia via ultrasound-guided rectus sheath and/or transversus abdominis plane nerve block. Indications for regional anesthesia included compromised airway from head or neck malignancy (5), cerebrovascular accident (4), or other neurologic condition (2). Patients receiving regional anesthesia tolerated the procedure without need for additional intraoperative analgesia. Average pain level in the regional anesthesia vs. conscious sedation groups recorded: 0.0 vs. 0.1 pre-procedure (p ¼ 0.11), 2.4 vs. 6.1 immediately post-procedure (p ¼ 0.005), and 3.0 vs. 2.6 at 24 hours post-procedure (p ¼ 0.47). Patients receiving regional anesthesia had decreased overall post-procedure narcotic analgesia requirement. No complications relating to nerve block were seen. Conclusions: Regional anesthesia is effective at controlling perioperative pain for percutaneous gastrostomy tube placement and is a useful alternative for patients who cannot tolerate conscious sedation due to airway or respiratory compromise.