Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2017.10.007
Brazilian Journal of Anesthesiology
Scientific Article

Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy

O bloqueio do plano transverso abdominal subcostal pode melhorar a analgesia após colecistectomia laparoscópica

Vladimir Vrsajkov; Nedjica Manč; ić; ; Dunja Mihajlović; ; Suzana Tonković; Milić; ević; ; Arsen Uvelin; Jelena Pantić; Vrsajkov

http://dx.doi.org/10.1016/j.bjane.2017.10.007 Braz J Anesthesiol, vol.68, n2, p.149-153, 2018
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Abstract

Abstract Background and goal of study: After laparoscopic cholecystectomy, patients have moderate pain in the early postoperative period. Some studies shown beneficial effects of subcostal transversus abdominis plane block on reducing this pain. Our goal was to investigate influence of subcostal transversus abdominis plane block on postoperative pain scores and opioid consumption. Materials and methods: We have randomized 76 patients undergoing laparoscopic cholecystectomy to receive either subcostal transversus abdominis plane block (n = 38) or standard postoperative analgesia (n = 38). First group received bilateral ultrasound guided subcostal transversus abdominis plane block with 20 mL of 0.33% bupivacaine per side before operation and tramadol 1 mg.kg−1 IV for pain breakthrough (≥6). Second group received after operation tramadol 1 mg.kg−1/6 h as standard hospital analgesia protocol. Both groups received acetaminophen 1 g/8 h IV and metamizole 2.5 g/12 h. Pain at rest was recorded for each patient using NR scale (0–10) in period of 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 16 h after the surgery. Results and discussion: We obtained no difference between groups according age, weight, intraoperative fentanyl consumption and duration of surgery. Subcostal transversus abdominis plane block significantly reduced postoperative pain scores compared to standard analgesia in all periods after surgery. Tramadol consumption was significantly lower in the subcostal transversus abdominis plane (24.29 ± 47.54 g) than in the standard analgesia group (270.2 ± 81.9 g) (p = 0.000). Conclusion: Our results show that subcostal transversus abdominis plane block can provide superior postoperative analgesia and reduction in opioid requirements after laparoscopic cholecystectomy.

Keywords

Subcostal block, Laparoscopic cholecystectomy, Analgesia, Regional anesthesia

Resumo

Resumo Justificativa e objetivo: Após a colecistectomia laparoscópica, os pacientes apresentam dor moderada no pós-operatório imediato. Alguns estudos mostraram efeitos benéficos do bloqueio do plano transverso abdominal subcostal na redução dessa dor. Nosso objetivo foi investigar a influência do bloqueio do plano transverso abdominal subcostal nos escores de dor no pós-operatório e no consumo de opioides. Materiais e métodos: Foram randomizados 76 pacientes submetidos à colecistectomia laparoscópica para receber o bloqueio do plano transverso abdominal subcostal (n = 38) ou analgesia padrão no pós-operatório (n = 38). O primeiro grupo recebeu bloqueio do plano transverso abdominal subcostal bilateral guiado por ultrassom com 20 mL de bupivacaína a 0,33% em cada lado antes da operação e tramadol IV (1 mg.kg−1) para controle da dor (≥ 6). O segundo grupo recebeu tramadol (1 mg.kg−1/6 h) como protocolo-padrão de analgesia hospitalar pós-cirurgia. Ambos os grupos receberam acetaminofeno IV (1 g/8 h) e dipirona (2,5 g/12 h). A dor em repouso foi registrada para cada paciente com o uso da escala NR (0-10) nos períodos de 10 min, 30 min, 2 h, 4 h, 8 h, 12 h e 16 h após a cirurgia. Resultados e discussão: Não houve diferença entre os grupos em relação a idade, peso, consumo intraoperatório de fentanil e duração da cirurgia. O bloqueio do plano transverso abdominal subcostal reduziu significativamente o escore de dor no pós-operatório em comparação com a analgesia-padrão em todos os períodos após a cirurgia. O consumo de tramadol foi significativamente menor no grupo bloqueio do plano transverso abdominal subcostal (24,29 ± 47,54 g) do que no grupo analgesia padrão (270,2 ± 81,9 g) (p = 0,000). Conclusão: Nossos resultados mostram que o bloqueio do plano transverso abdominal subcostal pode proporcionar analgesia superior no pós-operatório e redução da necessidade de opioides após colecistectomia laparoscópica.

Palavras-chave

Bloqueio subcostal, Colecistectomia laparoscópica, Analgesia, Anestesia regional

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