Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2018.02.001
Brazilian Journal of Anesthesiology
Scientific Article

Ultrasound-guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy: comparison of efficacy of bupivacaine and levobupivacaine on postoperative pain control

Bloqueio do plano abdominal transverso guiado por ultrassom em pacientes submetidos à colecistectomia laparoscópica: comparação da eficácia de bupivacaína e levobupivacaína no controle da dor pós-operatória

Arzu Yı; ldı; rı; m Ar; Dilek Erdoğ; an Arı; ; Yı; ldı; z Yiğ; it Kuplay; Yalı; n İ; ş; can; Firdevs Karadoğ; an; Damla Kı; rı; m; Fatma Nur Akgün

http://dx.doi.org/10.1016/j.bjane.2018.02.001 Braz J Anesthesiol, vol.68, n5, p.455-461, 2018
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Abstract

Abstract Background and objective The use of transversus abdominis plane block with different local anesthetics is considered as a part of multimodal analgesia regimen in laparoscopic cholecystectomy patients. However no studies have been published comparing bupivacaine and levobupivacaine for transversus abdominis plane block. We aimed to compare bupivacaine and levobupivacaine in ultrasound-guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy. Methods Fifty patients (ASA I/II), undergoing laparoscopic cholecystectomy were randomly allocated into two groups. Following anesthesia induction, ultrasound-guided bilateral transversus abdominis plane block was performed with 30 mL of bupivacaine 0.25% in Group B (n = 25) and 30 mL of levobupivacaine 0.25% in Group L (n = 25) for each side. The level of pain was evaluated using 10 cm visual analog scale (VAS) at rest and during coughing 1, 5, 15, 30 min and 1, 2, 4, 6, 12 and 24 h after the operation. When visual analogue scale > 3, the patients received IV tenoxicam 20 mg. If visual analogue scale remained >3, they received IV. tramadol 1 mg.kg−1. In case of inadequate analgesia, a rescue analgesic was given. The analgesic requirement, time to first analgesic requirement was recorded. Results Visual analogue scale levels showed no difference except first and fifth minutes postoperatively where VAS was higher in Group L (p < 0.05). Analgesic requirement was similar in both groups. Time to first analgesic requirement was shorter in Group L (4.35 ± 6.92 min vs. 34.91 ± 86.26 min, p = 0.013). Conclusions Bupivacaine and levobupivacaine showed similar efficacy at TAP block in patients undergoing laparoscopic cholecystectomy.

Keywords

Bupivacaine, Cholecystectomy, Laparoscopic surgery, Levobupivacaine, Postoperative analgesia

Resumo

Resumo Justificativa e objetivo O uso do bloqueio do plano transverso abdominal com diferentes anestésicos locais é considerado como parte do regime de analgesia multimodal em pacientes submetidos à colecistectomia laparoscópica. No entanto, nenhum estudo comparando bupivacaína e levobupivacaína para bloqueio do plano transverso abdominal foi publicado. Nosso objetivo foi comparar bupivacaína e levobupivacaína em bloqueio do plano transverso abdominal guiado por ultrassom em pacientes submetidos à colecistectomia laparoscópica. Métodos Cinquenta pacientes (ASA I/II), submetidos à colecistectomia laparoscópica foram alocados aleatoriamente em dois grupos. Após a indução da anestesia, o bloqueio do plano transverso abdominal bilateral guiado por ultrassom foi realizado com 30 mL de bupivacaína a 0,25% no Grupo B (n = 25) e 30 mL de levobupivacaína a 0,25% no Grupo L (n = 25) para cada lado. O nível de dor foi avaliado usando a escala visual analógica de 10 cm em repouso e durante a tosse em 1, 5, 15, 30 minutos e em 1, 2, 4, 6, 12 e 24 horas após a operação. Quando a escala visual analógica > 3, os pacientes receberam 10 mg de tenoxicam por via intravenosa (IV). Se a escala visual analógica permanecesse > 3, os pacientes recebiam tramadol IV (1 mg.kg−1). Em caso de analgesia inadequada, um analgésico de resgate foi administrado. A necessidade de analgésico e o tempo até a primeira solicitação de analgésico foram registrados. Resultados Os escores da escala visual analógica não mostraram diferença, exceto no primeiro e quinto minutos de pós-operatório, onde a escala visual analógica foi maior no Grupo L (p < 0,05). A necessidade de analgésico foi semelhante em ambos os grupos. O tempo até a primeira solicitação de analgésico foi menor no Grupo L (4,35 ± 6,92 min vs. 34,91 ± 86,26 min, p = 0,013). Conclusões Bupivacaína e levobupivacaína apresentaram eficácia similar no bloqueio TAP em pacientes submetidos à colecistectomia laparoscópica.

Palavras-chave

Bupivacaína, Colecistectomia, Cirurgia laparoscópica, Levobupivacaína, Analgesia pós-operatória

References

Petersen PL, Stjernholm P, Kristiansen VB. The beneficial effect of transversus abdominis plane block after laparoscopic cholecystectomy in day-case surgery: a randomized clinical trial. Anesth Analg. 2012;115:527-33.

Dabbagh AA. Pain after laparoscopic cholecystectomy. Zanco J Med Sci. 2009;13:37-42.

Mitra S, Khandelwal P, Roberts K. Pain relief in laparoscopic cholecystectomy – a review of the current options. Pain Pract. 2012;12:485-96.

De Oliveira GS, Fitzgerald PC, Marcus RJ. A dose-ranging study of the effect of transversus abdominis block on postoperative quality of recovery and analgesia after outpatient laparoscopy. Anesth Analg. 2011;113:1218-25.

Katircioğlu K, Hasegeli L, Ibrahimhakkioglu HF. A retrospective review of 34,109 epidural anesthetics for obstetric and gynecologic procedures at a single private hospital in Turkey. Anesth Analg. 2008;107:1742-5.

Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg. 2000;87:273-84.

El-Dawlatly AA, Turkistani A, Kettner SC. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth. 2009;102:763-7.

Ra YS, Kim CH, Lee GY. The analgesic effect of the ultrasound-guided transverse abdominis plane block after laparoscopic cholecystectomy. Korean J Anesthesiol. 2010;58:362-8.

Finnerty O, McDonnell JG. Transversus abdominis plane block. Curr Opin Anesthesiol. 2012;25:610-4.

Hebbard P, Fujiwara Y, Shibata Y. Ultrasound guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007;35:616-8.

Bava EP, Ramachandran R, Rewari V. Analgesic efficacy of ultrasound guided transversus abdominis plane block versus local anesthetic infiltration in adult patients undergoing single incision laparoscopic cholecystectomy: a randomized controlled trial. Anesth Essays Res. 2016;10:561-7.

Sinha S, Palta S, Saroa R. Comparison of ultrasound-guided transversus abdominis plane block with bupivacaine and ropivacaine as adjuncts for postoperative analgesia in laparoscopic cholecystectomies. Indian J Anaesth. 2016;60:264-9.

Ortiz J, Suliburk JW, Wu K. Bilateral transversus abdominis plane block does not decrease postoperative pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites. Reg Anesth Pain Med. 2012;37:188-92.

Kadam VR, Hower S, Kadam V. Evaluation of postoperative pain scores following ultrasound guided transversus abdominis plane block versus local infiltration following day surgery laparoscopic cholecystectomy – retrospective study. J Anaesthesiol Clin Pharmacol. 2016;32:80-3.

Bhatia N, Arora S, Wig J. Comparison of posterior and subcostal approaches to ultrasound-guided transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy. J Clin Anesth. 2014;26:294-9.

Oksar M, Koyuncu O, Turhanoglu S. Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy. J Clin Anesth. 2016;34:72-8.

Perkins FM, Kehlet H. Chronic pain as an outcome of surgery a review of predictive factors. Anesthesiology. 2000;93:1123-33.

Bisgaard T, Rosenberg J, Kehlet H. From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis. Scand J Gastroenterol. 2005;40:1358-64.

Alfieri S, Amid PK, Campanelli G. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011:239-49.

Bay-Nielsen M, Perkins FM, Kehlet H. Pain and functional Impairment 1-year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg. 2001;233:1-7.

Poobalan AS, Bruce J, Cairns W. A review of chronic pain after inguinal herniorrhaphy. Clin J Pain. 2003;19:48-54.

Koch T, Fichtner A, Schwemmer U. Levobupivacaine for epidural anaesthesia and postoperative analgesia in hip surgery. Anaesthesist. 2008;57:475-82.

Cox CR, Checketts MR, Mackenzie N. Comparison of S(-)-bupivacaine with racemic (RS)-bupivacaine in supraclavicular brachial plexus block. Br J Anaesth. 1998;80:594-8.

Peng K, Ji F, Liu H. Ultrasound-guided transversus abdominis plane block for analgesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Med Princ Pract. 2016;25:237-46.

Kopman AF, Naguib M. Laparoscopic surgery and muscle relaxants: is deep block helpful?. Anesth Analg. 2015;120:51-8.

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