Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.005
Brazilian Journal of Anesthesiology
Clinical Research

Efficacy of ultrasound-guided Transversus Abdominis Plane (TAP) block in inguinal hernia surgery and the immunomodulatory effects of proinflammatory cytokines: prospective, randomized, placebo-controlled study

Eficácia do bloqueio do Plano Transverso Abdominal (PTA) guiado por ultrassom em cirurgia de hérnia inguinal e os efeitos imunomoduladores de citocinas pró-inflamatórias: estudo prospectivo, randomizado, controlado por placebo

Ebru Canakci, Murat Cihan, Ali Altinbas, Zubeyir Cebeci, Ahmet Gultekin, Nilay Tas

Downloads: 1
Views: 107

Abstract

Background
Tumor Necrosis Factor-α (TNF-α) and Interleukin-1β (IL-1β) are among the cytokines released secondary to the surgical stress response. The objective of this study was to investigate the effect of a Transversus Abdominis Plane (TAP) block on postoperative pain and its immunomodulatory activity through proinflammatory cytokines.

Methods
TAP (study group; n = 40) or p-TAP (placebo group; n = 40). Patients in the TAP group underwent an Ultrasound (US) guided unilateral TAP block using 20-cc 0.5% bupivacaine solution. Patients in the p-TAP group underwent a sham block using 20-cc isotonic solution. The TNF-α and IL-1β levels were measured three times at preoperative hour-0 and postoperative hours 4 and 24. Visual Analog Scale (VAS) scores were recorded at 0 -hs, 30-minutes, 4 -hs and 24 -hs. Analgesic use within the first 24 -hs following surgery was monitored.

Results
The postoperative VAS score was decreased in the TAP group at all time points (0, 4, and 24 hours), and the differences between groups were statistically significant (p <  0.001 for all comparisons). In the TAP group, the TNF-α and IL-1β levels at 4 and 24 hours post operation were significantly lower than the preoperative levels (p <  0.001 for all comparisons).

Conclusion
The TAP block for pre-emptive analgesia enabled effective hemodynamic control during the intraoperative period, provided effective pain control in the postoperative period, and decreased inflammation and surgical stress due to the decreased levels of the proinflammatory cytokines TNF-α and IL-1β in the first postoperative 24 hours, indicating immunomodulatory effect.

Keywords

Immunomodulation;  Pain control;  Proinflammatory cytokines;  Transversus abdominis plane block

Resumo

Introdução: O fator de necrose tumoral-α (TNF-α) e a interleucina-1 (IL-1β) estão entre as citocinas liberadas secundariamente à resposta ao estresse cirúrgico. O objetivo deste estudo foi investigar o efeito do bloqueio do plano transverso abdominal (PTA) na dor pós-operatória e sua atividade imunomoduladora por meio de citocinas pró-inflamatórias. Métodos: TAP (grupo de estudo; n = 40) ou p-PTA (grupo de placebo; n = 40). Os pacientes do grupo PTA foram submetidos a bloqueio PTA unilateral guiado por ultrassom (US) com solução de bupivacaína 20 cc a 0,5%. Os pacientes do grupo p-PTA foram submetidos a sham block com solução isotônica de 20 cc. Os níveis de TNF-α e IL-1β foram medidos três vezes na hora pré-operatória 0 e horas pós-operatórias 4 e 24. Os escores da Escala Visual Analógica (EVA) foram registrados em 0 horas, 30 minutos, 4 horas e 24 horas. O uso de analgésicos nas primeiras 24 horas após a cirurgia foi monitorado. Resultados: O escore EVA pós-operatório diminuiu no grupo PTA em todos os momentos (0, 4 e 24 horas), e as diferenças entre os grupos foram estatisticamente significativas (p <0,001 para todas as comparações). No grupo PTA, os níveis de TNF-α e IL-1β em 4 e 24 horas após a operação foram significativamente menores do que os níveis pré-operatórios (p <0,001 para todas as comparações). Conclusão: O bloqueio PTA para analgesia preventiva possibilitou o controle hemodinâmico efetivo no intraoperatório, proporcionou controle efetivo da dor no pós-operatório e diminuição da inflamação e do estresse cirúrgico devido à diminuição dos níveis das citocinas pró-inflamatórias TNF- e IL- 1 nas primeiras 24 horas de pós-operatório, indicando efeito imunomodulador.

Palavras-chave

Imunomodulação; Controle da dor; Citocinas próinflamatórias; Bloqueio do plano transverso abdominal

References

1 Z. Kayhan Clinic anesthesiology (3 ed.), Logos Publishing, Istanbul (2004)

2 J.P. Desborough The stress response to trauma and surgery Br J Anaesth, 85 (2000), pp. 109-117

3 E. Marana, G. Scambia, M.L. Maussier, et al. Neuroendocrine stress response in patients undergoing benign ovarian cyst surgery by laparoscopy, minilaparotomy, and laparotomy J Am Assoc Gynecol Laparosc., 10 (2003), pp. 159-165

4 E. Marana, M.G. Annetta, F. Meo, et al. Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery Can J Anaesth., 50 (2003), pp. 348-354

5 I. Kelbel, M. Weiss Anaesthetics and immune function Curr Opin Anaesthesiol., 14 (2001), pp. 685-691

6 J. Yang, D. Papandria, D. Rhee, H. Perry, F. Abdullah Low-cost mesh for inguinal hernia repair in resource-limited settings Hernia., 15 (2011), pp. 485-489

7 A.N. Rafi Abdominal field block: a new approach via the lumbar triangle Anaesthesia., 56 (2001), pp. 1024-1026

8 G.M. El-Labban, E.N. Hokkam, M.A. El-Labban, K. Morsy, S. Saadl, K.S. Heissam Intraincisional vs intraperitoneal infiltration of local anaesthetic for controlling early post-laparoscopic cholecystectomy pain J Minim Access Surg., 7 (2011), pp. 173-177

9 F. Jin, F. Chung Multimodal analgesia for postoperative pain control J Clin Anesth., 13 (2001), pp. 524-539

10 S. Suresh, V.W. Chan Ultrasound guided transversus abdominis plane block in infants, children and adolescents: a simple procedural guidance for their performance Paediatr Anaesth., 19 (2009), pp. 296-299

11 A. Özdilek, Ç.A. Beyoğlu, Ç Demirdağ, et al. Perioperative analgesic effects of preemptive ultrasound-guided subcostal transversus abdominis plane block for percutaneous nephrolithotomy: a prospective, randomized trial J Endourol., 34 (2020), pp. 434-440

12 J.G. McDonnell, G. Curley, J. Carney, et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial Anesth Analg., 106 (2008), pp. 186-191

13 G. Niraj, A. Searle, M. Mathews, et al. Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy Br J Anaesth., 103 (2009), pp. 601-605

14 A.A. El-Dawlatly, A. Turkistani, S.C. Kettner, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy Br J Anaesth., 102 (2009), pp. 763-767

15 B.D. O’Donnell, J.G. McDonnell, A.J. McShane The transversus abdominis plane (TAP) block in open retropubic prostatectomy Reg Anesth Pain Med., 31 (2006), p. 91

16 R. Liu, H. Qin, M. Wang, K. Li, G. Zhao Transversus abdominis plane block with general anesthesia blunts the perioperative stress response in patients undergoing radical gastrectomy BMC Anesthesiol., 19 (2019), p. 205

17 J.M. Flaherty, D.B. Auyong, S.C. Yuan, et al. Continuous transversus abdominis plane block for primary open inguinal hernia repair: a randomized, double-blind, placebo-controlled trial Pain Med., 21 (2020), pp. e201-7

18 J.D. Vaillant, A. Fraga, M.T. Díaz, et al. Ozone oxidative postconditioning ameliorates joint damage and decreases pro-inflammatory cytokine levels and oxidative stress in PG/PS-induced arthritis in rats Eur J Pharmacol., 714 (2013), pp. 318-324

19 B. Xing, H. Chen, L. Wang, X. Weng, Z. Chen, X. Li Ozone oxidative preconditioning protects the rat kidney from reperfusion injury via modulation of the TLR4-NF-κB pathway Acta Cir Bras., 30 (2015), pp. 60-66
 

602691a30e8825c17668ae7a rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections