Efficacy of ultrasound-guided oblique subcostal transversus abdominis plane block after laparoscopic sleeve gastrectomy: A double blind, randomized, placebo controlled study

Introduction: Pain control in the morbidly obese can be especially challenging because of increased sensitivity to opioid-induced respiratory depression. The subcostal transversus abdominis plane block is associated with a large area of spread (T7-L1). The aim of the study was to test the hypothesis that US-guided TAP blocks can reduce opioid consumption during the first 24 h after of laparoscopic sleeve gastrectomy in comparison with port site local anesthetic infiltration and systemic analgesia. Method: Sixty-three ASA II/III adult patients listed for elective laparoscopic sleeve gastrectomy were randomly allocated in one of three groups: Group I (OSTAP) received bilateral OSTAP block. Group II (Local) received local anesthetic infiltration at trocar port sites. Group III (Control) placebo group received TAP block and port site infiltration by same volumes of sterile normal saline. Twenty-four hours postopetrative morphine consumption, the dose of fentanyl (μg) required during surgery, equivalent morphine dose in the recovery unit (PACU) and first morphine dose were recorded. The quality of analgesia is assessed by Visual Analogue Scale for 24 h at rest and movement. Results: The mean opioid consumptions in PACU showed significant difference between the three groups, P = 0.02. The mean 24 h morphine consumption showed statistically significant difference between groups (P value < 0.001). Significant differences were found between both OSTAP and Local groups with control group (P < 0.001) and also between OSTAP and Local groups (P = 0.02). Pain score of OSTAP group was significantly lower than local infiltration group at 6 and 4 h at rest and movement respectively. OSTAP group had faster extubation time than other groups. Postoperative nausea and vomiting were not significant between groups. No signs or symptoms of local anesthetic systemic toxicity or complications were detected. Conclusion: Oblique subcostal TAP block is a good alternative for providing analgesia during the postoperative period. The block is easily performed using ultrasound guidance. It is safe, provides effective analgesia with significant morphine-sparing effect with reduced side-effects of opioids

A comparative study of the effect of caudal dexmedetomidine versus morphine added to bupivacaine in pediatric infra-umbilical surgery

Background: One of the most commonly used regional anesthetic techniques in pediatric surgeries is the caudal epidural block. Its main disadvantage remains the short duration of action. Hence, different additives have been used. Dexmedetomidine is a potent as well as highly selective α2 adrenergic receptor agonist. The aim of this randomized, double-blinded, study was to compare the duration of postoperative analgesia of caudal dexmedetomidine versus morphine in combination with bupivacaine in pediatric patients undergoing lower abdominal or perineal surgery. Patients and Methods: A total of 50 pediatric patients 1-5 years old The American Society of Anesthesiologists status I, II scheduled for lower abdominal and perineal surgeries were included in the study. The patients were enrolled into 2 equal groups: Group A patients (n = 25) received dexmedetomidine with bupivacaine while Group B patients (n = 25) received morphine with bupivacaine. Patients were placed in a supine position then inhalational general anesthesia was induced, and laryngeal mask airway (LMA) was placed. Patients were then given caudal epidural analgesia. By the end of surgery reversal of muscle relaxation was done and the LMA was removed. Post-operatively, the sedation as well as pain score were observed and recorded. Results: The current study showed that minor complications were recorded in the post-anesthesia care unit; in addition, significantly longer periods of analgesia and sedation were detected in Group A. However, no significant differences in demographic data, as well as in the duration of surgery, and the time of emergence from anesthesia and patient condition during recovery were detected. Conclusion: The present study suggested that use of dexmedetomidine, during single dose injection, as an additive to the local anesthetic bupivacaine in caudal epidural analgesia prolongs the duration of post-operative analgesia following lower abdominal as well as perineal surgery compared with caudal morphine with no side-effects on the vital signs. Postoperative side effects were seen with caudal morphine injection rather than with dexmedetomidine

Efficacy of combined ultrasound guided anterior and posterior rectus sheath block for postoperative analgesia following umbilical hernia repair: Randomized, controlled trial

Background: Anatomical variations in the thoracic nerves T7 to T11was found in up to 30% of the population as the anterior cutaneous branch of the nerves are formed before the rectus sheath and so do not penetrate the posterior wall of the rectus sheath. Posterior rectus sheath block was found to be effective for perioperative analgesia. We tested the efficacy of addition of anterior rectus sheath block to capture the anterior cutaneous branch of intercostal nerves as they emerge from the rectus muscle in anterior rectus sheath. Method: Sixty-three ASA I/II adult patients listed for elective umbilical hernia repair were randomly allocated in one of three groups: Bupivacaine hydrochloride 0.25% was injected by ultrasound guided bilateral posterior rectus sheath in Group I (PRSB) and bilateral anterior and posterior rectus sheath in Group II (APRSB). Group III received bilateral anterior and posterior rectus sheath block using isotonic saline. Twenty-four hours postopetrative morphine consumption, Intraoperative rescue fentanyl dose, equivalent morphine dose in the recovery unit and first morphine dose were recorded. The quality of analgesia is assessed by Visual Analogue Scale for 24 h. Results: Mean intraoperative rescue fentanyl dose was 19.23 ± 4.96 μg, 15.28 ± 2.75 μg and 12.85 ± 3.65 μg in control, PRSB and APRSB groups respectively (P < 0.001). The mean opioid consumptions in PACU was PRSB 3.47 ± 0.13 mg, APRSB 2.91 ± 0.15 mg and control 4.04 ± 0.56 mg respectively (P < 0.001). Significant difference in intraoperative rescue fentanyl was found between PRSB and APRSB group (P = 0.020). Also statistically significant difference was found between PRSB and APRSB groups in 24 h morphine consumption (P = 0.034). Conclusion: Addition of ultrasound anterior rectus sheath block together with posterior rectus sheath block added more significant analgesia than if we perform posterior rectus sheath alone. This was evidenced by decrease in Intraoperative rescue fentanyl, PACU morphine analgesia, 24 h morphine and pain assessment score