Article (Scientific journals)
Bilateral subcostal transversus abdominis plane block does not improve the postoperative analgesia provided by multimodal analgesia after laparoscopic cholecystectomy: A randomised placebo-controlled trial.
Houben, Alan; Moreau, Anne-Sophie; DETRY, Olivier et al.
2019In European Journal of Anaesthesiology, 36 (10), p. 772-777
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Abstract :
[en] BACKGROUND: Laparoscopic cholecystectomy might be considered minor surgery, but it may result in severe postoperative pain. Subcostal transversus abdominis plane (TAP) block, which produces long-lasting supra-umbilical parietal analgesia, might improve analgesia after laparoscopic cholecystectomy. OBJECTIVE: We investigated whether subcostal TAP block would reduce opioid consumption and pain after laparoscopic cholecystectomy in patients provided with multimodal analgesia. DESIGN: A randomised, placebo-controlled, double-blind study. SETTING: The study was conducted at a university teaching hospital from December 2017 to June 2018. PATIENTS: Sixty patients scheduled for laparoscopic cholecystectomy were included. Anaesthesia and postoperative analgesia (etoricoxib, paracetamol, ketamine and dexamethasone) were standardised. INTERVENTION: After induction of anaesthesia, patients were allocated into two groups: ultrasound-guided bilateral subcostal TAP block with 20 ml of levobupivacaine 0.375% and epinephrine 5 mug ml or 0.9% saline with epinephrine 5 mug ml. MAIN OUTCOME MEASURES: Opioid consumption in the recovery room and during the first 24 h after surgery were recorded. Postoperative somatic and visceral pain scores, fatigue and nausea were measured. Intra-operative end-tidal concentrations of sevoflurane (FETSEVO) were also recorded. RESULTS: Twenty-four hour postoperative opioid consumption were similar in both groups: 21.2 mg (95% CI 15.3 to 27.1) vs. 25.2 (95% CI 15.1 to 35.5) oral morphine equivalent in the levobupivacaine and 0.9% saline groups, respectively; P = 0.48. No significant between-group differences were observed with regards to parietal (P = 0.56) and visceral (P = 0.50) pain scores, fatigue and nausea. FETSEVO was slightly lower in the levobupivacaine group (P < 0.01). CONCLUSION: Subcostal TAP block does not improve the analgesia provided by multimodal analgesia after laparoscopic cholecystectomy. It allows for a small reduction in intra-operative sevoflurane requirements. TRIAL REGISTRATION: NCT0339153.
Disciplines :
Gastroenterology & hepatology
Surgery
Anesthesia & intensive care
Author, co-author :
Houben, Alan ;  Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
Moreau, Anne-Sophie
DETRY, Olivier  ;  Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Chirurgie abdo, sénologique, endocrine et de transplantation
KABA, Abdourahmane ;  Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
JORIS, Jean ;  Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
Language :
English
Title :
Bilateral subcostal transversus abdominis plane block does not improve the postoperative analgesia provided by multimodal analgesia after laparoscopic cholecystectomy: A randomised placebo-controlled trial.
Publication date :
2019
Journal title :
European Journal of Anaesthesiology
ISSN :
0265-0215
eISSN :
1365-2346
Publisher :
Wolters Kluwer Health, Spain
Volume :
36
Issue :
10
Pages :
772-777
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 01 October 2019

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