Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial
Vasanth Rao Kadam,1 Roelof M Van Wijk,1 John L Moran,2 Shantan Ganesh,3 A Kumar,1 Rajesh Sethi,1 Patricia Williams2,4 1Department of Anaesthesia, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA, 2Intensive Care Unit, The Queen Elizabeth Hospital, School of Medi...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2017-07-01
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| Series: | Journal of Pain Research |
| Subjects: | |
| Online Access: | https://www.dovepress.com/continuous-transversus-abdominis-plane-block-vs-intermittent-bolus-for-peer-reviewed-article-JPR |
| _version_ | 1818504711106461696 |
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| author | Rao Kadam V Van Wijk RM Moran JL Ganesh S Kumar A Sethi R Williams P |
| author_facet | Rao Kadam V Van Wijk RM Moran JL Ganesh S Kumar A Sethi R Williams P |
| author_sort | Rao Kadam V |
| collection | DOAJ |
| description | Vasanth Rao Kadam,1 Roelof M Van Wijk,1 John L Moran,2 Shantan Ganesh,3 A Kumar,1 Rajesh Sethi,1 Patricia Williams2,4 1Department of Anaesthesia, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA, 2Intensive Care Unit, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA, 3Department of Surgery, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA, 4Department of Epidemiology and Preventive Medicine, School Public Health and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia Background: Continuous and intermittent bolus techniques of transversus abdominis plane (TAP) blocks have been used for analgesia after abdominal surgery. Although both are effective, there are no studies comparing them. The aim of this study is to compare analgesia and cost-effectiveness between these groups.Methods: After obtaining ethical approval, 20 American Society of Anesthesiologists ASA grade I to III patients undergoing elective abdominal surgery were recruited with 10 patients allocated to each arm. Bilateral ultrasound-guided TAP blocks were performed with an initial bolus of 0.5% ropivacaine 20 mL per side, followed by catheter insertion. After surgery, the continuous infusion group received 0.2% ropivacaine 8 mL/hour on each side and the intermittent bolus group received doses of 0.2% ropivacaine 20 mL per side every 8 hours for 48 hours. Both groups received intravenous fentanyl patient-controlled analgesia and regular oral paracetamol. Parameters recorded included numerical rating scores for pain and post-operative analgesic consumption at baseline (time 0) and at 1 hour, 1 day and 2 days post-operatively. The duration of catheter insertion, complications, patient satisfaction and information regarding costs were also recorded. Patient satisfaction was assessed utilizing a 4-point “Likert” scale on day 2 and on day 30. Pain and Likert scores were analysed by non-parametric sum rank test and all two-sampled t-tests assumed unequal variances.Results: There was no difference between duration of TAP block, anesthetic and surgical technique and length of stay (p=0.23). Primary outcomes: pain scores at rest and cough were not significantly different (p=0.20) between the groups. Satisfaction scores were similar at day 2 and 30 (p=0.77). However, the bolus group was more cost-effective (AU$347.98 vs AU$429.43).Conclusion: Continuous or bolus TAP blocks are effective analgesic techniques in abdominal surgery, with bolus technique being more economical. Keywords: transversus abdominis plane block, postoperative pain, continuous catheter, bolus dosing |
| first_indexed | 2024-12-10T21:40:53Z |
| format | Article |
| id | doaj.art-575dcd1304e54eb6aba88eb03a62acf6 |
| institution | Directory Open Access Journal |
| issn | 1178-7090 |
| language | English |
| last_indexed | 2024-12-10T21:40:53Z |
| publishDate | 2017-07-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj.art-575dcd1304e54eb6aba88eb03a62acf62022-12-22T01:32:30ZengDove Medical PressJournal of Pain Research1178-70902017-07-01Volume 101705171233825Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trialRao Kadam VVan Wijk RMMoran JLGanesh SKumar ASethi RWilliams PVasanth Rao Kadam,1 Roelof M Van Wijk,1 John L Moran,2 Shantan Ganesh,3 A Kumar,1 Rajesh Sethi,1 Patricia Williams2,4 1Department of Anaesthesia, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA, 2Intensive Care Unit, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA, 3Department of Surgery, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA, 4Department of Epidemiology and Preventive Medicine, School Public Health and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia Background: Continuous and intermittent bolus techniques of transversus abdominis plane (TAP) blocks have been used for analgesia after abdominal surgery. Although both are effective, there are no studies comparing them. The aim of this study is to compare analgesia and cost-effectiveness between these groups.Methods: After obtaining ethical approval, 20 American Society of Anesthesiologists ASA grade I to III patients undergoing elective abdominal surgery were recruited with 10 patients allocated to each arm. Bilateral ultrasound-guided TAP blocks were performed with an initial bolus of 0.5% ropivacaine 20 mL per side, followed by catheter insertion. After surgery, the continuous infusion group received 0.2% ropivacaine 8 mL/hour on each side and the intermittent bolus group received doses of 0.2% ropivacaine 20 mL per side every 8 hours for 48 hours. Both groups received intravenous fentanyl patient-controlled analgesia and regular oral paracetamol. Parameters recorded included numerical rating scores for pain and post-operative analgesic consumption at baseline (time 0) and at 1 hour, 1 day and 2 days post-operatively. The duration of catheter insertion, complications, patient satisfaction and information regarding costs were also recorded. Patient satisfaction was assessed utilizing a 4-point “Likert” scale on day 2 and on day 30. Pain and Likert scores were analysed by non-parametric sum rank test and all two-sampled t-tests assumed unequal variances.Results: There was no difference between duration of TAP block, anesthetic and surgical technique and length of stay (p=0.23). Primary outcomes: pain scores at rest and cough were not significantly different (p=0.20) between the groups. Satisfaction scores were similar at day 2 and 30 (p=0.77). However, the bolus group was more cost-effective (AU$347.98 vs AU$429.43).Conclusion: Continuous or bolus TAP blocks are effective analgesic techniques in abdominal surgery, with bolus technique being more economical. Keywords: transversus abdominis plane block, postoperative pain, continuous catheter, bolus dosinghttps://www.dovepress.com/continuous-transversus-abdominis-plane-block-vs-intermittent-bolus-for-peer-reviewed-article-JPRTransversus abdominis plane blockpostoperative paincontinuous catheterbolus dosing |
| spellingShingle | Rao Kadam V Van Wijk RM Moran JL Ganesh S Kumar A Sethi R Williams P Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial Journal of Pain Research Transversus abdominis plane block postoperative pain continuous catheter bolus dosing |
| title | Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial |
| title_full | Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial |
| title_fullStr | Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial |
| title_full_unstemmed | Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial |
| title_short | Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial |
| title_sort | continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery a randomized trial |
| topic | Transversus abdominis plane block postoperative pain continuous catheter bolus dosing |
| url | https://www.dovepress.com/continuous-transversus-abdominis-plane-block-vs-intermittent-bolus-for-peer-reviewed-article-JPR |
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