Post-operative pain after ultrasound transversus abdominis plane block versus trocar site infiltration in laparoscopic nephrectomy: a prospective study

Araújo, Ana M.; Guimarães, Joana; Nunes, Catarina S.; Couto, Paula S.; Amadeu, Eduarda

doi:10.1016/j.bjane.2016.08.004

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Revista Brasileira de Anestesiologia

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Português Español

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Scientific Articles • Rev. Bras. Anestesiol. 67 (5) • Sep-Oct 2017 • https://doi.org/10.1016/j.bjane.2016.08.004 copy

Post-operative pain after ultrasound transversus abdominis plane block versus trocar site infiltration in laparoscopic nephrectomy: a prospective study^☆ ☆ This study was conducted at Centro Hospitalar do Porto (CHP), Porto, Portugal.

About the authors

Abstract

Background

Transversus abdominis plane (TAP) block is useful in reducing post-operative pain in laparoscopic nephrectomy compared to placebo. The purpose of this work is to compare post-operative pain and recovery after TAP block or trocar site infiltration (TSI) in this surgery.

Methods

A prospective, single blinded study on patients scheduled for laparoscopic nephrectomy. Patients were assigned to two groups: TSI Group: trocar site infiltration at the end of surgery; TAP Group: unilateral ultrasound-guided TAP block after induction. Sevoflurane and remifentanil, in a target controlled infusion mode, were used for maintenance of general anesthesia. Before the end of surgery paracetamol, tramadol and morphine were administered. Visual analogue scale (VAS 0-100 mm) at rest and with cough was applied in three moments: in recovery room (T1 at admission and T2 before discharge) and 24 h after surgery (T3). Pain scores with incentive spirometer were also evaluated at T3. In recovery, morphine was administered as a rescue drug whenever VAS > 30 mm. Time to oral intake, chair sitting, ambulation and length of hospital stay were evaluated 24 h after surgery. Statistical analysis: Student's t-test and Chi-square test, and linear regression models. A p-value < 0.05 was considered significant. Data are presented as mean (SD).

Results

Forty patients were enrolled in the study. The primary outcome variable, VAS pain scores did not show a statistical significant difference between groups (p > 0.05). VAS at rest (TAP vs. TSI groups) was: T1 = 33 ± 29 vs. 39 ± 32, T2 = 10 ± 9 vs. 17 ± 18 and T3 = 7 ± 12 vs. 10 ± 18. VAS with cough (TAP vs. TSI groups) was: T1 = 51 ± 34 vs. 45 ± 32, T2 = 24 ± 24 vs. 33 ± 23 and T3 = 20 ± 23 vs. 23 ± 23. VAS with incentive spirometer (TAP vs. TSI groups) was: T3 = 21 ± 27 vs. 21 ± 25. Intraoperative remifentanil consumption was similar between TAP (0.16 ± 0.07 mcg.kg^-1.min^-1) and TSI (0.18 ± 0.9 mcg.kg^-1.min^-1) groups. There were no differences in opioid consumption between TAP (4.4 ± 3.49 mg) and TSI (6.87 ± 4.83 mg) groups during recovery. Functional recovery parameters were not statistically different between groups.

Conclusions

Multimodal analgesia with TAP block did not show a significant clinical benefit compared with trocar site infiltration in laparoscopic nephrectomies.

KEYWORDS
Multimodal analgesia; Laparoscopic nephrectomy; Ultrasound Transversus abdominis plane block

Variables	TAP group	TSI group
Local anesthetic technique ^a a Input variables for multivariate linear model. ASA, American Society of Anesthesiology; LBM, lean body mass; TAP, transverse abdominal plane; TSI, trocar site infiltration.	TAP block	TSI
Age (years) ^a a Input variables for multivariate linear model. ASA, American Society of Anesthesiology; LBM, lean body mass; TAP, transverse abdominal plane; TSI, trocar site infiltration.	53.21 (16.32)	53.10 (13.72)
Gender ^a a Input variables for multivariate linear model. ASA, American Society of Anesthesiology; LBM, lean body mass; TAP, transverse abdominal plane; TSI, trocar site infiltration.
Female	11	16
Male	8	4
Weight (kg) ^a a Input variables for multivariate linear model. ASA, American Society of Anesthesiology; LBM, lean body mass; TAP, transverse abdominal plane; TSI, trocar site infiltration.	69.47 (12.10)	71.15 (15.92)
Height (cm)	164.63 (9.27)	162.80 (6.48)
LBM (kg)	49. 86 (7.97)	48. 26 (7.37)
ASA classification ^a a Input variables for multivariate linear model. ASA, American Society of Anesthesiology; LBM, lean body mass; TAP, transverse abdominal plane; TSI, trocar site infiltration.
ASA I	7	6
ASA II	11	12
ASA III	1	2
Duration of surgery (min) ^a a Input variables for multivariate linear model. ASA, American Society of Anesthesiology; LBM, lean body mass; TAP, transverse abdominal plane; TSI, trocar site infiltration.	156.05 (47.84)	154.30 (35.47)

Variables	TAP group	TSI group	p-Value
VAS-R T1 (mm)^a a Output variables for multivariate linear model.	32.79 (29.45)	39.40 (32.23)	0.509
VAS-R T2 (mm)^a a Output variables for multivariate linear model.	10.11 (9.57)	16.75 (18.08)	0.159
VAS-R T3 (mm)^a a Output variables for multivariate linear model.	7.21 (12.35)	10.45 (18.05)	0.519
VAS-C T1 (mm)^a a Output variables for multivariate linear model.	44.63 (31.89)	50.95 (33.60)	0.551
VAS-C T2 (mm)^a a Output variables for multivariate linear model.	23.74 (23.81)	32.90 (22.78)	0.227
VAS-C T3 (mm)^a a Output variables for multivariate linear model.	20.16 (23.23)	22.75 (23.24)	0.730
VAS-S T3 (mm)^a a Output variables for multivariate linear model.	21.06 (26.67)	20.63 (25.23)	0.962
Remifentanil consumption (mcg)	1247.11 (630.27)	1284.05 (583.91)	0.854
Remifentanil consumption (mcg.MCM^-1.min^-1)	0.16 (0.07)	0.18 (0.09)	0.541
Morphine consumption at recovery room (mg)^b b Input variables for multivariate linear model. T1, recovery room admission; T2, recovery room discharge; T3, 24 h postoperative; TAP, transverse abdominal plane; TSI, trocar site infiltration; VAS-R, visual analogue scale score at rest; VAS-C, visual analogue scale score while coughing; VAS-S, visual analogue scale with incentive spirometer.	4.40 (3.49)	6.87 (4.83)	0.077

Variables	TAP group	TSI group	p-Value
Time to oral intake			0.303
<6 h	17	13
≥6-12 h	1	2
>12-18 h	1	4
>18-24 h	0	0
>24 h	0	1

Chair sitting			0.323
<6 h	0	0
≥6-12 h	0	1
>12-18 h	14	13
>18-24 h	4	2
>24 h	1	4

Ambulation			0.229
<6 h	0	0
≥6-12 h	0	1
12-18 h	7	9
>18-24 h	8	3
>24 h	4	7
Length of hospital stay (days)	3.84 (0.96)	4.20 (1.70)	0.422

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:joanaguimaraes@gmail.com Corresponding author.

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Post-operative pain after ultrasound transversus abdominis plane block versus trocar site infiltration in laparoscopic nephrectomy: a prospective study☆ ☆ This study was conducted at Centro Hospitalar do Porto (CHP), Porto, Portugal.

Abstract

Background

Methods

Results

Conclusions

Post-operative pain after ultrasound transversus abdominis plane block versus trocar site infiltration in laparoscopic nephrectomy: a prospective study^☆ ☆ This study was conducted at Centro Hospitalar do Porto (CHP), Porto, Portugal.