ANALGESIC EFFICACY OF POST-OPERATIVE TRANSVERSE ABDOMINAL PLANE BLOCK IN INFRAUMBILICAL OBSTETRIC AND GYNAECOLOGICAL SURGERIES USING 0.5%LEVOBUPIVACAINE WITH FENTANYL VERSUS 0.5%ROPIVACAINE WITH FENTANYL, BILATERALLY, POSTOPERATIVELY-AN OBSERVATIONAL, INT
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Keywords
levobupivacaine, postoperative pain, ropivacaine, transversus abdominis plane block
Abstract
AIMS: to study and compare analgesic efficacy of 0.5% levobupivacaine with fentanyl versus 0.5% ropivacaine with fentanyl in trans abdominal plane block in obstetrics & gynecological surgeries.
OBJECTIVES: to evaluate and compare duration of block, analgesia postoperatively and rescue doses of intravenous diclofenac given within first 24hrs [numbers.]
INTRODUCTION: The transverse abdominis plane block has shown promising results in reducing the usage of opioids and providing effective postoperative pain relief by introducing local anesthetics into the transversus abdominis plane via the triangle of Petit and block the sensory nerves of the anterior abdominal wall.
MATERIALS AND METHODS: This prospective, randomized, comparative study comprised female patients (ASA grade 1/2), ages 18 to 65, undergoing elective infraumbilical obstetrics and gynecological surgeries. PNS directed TAP block was given bilaterally, postoperatively, to two groups of 35 patients each: group-R-0.5% ropivacaine[18ml]+fentanyl [2ml=100 mcg], while group-L received 0.5% levobupivacaine[18ml]+fentanyl [2ml=100 mcg].
END RESULT: Group-R showed delayed request of first rescue analgesia (intravenous diclofenac), lesser analgesia(171.08±18.21 mg of total intravenous diclofenac in 24 hours) versus in Group-L(291.20±21.4 mg),p<0.0001 and had lower VAS scores at 0,4,8,12,16,20,24 hours postoperatively(p< 0.05).
CONCLUSION- postoperative pain management with TAP block for lower abdominal surgeries using 0.5% ropivacaine was associated with greater duration of analgesia, delayed first demand for rescue analgesia and decreased necessity for total number of rescue analgesics. These findings support the use of ropivacaine in TAP blocks to improve pain management and patient outcomes during gynecological and obstetric procedures.
References
2. McDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, et al. The Analgesic Efficacy of Transversus Abdominis Plane Block After Cesarean Delivery: A Randomized Controlled Trial. Anesth Analg. 2008;106(1):186–191.
3. 3.Carney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG. The Transversus Abdominis Plane Block Provides Effective Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy. Anesth Analg. 2008;107(6):2056–2060.
4. 4.Sharma P, chand T, Saxena A, Bansal R, Mittal A, Shrivastava U. Evaluation of postoperative analgesic efficacy of transversus abdominis plane block after abdominal surgery: A comparative study. J Nat Sc Biol Med 2013;4:177-80.
5. Hansen TG. Ropivacaine: A pharmacological review. Expert Rev Neurother. 2004;4:781–91.
6. Foster RH, Markham A. Levobupivacaine: A review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59:551–79.
7. Goel S, Bhardwaj N, Grover VK. Intrathecal fentanyl added to intrathecal bupivacaine for day case surgery: A randomized study. Eur J Anaesthesiol. 2003;20:294–7.
8. Van de Velde M. There is no place in modern obstetrics for racemic bupivacaine. Int J Obstet Anesth. 2006;15:38–41
9. Erdil F, Bulut S, Demirbilek S, Gedik E, Gulhas N, Ersoy MO. The effects of intrathecal levobupivacaine and bupivacaine in the elderly. Anaesthesia. 2009;64:942–6.
10. Hakan Erbay R, Ermumcu O, Hanci V, Atalay H. A comparison of spinal anesthesia with low-dose hyperbaric levobupivacaine and hyperbaric bupivacaine for transurethral surgery: A randomized controlled trial. Minerva Anestesiol. 2010;76:992–1001.
11. Oraon P, Hembrom B, Kumar M, Ram B, Lakra L. Comparative Study between Intrathecal 0.5% Isobaric Levobupivacaine, 0.5% Isobaric Ropivacaine, and 0.5% Hyperbaric Bupivacaine in Elective Lower Segment Cesarean Section: A Randomized Clinical Study. Anesth Essays Res. 2022 Apr-Jun;16(2):238-243. doi: 10.4103/aer.aer_60_22. Epub 2022 Oct 7. PMID: 36447919; PMCID: PMC9701329.
12. Kauser D, Mathew S. Comparison of 0.2% Ropivacaine with 0.25% Levobupivacaine in Ultrasound Guided Transverse Abdominis plane block for Postoperative Analgesia in LSCS. Indian Journal of Public Health Research & Development. 2022 Jul 1;13(3).
13. Fredrickson M, Seal P, Houghton J. Early experience with the transversus abdominis plane block in children. Paediatr Anaesth 2008; 18: 891– 2.
14. Loukas M, Tubbs RS, El-Sedfy A, Jester A, Polepalli S, Kinsela C. The clinical anatomy of the triangle of Petit. Hernia 2007; 11: 441– 4.
15. Kerai S, Saxena KN, Anand R, Dali JS, Taneja B. Comparative evaluation of transversus abdominis plane block with transcutaneous electrical nerve stimulation for postoperative analgesia following lower segment caesarean section. J Obstet Anaesth Crit Care 2011; 1:30-4.
16. Tran TMN, Ivanusic JJ, Hebbard P, Barrington MJ. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth Jan 2009; 102(1):123-127.
17. Capogna G, Celleno D, Fusco P, Lyons G, Columb M. Relative potencies of bupivacaine and Ropivacaine for analgesia in labour. Br J Anaesth 1999; 82(3):371-3.
18. J.H. Mc Clure.Ropivacaine. Br J Anaesth 1996; 76: 300-307.
19. Callesen T. Inguinal hernia repair: anaesthesia, pain and convalescence. Dan Med Bull. Aug 2003; 50(3):203-18.
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Dr. Saniya Khan
Resident, Department of Anaesthesiology, Index Medical College Hospital and Research Centre, Indore, M.P., India
Dr. Sangeeta Bansal Agarwal
Professor and HOD, Department of Anaesthesiology, Index Medical College Hospital and Research Centre, Indore, M.P., India
Dr. Surabhi Sharma
Resident, Department of Anaesthesiology, Index Medical College Hospital and Research Centre, Indore, M.P., India