Background Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects. Objective To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia. Methods Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Generalized Linear Model (GLM) for non-normally distributed data. The effect size was estimated with Eta Square (documentclass[12pt]{minimal} usepackage{wasysym} usepackage[substack]{amsmath} usepackage{amsfonts} usepackage{amssymb} usepackage{amsbsy} usepackage[mathscr]{eucal} usepackage{mathrsfs} DeclareFontFamily{T1}{linotext}{} DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} DeclareSymbolFontAlphabet{mathLINOTEXT}{linotext} begin{document} ${eta ^2}$end{document}), considering values ≥0.38 as indicative of large effects. A two-tailed p-value < 0.05 was deemed statistically significant. Results Statistically significant differences in pain scores were noted at 0 and 6 hours post-surgery (p<0.01). The TAP block group reported lower pain scores at 0 hours (mean=0.04) and 6 hours (mean=1.16) compared to the epidural group, reflecting a substantial effect size. Conclusion The TAP block proves advantageous in mitigating postoperative pain for women post-caesarean delivery, particularly in the initial 6 postpartum hours. This relief promotes early mother-infant bonding and facilitates breastfeeding.
{"title":"Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study","authors":"J. Salazar-Flórez, Leidy Arenas-Cardona, Ninemy Marhx, Eduardo López-Guerrero, Ángela Echeverri-Rendón, Luz Giraldo-Cardona","doi":"10.2147/LRA.S444947","DOIUrl":"https://doi.org/10.2147/LRA.S444947","url":null,"abstract":"Background Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects. Objective To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia. Methods Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Generalized Linear Model (GLM) for non-normally distributed data. The effect size was estimated with Eta Square (documentclass[12pt]{minimal} usepackage{wasysym} usepackage[substack]{amsmath} usepackage{amsfonts} usepackage{amssymb} usepackage{amsbsy} usepackage[mathscr]{eucal} usepackage{mathrsfs} DeclareFontFamily{T1}{linotext}{} DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} DeclareSymbolFontAlphabet{mathLINOTEXT}{linotext} begin{document} ${eta ^2}$end{document}), considering values ≥0.38 as indicative of large effects. A two-tailed p-value < 0.05 was deemed statistically significant. Results Statistically significant differences in pain scores were noted at 0 and 6 hours post-surgery (p<0.01). The TAP block group reported lower pain scores at 0 hours (mean=0.04) and 6 hours (mean=1.16) compared to the epidural group, reflecting a substantial effect size. Conclusion The TAP block proves advantageous in mitigating postoperative pain for women post-caesarean delivery, particularly in the initial 6 postpartum hours. This relief promotes early mother-infant bonding and facilitates breastfeeding.","PeriodicalId":508030,"journal":{"name":"Local and Regional Anesthesia","volume":"164 ","pages":"39 - 47"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140761918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Majaliwa Shabani, Seydina Alioune Beye, Abdoulaye Traore, Pablo Echave, Xavier Raingeval, Daouda Coulibaly, Sophie Crespo
Purpose: The posterior femoral cutaneous nerve (PFCN) block is used in regional anesthesia for lower extremity surgery. This study introduces a new ultrasound-guided technique called the “Gluteus-Deep Investing Fascia compartment Block (GDIF block)“ for blocking the PFCN. This approach involves injecting local anesthetic into the potential space between the gluteus maximus muscle and the deep investing fascia, named the ‘Gluteus Deep Investing Fascia Compartment’. The study discusses the anatomical and sonographic features crucial for identifying this compartment and explores the potential benefits of this approach for achieving effective PFCN block. Additionally, it examines the clinical application of the GDIF block for PFCN block as part of the Complete Lower Extremity Fascia Tri-compartment Block technique, named ”CLEFT Block.” This technique combines the suprainguinal fascia iliaca block with GDIF compartment block for PFCN and a sciatic nerve block as exclusive anesthesia technique. Patients and Methods: Nine patients with weapon-related lower limb injuries underwent surgery at district hospitals supported by the International Committee of the Red Cross. Between October and December 2023, seventeen above-knee procedures were performed for the nine patients using the GDIF block as part of a CLEFT block technique. Anesthesia was performed with a CLEFT block technique using a volume ratio of 1:1 of 1% lidocaine and 0.5% levobupivacaine. Results: The GDIF block technique for PFCN blockade was performed successfully in all patients without complications, achieving complete PFCN blockade. The CLEFT block technique proved effective as the sole anesthetic technique for seventeen above-knee procedures. All surgeries were completed successfully without additional pain medication or conversion to general anesthesia. Conclusion: The GDIF block appears to be a promising technique for anesthetic management, alone or as part of the CLEFT block. Further research with a larger patient population is necessary to validate these findings.
{"title":"THE GLUTEUS DEEP INVESTING FASCIA COMPARTMENT BLOCK: A Novel Technique for Posterior Femoral Cutaneous Nerve Block","authors":"Majaliwa Shabani, Seydina Alioune Beye, Abdoulaye Traore, Pablo Echave, Xavier Raingeval, Daouda Coulibaly, Sophie Crespo","doi":"10.2147/lra.s455702","DOIUrl":"https://doi.org/10.2147/lra.s455702","url":null,"abstract":"Purpose: The posterior femoral cutaneous nerve (PFCN) block is used in regional anesthesia for lower extremity surgery. This study introduces a new ultrasound-guided technique called the “Gluteus-Deep Investing Fascia compartment Block (GDIF block)“ for blocking the PFCN. This approach involves injecting local anesthetic into the potential space between the gluteus maximus muscle and the deep investing fascia, named the ‘Gluteus Deep Investing Fascia Compartment’. The study discusses the anatomical and sonographic features crucial for identifying this compartment and explores the potential benefits of this approach for achieving effective PFCN block. Additionally, it examines the clinical application of the GDIF block for PFCN block as part of the Complete Lower Extremity Fascia Tri-compartment Block technique, named ”CLEFT Block.” This technique combines the suprainguinal fascia iliaca block with GDIF compartment block for PFCN and a sciatic nerve block as exclusive anesthesia technique. Patients and Methods: Nine patients with weapon-related lower limb injuries underwent surgery at district hospitals supported by the International Committee of the Red Cross. Between October and December 2023, seventeen above-knee procedures were performed for the nine patients using the GDIF block as part of a CLEFT block technique. Anesthesia was performed with a CLEFT block technique using a volume ratio of 1:1 of 1% lidocaine and 0.5% levobupivacaine. Results: The GDIF block technique for PFCN blockade was performed successfully in all patients without complications, achieving complete PFCN blockade. The CLEFT block technique proved effective as the sole anesthetic technique for seventeen above-knee procedures. All surgeries were completed successfully without additional pain medication or conversion to general anesthesia. Conclusion: The GDIF block appears to be a promising technique for anesthetic management, alone or as part of the CLEFT block. Further research with a larger patient population is necessary to validate these findings.","PeriodicalId":508030,"journal":{"name":"Local and Regional Anesthesia","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140763344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Charcot Marie Tooth disease is a common cause of pediatric peripheral neuropathy, which can lead to distal muscle wasting and weakness necessitating orthopedic procedures. We present an eleven-year-old male with Charcot Marie Tooth disease who received peripheral nerve blocks for ankle surgery, with a total dose of 1.75 mg/kg of bupivacaine 0.25%. Upon follow-up, it was identified that the sensory blockade did not resolve until thirty-six hours, postoperatively. There were no noted long-term sequalae on surgical follow-up. If a patient with Charcot Marie Tooth receives a peripheral nerve block, the patient should receive close short- and long-term follow-up to monitor for block complication or disease exacerbation.
{"title":"Prolonged Duration of Peripheral Nerve Blockade in a Pediatric Patient with Charcot Marie Tooth Disease: A Case Report","authors":"Natalie Barnett, Amanda M. Bunnell, Matthew Dow","doi":"10.2147/LRA.S455285","DOIUrl":"https://doi.org/10.2147/LRA.S455285","url":null,"abstract":"Abstract Charcot Marie Tooth disease is a common cause of pediatric peripheral neuropathy, which can lead to distal muscle wasting and weakness necessitating orthopedic procedures. We present an eleven-year-old male with Charcot Marie Tooth disease who received peripheral nerve blocks for ankle surgery, with a total dose of 1.75 mg/kg of bupivacaine 0.25%. Upon follow-up, it was identified that the sensory blockade did not resolve until thirty-six hours, postoperatively. There were no noted long-term sequalae on surgical follow-up. If a patient with Charcot Marie Tooth receives a peripheral nerve block, the patient should receive close short- and long-term follow-up to monitor for block complication or disease exacerbation.","PeriodicalId":508030,"journal":{"name":"Local and Regional Anesthesia","volume":"306 ","pages":"49 - 53"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140789014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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