Pub Date : 2023-12-12DOI: 10.4103/joacp.joacp_269_22
S. Shah, R. Chawla, Manish Gupta
Empirically adjusted, standard drug doses fail to address interindividual pharmacokinetic and pharmacodynamics variability. Target-controlled infusion (TCI) delivers drugs in calibrated boluses to achieve and maintain a selected target plateau drug level (plasma or effect site). Interactive total intravenous anesthesia (iTIVA™) smartphone software simulates TCI and employs 31 established pharmacokinetic models for 11 different intravenous agents and is coupled with standard volumetric infusion pumps for administering TCI. This prospective, observational, study investigates the degree of agreement between iTIVA and a conventional TCI pump (CTP) for the volume of propofol infused using the Schnider pharmacokinetic model in adult patients of either sex undergoing oncosurgery lasting 1–3 h under total intravenous anesthesia. Bland–Altman analysis of 124 data pairs from 30 patients provided bias, precision, and limits of agreement between the volumes infused by CTP and iTIVA (V-CTP and V-iTIVA) during specific identical time periods. Spearman’s rho and Kendall’s tau rank correlation coefficients provided the degree of association between V-CTP and V-iTIVA. Spearman’s rho and Kendall’s tau were 0.996 and 0.964, respectively. Bias or the mean of differences was −0.02, while the limits of agreement were 0.58 and −0.63, respectively (Bland–Altman plot). The maximum allowed difference of 2 ml was much larger than the 95% confidence intervals for the limits of agreement. The Mountain plot was short tailed (−1.28 to 1.55) and centred over zero (0.01). The volume of propofol infused using TCI pump was similar to that calculated by iTIVA in identical time periods, confirming the clinical applicability of iTIVA.
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Pub Date : 2023-12-12DOI: 10.4103/joacp.joacp_424_22
V. Ahuja, Aastika Mahajan, D. Thapa, S. Mitra, Deepika Gupta, Sanjay Gupta, Rajeev Sharma, Simrandeep Singh
Moderate-to-severe intensity pain is reported on the first day following lower abdominal surgery. No study has compared transversus abdominis plane (TAP) block with retrolaminar block (RLB) in laparoscopic inguinal hernia surgery for postoperative pain relief. In this prospective, randomized trial, 42 male patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18–65 years, and having a BMI <40 kg/m2 received TAP or RLB following laparoscopic inguinal hernia surgery. A standard general anesthetic technique was performed. Patients were randomized into two groups: single-shot TAP block (group I) (n = 21) or the RLB (group II) (n = 21) with bilateral 20 ml of 0.375% ropivacaine. Postoperatively, IV paracetamol 1 g was administered as rescue analgesia. Postoperative cumulative Visual Analogue Scale (VAS) score 24 hours after surgery was considered as the primary outcome. Postoperative cumulative VAS score at rest at 24 h, represented as mean ± S.D (95% CI), in the TAP block group was 3.54 ± 3.04 (2.16–4.93) and in the RLB group was 6.09 ± 4.83 (3.89–8.29). P value was 0.112 and VAS on movement was 7.95 ± 3.41 (6.39–9.50 [2.5–15.0]) in TAP block group, whereas P value was 0.110 and VAS on movement was 10.83 ± 5.51 (8.32–13.34) in the RLB group. Similar postoperative cumulative pain score on movement at 24 h was present in patients receiving TAP block or RLB. However, VAS score at rest and on movement was reduced in patients receiving TAP block at 18 and 24 h postoperatively.
据报道，下腹部手术后第一天会出现中度至重度疼痛。在腹腔镜腹股沟疝手术中，还没有研究对腹横肌平面（TAP）阻滞和腹后神经阻滞（RLB）术后止痛效果进行比较。 在这项前瞻性随机试验中，42 名美国麻醉医师协会（ASA）体能状况 I 级和 II 级、年龄在 18-65 岁之间、体重指数小于 40 kg/m2 的男性患者在腹腔镜腹股沟疝手术后接受了 TAP 或 RLB。手术采用标准的全身麻醉技术。患者被随机分为两组：单次 TAP 阻滞（I 组）（n = 21）或 RLB（II 组）（n = 21），双侧使用 20 毫升 0.375% 罗哌卡因。术后，静脉注射 1 克扑热息痛作为镇痛药物。术后 24 小时累积视觉模拟量表（VAS）评分被视为主要结果。 术后 24 小时静息时的累积 VAS 评分（以平均值 ± S.D (95% CI) 表示），TAP 阻滞组为 3.54 ± 3.04 (2.16-4.93)，RLB 组为 6.09 ± 4.83 (3.89-8.29)。TAP 阻滞组的 P 值为 0.112，活动时的 VAS 为 7.95 ± 3.41（6.39-9.50 [2.5-15.0]），而 RLB 组的 P 值为 0.110，活动时的 VAS 为 10.83 ± 5.51（8.32-13.34）。 接受 TAP 阻滞或 RLB 的患者术后 24 小时活动时的累积疼痛评分相似。然而，接受 TAP 阻滞治疗的患者在术后 18 和 24 小时休息和活动时的 VAS 评分均有所下降。
{"title":"Comparison of the analgesic efficacy of two different fascial blocks in patients undergoing laparoscopic inguinal hernia surgery: A randomized control trial","authors":"V. Ahuja, Aastika Mahajan, D. Thapa, S. Mitra, Deepika Gupta, Sanjay Gupta, Rajeev Sharma, Simrandeep Singh","doi":"10.4103/joacp.joacp_424_22","DOIUrl":"https://doi.org/10.4103/joacp.joacp_424_22","url":null,"abstract":"Moderate-to-severe intensity pain is reported on the first day following lower abdominal surgery. No study has compared transversus abdominis plane (TAP) block with retrolaminar block (RLB) in laparoscopic inguinal hernia surgery for postoperative pain relief. In this prospective, randomized trial, 42 male patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18–65 years, and having a BMI <40 kg/m2 received TAP or RLB following laparoscopic inguinal hernia surgery. A standard general anesthetic technique was performed. Patients were randomized into two groups: single-shot TAP block (group I) (n = 21) or the RLB (group II) (n = 21) with bilateral 20 ml of 0.375% ropivacaine. Postoperatively, IV paracetamol 1 g was administered as rescue analgesia. Postoperative cumulative Visual Analogue Scale (VAS) score 24 hours after surgery was considered as the primary outcome. Postoperative cumulative VAS score at rest at 24 h, represented as mean ± S.D (95% CI), in the TAP block group was 3.54 ± 3.04 (2.16–4.93) and in the RLB group was 6.09 ± 4.83 (3.89–8.29). P value was 0.112 and VAS on movement was 7.95 ± 3.41 (6.39–9.50 [2.5–15.0]) in TAP block group, whereas P value was 0.110 and VAS on movement was 10.83 ± 5.51 (8.32–13.34) in the RLB group. Similar postoperative cumulative pain score on movement at 24 h was present in patients receiving TAP block or RLB. However, VAS score at rest and on movement was reduced in patients receiving TAP block at 18 and 24 h postoperatively.","PeriodicalId":508221,"journal":{"name":"Journal of Anaesthesiology Clinical Pharmacology","volume":"13 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139182440","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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