Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2012
Electron-microscopic imaging of endothoracic fascia in the thoracic paravertebral space in rats.
Anesthesia and analgesia with paravertebral block are reportedly variable. Existence of an endothoracic fascia has been proposed as one of the possible mechanisms leading to variability. We undertook an electron-microscopy imaging study to investigate the endothoracic fascia in the thoracic paravertebral space (TPS) in rats. ⋯ The endothoracic fascia in rats appears to divide the TPS into EPC and SETC. These anatomic characteristics may have implications in thoracic paravertebral blockade.
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Ultrasound guidance has led a surge of interest in transversus abdominis plane (TAP) block for postoperative analgesia following abdominal surgery. Despite or because of the numerous descriptive applications and techniques that have recently populated the literature, results of comparative studies for TAP block have been inconsistent. This systematic review pragmatically addresses many unanswered questions, specifically the following: what are the effects of surgical procedure, block dose, block technique, and block timing on TAP block analgesia? Eighteen intermediate- to good-quality randomized trials that included diverse surgical procedures were identified. ⋯ Eight of 9 trials using preincisional TAP block and 4 of 9 with postincisional block revealed better analgesic outcomes. Although the majority of trials reviewed suggest superior early pain control, we were unable to definitively identify the surgical procedures, dosing, techniques, and timing that provide optimal analgesia following TAP block. This review suggests that our understanding of the TAP block and its role in contemporary practice remains limited.
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Reg Anesth Pain Med · Mar 2012
Randomized Controlled Trial Comparative StudyBilateral transversus abdominis plane block does not decrease postoperative pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites.
Transversus abdominis plane (TAP) block has been shown to reduce pain and analgesic requirements after abdominal surgery. Our hypothesis was that bilateral TAP blocks decrease pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites. ⋯ Bilateral ultrasound-guided TAP block is equivalent to local anesthetic infiltration of trocar insertion sites for overall postoperative pain in a heterogeneous group of patients undergoing laparoscopic cholecystectomy.