Articles: postoperative-pain
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Int J Obstet Anesth · Nov 2019
A triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section.
What did they do?
Tamura and team randomised 176 elective CS patients to spinal anaesthesia with or without morphine, in addition to placebo or ultrasound-guided quadratus lumborum block (QLB).
And they found
Only intrathecal morphine significantly improved analgesia, not QLB whether performed with or without spinal morphine. Thus QLB probably does not improve analgesia further beyond current best practices.
Not so fast...
While this modest-sized RCT concluded that QLB did not improve pain after caesarean section, the conclusion is i) somewhat inconsistent with earlier studies that did show benefit, and ii) the adjuvant analgesic regime1 used may not be applicable to practice outside Japan.
summary
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The researchers administered the remaining 90 mcg fentanyl IV, along with droperidol 1.25 mg and acetaminophen/paracetamol 15mg/kg after baby delivery. An NSAID (diclofenac 50mg) was only provided when breakthrough pain was requested. ↩
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Laparoscopic cholecystectomy (LC) is a frequently applied minimally invasive surgery. Intraoperative access is provided with small keyhole entries on the abdominal wall. However, LC causes moderate to severe postoperative pain. The subcostal approach of TAP block was described by Hebbard et al. for postoperative analgesia especially for upper abdominal surgeries. Ultrasound-guided erector spinae plane (US-ESP) block is a novel technique targeting ventral rami, dorsal rami and rami communicantes of the spinal nerves. ⋯ Ultrasound-guided ESP block reduced postoperative tramadol consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery.
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To evaluate and compare the analgesic effect of ultrasound-guided erector spinae plane (ESP) block with ultrasound-guided Quadratus Lumborum Block in pediatric lower abdominal surgeries. ⋯ This study shows that the ESPB provides similar postoperative analgesia to the QLB in pediatric patients undergoing lower abdominal surgery. Clinicians could decide according to their clinical experiences. CLINICAL TRIALS: https://clinicaltrials.gov/ct2/show/NCT03463382.
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Int J Obstet Anesth · Nov 2019
ReviewSystemic adjunct analgesics for cesarean delivery: a narrative review.
It is critical to adequately treat postoperative cesarean delivery pain. The use of parenteral or neuraxial opioids has been a mainstay, but opioids have side effects that can be troubling and the opioid crisis in the United States has highlighted the necessity to utilize analgesics other than opioids. Other analgesic options include neuraxial analgesics, nerve blocks such as the transversus abdominis plane block, and non-opioid parenteral and oral medications. The goal of this article is to review non-opioid systemic analgesic adjuncts following cesarean delivery, focusing on their efficacy and side effects as well as their impact on reduction of opioid requirements after surgery.
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Following abdominal surgery, the provision of postoperative analgesia with local anaesthetic infusion through both transmuscular quadratus lumborum block and pre-peritoneal catheter have been described. This study compared these two methods of postoperative analgesia following laparotomy. Eighty-two patients 18-85 years of age scheduled to undergo elective surgery were randomly allocated to receive either transmuscular quadratus lumborum block or pre-peritoneal catheter block. ⋯ In the transmuscular quadratus lumborum group, there was a reduction in numerical rating score at rest (p = 0.036) and satisfaction scores on days 1 and 30 (p = 0.004, p = 0.006, respectively), but fentanyl usage was similar. In the transmuscular quadratus lumborum group, the highest and lowest blocks observed in the recovery area were T4 and L1, respectively. The transmuscular quadratus lumborum technique cost 574.64 Australian dollars more per patient than the pre-peritoneal catheter technique.