A Randomized Controlled Trial of Ropivacaine Alone and In Combination with Dexamethasone for Oblique Subcostal Transversus Abdominis Plane (OSTAP) Block in Open Cholecystectomy
Indian Journal of Surgery - Trang 1-6 - 2023
Tóm tắt
Recent randomized trials indicate that oblique subcostal transversus abdominis plane block provides effective analgesia in upper abdominal surgery. Addition of dexamethasone to local anesthetic agent increases its analgesic efficacy. In this randomized, double-blind trial, sixty patients undergoing open cholecystectomy were allocated to two groups. After induction of anesthesia, group R received oblique subcostal transversus abdominis plane block with 18 ml of 0.75% of ropivacaine and 2 ml of normal saline, while 18 ml of 0.75% ropivacaine with 2 ml of dexamethasone was administered in group RD. The primary outcome assessed was total tramadol consumption postoperatively. Secondary outcomes included time to first request for tramadol, sedation score, nausea score, requirement of rescue antiemetics, any side effects, and quality of healing. The total amount of tramadol consumption was significantly lower in group RD as compared to group R (p = 0.009). The time to first request for tramadol was also significantly increased in group RD as compared to group R (p < 0.001). Amount of antiemetics required in group R was more than group RD, and the difference in the requirement was statistically significant (p = 0.017). Oblique subcostal transversus abdominis plane block is effective in providing postoperative pain relief following open cholecystectomy. Addition of dexamethasone to ropivacaine prolongs analgesic efficacy of ropivacaine.
Tài liệu tham khảo
Bisgaard T, Klarskov B, Kristiansen VB, Callesen T, Schulze S, Kehlet H, et al. (1999) Multi-Regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-model analgesia: A randomized, double-linded, placebo-controlled study. Anesth 89:1017–24
Barrington MJ, Ivanusic JJ, Rozen WM, Hebbard P (2000) Spread of injectate after ultrasound-guided subcostal transversus abdominis plane block: a cadaveric study. Anaesthesia 64:745–750
Hebbard P (2008) Subcostal transversus abdominis plane block under ultrasound guidance. Anesth Analg 106:674
Droger C, Benziger D, Gao F, Berde CB (1998) Prolonged intercostals nerve blockade in sheep using controlled-release of bupivacaine and dexamethasone from polymer microspheres. Anesthesiology 89:969–974
El-Dawlatly AA, Turkistani A, Kettner SC, Machata AM, Delvi MB, Thallaj A et al (2009) Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth 102(6):763–767
Chen CK, Phui VE (2011) The efficacy of ultrasound-guided oblique subcostal transversus abdominis plane block in patients undergoing open cholecystectomy. South Afr J Anesth Analg 17:308–310
Ammar AS, Mahmoud KM (2012) Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: a prospective randomized controlled trial. Saudi J Anaesth 6:229–233
Kumar S, Palaria U, Sinha AK, Punera DC, Pandey V (2014) Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia. Anesth Essays Res 8(2):202
Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A (2006) Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg 102(1):263–267
Becker DE (2013) Basic and clinical pharmacology of Glucocorticosteroids. Anaesth Prog 60:25–32
Kuthiala G, Chaudhary G (2011) Ropivacaine: a review of its pharmacology and clinical use. Indian J Anaesth 55(2):104