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A Comparative Study of Injection 0.5% Bupivacaine and Injection 0.75%
Ropivacaine for Their Duration of Anaesthesia/Analgesia in Transversus Abdominis Plane Block for Unilateral Inguinal Hernia Repair under Ultrasound
Guidance
A. Mohammed Sadiq Basha, S. Selvamani*
Department of Anaesthesiology, Pain Medicine And Critical Care, Sree Balaji Medical College
& Hospital Affiliated to Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
*Corresponding author e-mail id: [email protected]
Abstract
The effectiveness of 0.5 percent bupivacaine versus 0.75 percent ropivacaine in ultrasound guided - TAP block in patients undergoing unilateral inguinal hernioplasty under local anaesthesia was compared in a prospective, randomized trial. There was no statistically meaningful variation in population characteristics between the two studied groups, and the period of analgesia between the two groups - 0.5 percent Bupivacaine and 0.75 percent Ropivacaine - was statistically negligible.
Furthermore, this research focused on critical criteria that were well preserved throughout all groups during the study time, and there was no TAP block loss in either group, and both patients had pain control for 6 to 10 hours after surgery. Patient satisfaction was high in all categories. In none of the groups, there were any negative responses or side effects.
Keywords : herniorrhaphy, bupivacaine, TAP block, hemostasis, VAS Score and anaesthetic
1. Introduction
Following abdominal surgery, the abdominal wall is a significant cause of discomfort. If postoperative analgesia is not taken care of, even a minor operation like inguinal herniorrhaphy can result in chronic pain in around 5-10% of patients, which can have a major impact on everyday activities (1-4). Anaesthetists administer opioids or nonsteroidal anti-inflammatory drugs (NSAIDs) for postoperative analgesia. Opioids have a variety of side effects, including respiratory depression, emesis, decreased gut motility, sedation, and more. NSAIDS may cause hemostasis problems, renal failure, and gastrointestinal hemorrhage, among other things. It is noticed that the drugs have action on peripheral site which eventually causes less adverse effect (5-7). Hence regional anaesthetic technique has gained wide spread importance in postoperative analgesia regimen. Transversus Abdominis Plane (TAP) block
is considered to be a regional block. Soon after the lower abdominal surgery, when pain is appeared, analgesia is provided. It is duty of the doctor to patients relieve the patients from surgical pain. The best practices by anaesthetists for post operative pain control is to adopt regional anaesthetic techniques and to follow latest trends in pharmacology with regard to pain relief. The common surgery in the latest trend is inguinal herninoplasty (8-10).
To gain comfort and in order to restore the basic functions like breathing, cough, mobility and speech in a better way postoperative pain management is vital. Use of opioids and NSAIDS can result in significant adverse effects.Other techniques like rectus abdominis sheath block, paravertebral block, ilioinguinal / ilio -hypogastric block, local anaesthetic infiltration etc are also tes ted. Yet, these have disadvantages as they are not easy to perform, do not give adequate analgesia, do not produce long enough analgesic duration etc. Multimodal analgesia is the current trend which i s explained by the approach of two or more pain management practices simultaneously. Multi modal analgesia helps in controlling the pain in a better way. It also helps in reducing the individual dose of the agent which eventually reduces cost and hence gives less side effects. In the current trend, Transversus Abdominis Plane (TAP) block is being considered as a part of analgesia (11-13).
TAP is a neuro fascial plane between the Internal Oblique (IO) and Transversus Abdominis (TA) muscle of the abdominal wall through which all sensory nerves supply the parietal peritoneum, skin and muscles of anterior abdominal wall. It is also effective in analgesics in post operative inguinal hernia surgeries. TAP block 1 was first described by Rafi et al 2 in 2001 and was McDonnel et al3 (2004) reviwed it McDonnell et al. identified that after the abdominal surgery including LSCS, morphine usage is reduced when the transverses abdominis plane (TAP) block is performed. It was also inferred that landmark based TAP block can be used to manage postoperative analgesics after LSCS.The objective of our study was to evaluate the effectiveness of TAP block to provide effective postoperative analgesia in patients undergoing inguinal herninoplasty (14,15).
2. MATERIALS AND METHODS
Our study was conducted in our institution under ultra sound guidance. Total 40 patients undergoing unilateral inguinal hernioplasty surgery under spinal anaesthesia were included in the study. Patients were divided into 2 groups of 20 each.
Group B - Patients receiving USG-TAP block at the end of surgery with 20 ml Inj.
Bupivacaine 0.50% -20 patients.
Group R- Patients receiving USG-TAP block at the end of surgery with 20 ml Inj. Ropivacaine 0.75% - 20 patients. Pre-anaesthetic check-up was done.
Inclusion & exclusion criteria were as follows;
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Inclusion criteria :
1.
Male & Female patients giving written and informed consent for the study2.
ASA grade I & II.3.
All patients of age group 20 to 65 years of age.4.
Patients undergoing unilateral inguinal hernia surgery under spinal anaesthesia.Exclusion criteria :
1. Patient refusal 2. Bleeding disorders
3. Allergy to local anaesthetics 4. Mental disorders
5. Morbid obesity
6. Abnormal liver function tests 7. Infection at local site of block 8. Hemodynamic instability
9.Contraindications for spinal anaesthesia 10. Any anatomical deformity at site of block 11. ASA III & above
Patient details including Age, Sex, Weight, ASA grading were noted.
Thorough History taken and Clinical Examination done.
MATERIALS REQUIRED
1. Ultrasound machine with a linear transducer (7 -13 MHz) 2. Sterile gloves 2. Ultrasound probe cover
3.Antiseptic solution for skin disinfection 4. ultrasound gel
5. 23-gauge spinal needle
6. 20ml syringe with injection tubing
Consent
Those patients who qualify as per the selection criteria were explained regarding surgical procedure, anaesthesia procedure & drugs to be used in their vernacular language.A written informed consent was obtained in each case in their vernacular language. All patients were explained the
concept of V.A.S score and their V.A.S scores were assessed accordingly.
METHODOLOGY
After Ethical Committee approval, we investigated forty patients undergoing unilateral inguinal hernioplasty. The patients were randomized and allotted to two groups by computer generated tables to undergo TAP block with bupivacaine ( n =20) [GROUP B] versus ropivacaine (n = 20) [GROUP R].
The person injecting the solution while giving TAP block was blind and hence did not know whether the drug is bupivacaine or ropivacaine as it was prepared by another person in operation theatre. As well as the person e valuating the VAS score was not knowing whether the subject had received bupivacaine or ropivacaine. Written informed consent was taken on previous day and all the patients were explained visual analogue scale Patient preparation for spinal anaesthesia and TAP block was done so as to maintain all aseptic conditions.
ON THE DAY OF SURGERY
Consent and fasting status were confirmed. In the operation theatre, standard monitoring including ECG, non -invasive BP, pulse oximeter were attached. Peripheral line w as taken with 18G IV cannula. Patients were given intravenous ranitidine and intravenous ondansetron as per the institutional protocol. In a sitting posture, both patients underwent uniform spinal anaesthesia with 0.5 percent bupivacaine 3.5 ml. The level of analgesia attained was noted. The pin prick method was used to evaluate the block. Intraoperatively, patients are tracked. Hypotension was described as a drop in systolic blood pressure of more than 20% from baseline, and it was treated with mepheneteramine 6 mg incremental doses and a bolus of 200 ml ringer lactate. Bradycardia was described as a heart rhythm of less than 50 beats per minute, and it was treated with 0.6 mg of intravenous atropine. The patient received no analgesic or sedation during the procedure.
Intra operative monitoring:
Vitals were monitored at 5,10,15,30,45,60,75,90,120… mints till the end of surgery.
Pulse, Blood Pressure, SPO 2 monitored and recorded.
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observed.
At the end of surgery, Petits triangle was identified on the side of surgery and USG guided TAP block performed.STUDY PROCEDURE
CONDUCT OF ULTRA SOUND GUIDED TAP BLOCK PREPARING A STERILE TRANSDUCER FOR TAP BLOCK
1. First, the transducer is sterile-wrapped with a sterile gauze and is inserted into the cavity.
Enough gel is applied between the transducer and the sheath to ensure that the gel transducer remains in place in contact with the gel.
2. This sheathing should not have trapped air inside, since there should be complete contact between the parts of the sheath and the object or the intended wearer.
3. If you do not tie a tight the transducer with a sterile rubber bands, you will prevent the insertion of a foreign object into the trachea while scanning.
4. For the sonographers, isopropaque gels can be placed on the skin so that they do not create a barrier that traps air between the transducer and the ultrasound imaging gel
Procedure of block expansion
When using the TAP Block, I went for the behind-the-the-ears method. All sterile surgical operation was conducted under sterile conditions using all other-aperturement as well as well as linen treatment. The investigator was cleansed and an ultrasound probe is sterilized before reinsertion to the the probe was completed with an inert plastic cover laid over the f the best location in the ischium, ready for use on the spine After that, the transverse abdominal plane was crossed with a 23 gauge needle, the other abdominal layers were found to be located. Placement of the needle tip was confirmed by injecting a small volumes of water. an intravascular bolus of 15 ml of Drug solution was given to Group R, while one of Drug solution was given to the other Group B intravascularilyated group. Such critical signs were vital parameters including heart rate, oxygenation, blood pressure, and saturations were registered.
EVALUATION:
Vitals are taken once a day and checked at two hourly intervals afterward, as well as every four hours post-operation for pulse, blood pressure, and complications. Researchers found the presence and magnitude of pain to be measured by an observer who was unaware of allocation in the population.
People in the sample indicated the level of pain using a scale from 0 to 10 on a visual analog scale an
economic downturn that was noticed by the movements of the ankle and knee joint The analgesic rescue medication, Diclofen 75 mg, was administered intravenously for a pain level of 4 on the model animal. trackings a patient treated with the first dose of a certain analgesic and [analgesic]drug[s] in the first 24 hours, and the amount of additional dosage These assessment and improvement activities were monitored and assessed by an outside consultant. Propermissible methods were used to quantify the results of the study. The time required for analgesia (typically measured as the length of anesthesia) was established as the first criteria for administering postoperative pain relief. In addition to this, the patient was monitored for complications after the surgery.
ASSESSMENT
I. POSTOPERATIVE PAIN: Visual analogue scale 11
0 10
No pain worst pain imaginable
Grade 0 (0-1): Good analgesia
Grade 1 (1-4): moderate analgesia Grade 2 (4-7): mild analgesia
Grade 3 (7-10): No analgesia
II. DURATION OF POSTOPERATIVE ANALGESIA:
The period for which the VAS score remained below 4 and the patient did not demand any analgesic was taken to be the duration of postoperative analgesia.
Statistical Analysis:
Statistical analysis was performed with SPSS version 20. Mean and standard deviation represented normally distributed and median represented non -normally distributed continuous variables. Frequency and percentages represented categorical variables. Chi square test for categorical variables and student t test for continuous variables were used to detect significant difference in two groups. For non - normally distributed data, Wilcoxon signed rank sum test was used to find the significant difference. At 95% confidence level, p values <0.05 was considered significant.
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3. Results
In this double -blind comparative clinical study, we have studied 40 ASA physical status I & II patients, scheduled for unilateral mesh repair in our hospital, during the time period between August 2016 to February 2018.All the 40 patients undergoing inguinal hernioplasty were to undergo TAP block with either 0.50% bupivacaine ( n = 20) [Group B] or 0.75% Ropivacaine ( n= 20) [Group R]. All of them received a standard spinal anaesthesia with standard monitoring.
TAP block was performed using either 15 mL of 0.50% bupivacaine or 15 mL of 0.75%
ropivacaine on the side of surgery, at the end of surgery, after skin closure. TAP block was performed by the same investigator in all of the patients.Pain score was assessed post operatively by VAS scale. Rescue analgesics - Inj.diclofenac 75 mg intramuscular was given to the patients who had a VAS score more than 4. Time for first rescue analgesia, total dose of diclofenac consumed and number of diclofenac injections required in the first 24 hours after surgery were noted.
TABLE 1: DISTRIBUTION OF STUDY GROUPS
GROUP
GROUP B No of Cases %
Group B 20 50
Group R 20 50
Total 40 100
Total forty patients were divided into two groups, the Group B had 20 patients and the Group R had 20 patients.
GROUP
DISTRIBUTION
2 0 1 8 1 6 1 4 1 2 1 0 8 6 4 2 0
Group
B Group
R
TABLE 2: ASA
ASA GROUP B GROUP R
No % No %
I 12 60 11 55
II 8 40 9 45
Total 20 100 20 100
Among the total cases, In Group B, 60% belong to ASA I & 40% belong to ASA II. In Group R, 55% belong to ASA I & 45% belong to ASA II.
It is significant from the above table that in all the two groups the majority belongs to ASA I.
ASA CLASSIFICATION
12 10 8
6 ASA I
ASA II 4
2 0
GROUP B GROUP R
No of Cases
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TABLE 3: BASELINE CHARACTERISTICS OF SUBJECT (MEAN ± SD) (N = 20)
CHARACTERISTICS GROUP B GROUP R P value
Age 39.73 ±
6.78 years
40.14 ±
7.25 years 0.137
Weight 70.41 ±
5.24 kg
73.24 ±
4.21 kg 0.325
Height 163.54 ±
3.1 cm
164.25 ±
3.2 cm 0.128
Among the total 40 cases of which 20 were from Group B and 20 were from Group R.Majority of the patients were in age group of 30 -50 years in both the group.
Both groups were comparable in terms of age, weight and height.The mean age in Group B and Group R was 39.73 years and 40.14 years respectively. There was no statistically significant difference in mean age (p=0.137),The mean weight in Group B and Group R was 70.41 kg & 73.24 kg respectively. There was no statistically significant difference in mean weight (p=0.325).
The mean height in Group B and Group R was 163.54 c m and 164.25 cm respectively. There was no statistically significant difference in mean weight (p=0.128
).
BASELINE CHARACTERISTICS
180 160 140 120 100 80 60 40 20 0
Group B Group R
Age Weight Height
MEAN DURATION OF SURGERY
62.5 62 61.5 61 60.5 60
Group B Group R
TABLE 4: MEAN DURATION OF SURGERY IN MINUTES MEAN DURATION OF
SURGERY GROUP B
GROUP R P Value Duration of surgery 61.49 ± 9.54
min
61.58 ± 8.21
min 0.541
Mean duration of surgery in group B was 61.49 min and 61.58 min in group R respectively. There was no statistically significant difference in total duration required for surgery (p = 0.541)
TABLE 5 : POSTOPERATIVE MEAN VISUAL ANALOGOUS SCALE (VAS) AT DIFFERENT TIME INTERVAL IN EACH GROUP
TIME INTERVAL
MEAN VAS SCORE
P VALUE GROUP B GROUP R
0 min 0.00 0.00 > 0.05
30 min 0.03 ± 0.18 0.05 ± 0.6 > 0.05
60 min 0.23 ± 0.43 0.35 ± 0.3 > 0.05
2 hr 0.32 ± 0.64 0.34 ± 0.6 > 0.05
4 hr 1.63 ± 0.45 1.59 ± 0.9 > 0.05
6 hr 2.43 ± 0.5 2.32 ± 1.4 > 0.05
8 hr 3.62 ± 0.45 3.72 ± 1.8 > 0.05
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12 hr 4.12 ± 0.91 4.16 ± 1.4 > 0.05 18 hr 4.62 ± 0.62 4.69 ± 1.3 > 0.05 24 hr 4.75 ± 0.56 4.89 ± 0.8 > 0.05
The mean pain VAS Score in group B and group R was 0.00 and 0.00 respectively at 0 minute after surgery.The mean pain VAS Score in group B and group R was 0.03 and 0.05 respectively 30 minutes after surgery. The difference in the two groups was statistically insignificant (P value > 0.05).The mean pain VAS Score in group B and group R was 0.23 and 0.35 respectively, 60 mins after surgery. The difference in the two groups was statistically insignificant (P value > 0.05).The mean pain VAS Score in group B and group R was 0.32 and 0.34 respectively 2 hour after surgery. The difference in the two groups was statistically insignificant (P value > 0.05).The mean pain VAS Score in group B and group R was 1.63 and 1.59 respectively 4 hrs after surgery. The difference in the two groups was statistically insignificant (P value > 0.05).
The mean pain VAS Score in group B and group R was 2.43 and 2.32 respectively 6 hours after surgery. The difference in the two groups was statistically insignificant (P value > 0.05).The mean pain VAS Score in group B and group S was 3.62 and 3.72 respectively 8 hours after surgery. The difference in the two groups was statistically insignificant (P value > 0.05).
The mean pain VAS Score in group B and group R was 4.12 and 4.16 respectively 12 hours after surgery. The difference in the two groups was statistically insignificant (P value > 0.05).The mean pain VAS Score in group B and group R was 4.62 and 4.69 respectively, 18 hours after surgery. The difference in the two groups was statistically insignificant (P value > 0.05).The mean pain score/ on VAS in group B and group R was 4.75 and 4.89 respectively, 24 hours after surgery. The difference in the two groups was statistically insignificant (P value > 0.05).
VAS score was the same in both the groups at all the time in first 24 hours.
4.Discussion
most often conducted surgeries for elective hernalization of the inguinal canal is theraphosotomy in addition to being done as a day surgery, inguinal hernia repair is often performed as an outpatient operation side-allevinjoint symptom resolution and patient satisfaction, which are of great importance when it comes to patient satisfaction and joint recovery after surgery. The introduction of adequate post-operative analgesia helps to make it easier for patients to go home early and meet discharge conditions. Often, within the first two days of an inguinal hernia repair, there is a more noticeable pain. pain is intensified during the act of getting up or coughing (16-18). The typical postoperative patient who has inguinal hernia surgery will get an intravenous (intravenous) opioid. If ingested, systemic opioids can offer only short-term relief, since they don't help with the long-term causes of pain; they actually, they provide a high level of tolerance. Postoperative pain management is offered almost entirely with the use of anesthetics, though there are a few options in some situations. n Epidural analgesia, with the introduction of, has been replaced by transversospinal blocks, seems to be a good option for the relief of postoperative pain Truncal nerve blocks have an estimated failure rate of 15% and 30% by using anatomical landmarks, or techniques to locate them.
Although there are several ways to treat postoperative pain, anesthesia is one of many options, along with other various modalities. pain can be reduced by using nonsteroidal anti-inflammatory drugs (NSAIDs), opioid and local anestitic analgesics by a strategy that incorporates both regional and topical analgesics. Opioids have shown to be helpful in postoperative pain management, but further complicate morbidity can arise. (This treatment) is useful for treating inguinal herniasis is either peripheral nerve
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blocks or anesthetics (it is recommended) for inguinal surgery to administer painkillers around the areas that are painful (19-20).
In these days, more and more so than ever, transverse abdominal blocks are used to execute those procedures. While in the one hand, no overall uniform consensus remains as to the course of action, on the other hand, problems faced throughout the treatment almost often lead to broad discrepancies in individual choices. herniotomymy block, our sample tested the effectiveness of 0.5 i.75 i.v. rop'v buaine and 0.75 vcision %lipt with 1.0 vliptibration frequency blocks to determine which is better: the skills needed are at doing needle inserts for unilateral hernioplasty. We conducted a research involving 20 people in each category, which showed that our findings could be applied to existing information from the literature, after which we compared our obtained results with available evidence. In these research studies, the patients all had inguinal hernia surgery was performed on the right side Furthermore, immediate pain relief from TAP block helps the patients, such as decreased side effects of opioids and improved analgesics (21-24).
demographic characteristics
all of which enrolling 40 patients, 20 people in the A and 20 people in the group which comprise the second group R were chosen for the review. The mean (or average) age, weight, in (the) two groups in (data in) the study was the same (or within the defined range) (data 3 showed no evidence of age bias (or an average weight and body mass in the two groups weren't significantly different (or varied)).
Duration of surgery
Mean duration of surgery in group B was 61.49 ± 9.54 min and group R 61.58 ± 8.21 min. The total duration required for surgery in two groups (p=0.541) as shown in (Table no 4 /Graph 4) did not show any significant difference.
ASA status:
In patients under the bupivacaine group, 60% belonged ASA I & 40% to ASA II. In the ropivacaine group, 55% belonged to ASA I & 45% to ASA Thus, majority of the patients were of ASA I category and there was no statistically significant difference between both the groups.
Assessment of pain by VAS score:
In our study, pain severity was assessed according to Visual Analogue Scale Scoring system from 0 to 10. These assessments were performed in the PACU at 0, 30, 60 min, 2, 4, 6, 8 ,12, 18 and 24 hours after the surgery.
The mean pain score on VAS in group B at 0 ,30
min,60min, 2hr ,4 hrs, 6hrs, 8hrs, 12, 18 and 24hrs
were 0, 0 .03 ± 0.18, 0.23 ± 0.43, 0.32 ± 0.64,1.63 ± 0.45, 2.43 ± 0.5, 3.62 ± 0.45, 4.12 ± 0.91, 4.62 ± 0.62 and 4. 75 ±
0.56 respectively.
The mean pain score on VAS in group R at 0, 30 min, 60 min, 2 hr, 4 hrs, 6 hrs, 8 hrs ,12, 18 and 24 hrs were 0, 0.05 ±
0.6, 0.35 ± 0.3, 0 .34 ± 0.6, 1.59 ± 0.9, 2.32 ± 1.4, 3.72 ± 1.8,
4.16 ± 1.4, 4.69 ± 1.3 and 4.89 ± 0.8 respectively. The difference in the two groups was statistically insignificant (P value >0.05). Thus, the mean pain VAS score was the same in both the groups at all the time in first 24 hours.
This shows that the US-TAP block has the same impact in both groups and provides sustained analgesia in the early postoperative phase. Siddiqui et al. analyzed seven randomized, double-blinded trials in both blind and ultrasound directed TAP technique for postoperative analgesia in infra umbilical surgeries and found an overall and substantial decrease in IV PCA demand as part of a multimodal analgesic regimen. In the early postoperative time, the VAS score was found to be lower both at rest and while moving. He also discovered that postoperative fatigue, vomiting, and sedation were decreased.
Time for first rescue analgesia:
In our study, in patients given USG -guided TAP block, the time interval for requirement of first dose of rescue analgesia was prolonged in both the groups - 0.5 % bupivacaine group [mean analgesic duration - 312.21 ± 10.3 min] and 0.75% ropivacaine group [mean analgesic duration - 308.87 ± 12.2 min]. This finding suggests that the total rescue analgesic usage is the same in the first 24 –48 hr among the patients who received a TAP block with both the groups, immediately after unilateral inguinal hernioplasty. The difference was found to be statistically insignificant (25-28).
While PATEL et al. found a 34% in the patients with the same who received a sedation, their research found far less sedation is needed in patients who've received TAP blocks In a small clinical trial, they actually seen a reduction in adverse effects including nausea, vomiting, in turn, as they made small, intermittent adjustments to the amount of opioids that the patients were given, including fine-tuning their dosing and using the term opioid sparing protocols. A major concern is also noted here, and that the addition of this here encourages ambulation, no urinary retention, and a more productive state as well
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Mean Total dose of analgesic requirement in the first 24 hours:
Total dose of diclofenac consumption in group B was 75.03.± 0.45 mg and in group R it was 75.14 ± 0.68 mg which showed that diclofenac consumption was the same in both the groups and there was no statistical signficance.
Vital parameters:
The vital parameters such as heart rate, systolic and diastolic blood pressures and the oxygen saturation were comparable between group B and group R and there was no statistically significant difference between the groups.
In our study, we used 0.5 % of bupivacaine and 0.75 % of ropivacaine for USG TAP block. We did not find any local anaesthetic toxicity in our study group. The volume a nd concentrations of LA have been demonstrated by many studies but, not much is known about time of onset of analgesia and its duration of action. Therefore, it is necessary to study these parameters during a TAP block.
As an experiment, varying the dosage of the local anesthetic did not yield any major changes in the time of onset, it was concluded that the time of analgesia begins at the same rate after the activation of the block. The treatment was well-tolerated, and had no adverse effects, during the experiment and after the protocol. Adverse effects have been identified about the use of TAP block, as is mentioned in the literature. There was an instance of intra-abdominal pain and peritonitis, perhaps associated with US Block, in a patient who had hysterectomy with hernothoroplasty. Failure was caused by attempting to probe a section of the needle while trying to get a representative image of it, which lead to undue penetration. The directions and depth of the ultrasound do not need to be precisely defined because the needle has images of real time instead, as long as the frame rate of fluctuation is faster than the echo delay. . If intraabdominal operations are on the horizon, such as hernia surgeries and appendectomies, you may want to expand your USG-guided TAP block to include a segmental block to include these procedures. If improved further, patient pain and numbness could be treated with a – directed nerve block and provide greater assurance of safety and lower risks of complications.
CONCLUSION
To successfully and in terms of time, along with comparable VAS block (use 0.5% ropeth- bupiv lactate or the more potent form, 0.75% ropaine), yields an effect of around the same as 30 ml of 0.5%
ropvain in terms of sensitivity. the system was the similarity between the hemodynamic states was similar in both classes Ropivacemic acid can be linked to a lower cardiovascular and central nervous system toxicity of the drug, making it more suitable for use in patients. when injected using the same al velocity with equal concentrations and with ultrasound guidance produced equal to total arterial
embolization had no significant differences in length, dosage of analgesia was also the same for both of TAP block. A drug with a slightly better safety profile in comparison to bupivacaine is ropivatory.
Funding: No funding sources
Ethical approval: The study was approved by the Institutional Ethics Committee CONFLICT OF INTEREST
The authors declare no conflict of interest.
ACKNOWLEDGMENTS
The encouragement and support from Bharath University, Chennai is gratefully acknowledged. For provided the laboratory facilities to carry out the research work.
REFERENCES
1 Bidhan Paul, Debasis Banik, AKM Shamsul Alam. TAP block in Postoperative Analgesia, A First Time Clinical Trial In Bangladesh. JBSA 2014; 27(1): 3 -11
2 Rafi A. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001; 56:
1024 -26.
3 McDonnell J, O' Donnell B, Tuite D, Farrell T, Power C. The regional abdominal field infiltration (R.A.F.I.) technique: computerized tomographic and anatomical identification of a novel approach to the transverses abdominis neuro-vascular fascial plane. Anaesthesiology 2004; 101: A 899
4 Shibata Y, Sato Y, Fujiwara Y, Komatsu T. Transversus abdominis plane block Anaesth Analg.
2007; 105:883.
5 O'Donnell BD, McDonnell JG, Mc Shane AJ. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Regional Anaesthesia and Pain Medicine 2006; 31:91
6 Carney J, McDonnell JG, Ochana A, et al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.
Anaesthesia Analgesia2008; 107:2056 -60.
7 Morgan GE, Mikhail MS, Murray MJ: Lange’s Clinical Anaesthesiology, Section III. Regional Anaesthesia & Pain management. Chapter 18. Pain management, 4thedition.
8 Singapore. McGraw-Hill. 2008. Page 373.
9 Reid SA. The transversus abdominis plane block.
10 Anaesthesia Analgesia2007;105: 282–283.
11 Serpell M. (2006) Anatomy, physiology and pharmacology of pain. Surgery 24 (10): 350 -353 12 H. Breivik, P. C, Borchgrevink, S. M. Allen, L. A. Rosseland L, Romundstad E. K, Breivik
3625 http://annalsofrscb.ro
Hals, G. Kvarstein, A. Stubhaug. Assesment of pain: British journal of anesthesia. May 16 2008; 101 (1): 17 –24.
13 Woolf CJ, Chong MS. Pre-emptive analgesia – treating postoperative pain by preventing the establishment of ceSerpell M. (2006) Anatomy, physiology and pharmacology of pain. Surgery 24 .
14 Melzack R , Wall PD. Pain mechanisms: new theory science. 1965;150(3699): 971 -9.
15 Central sensitization. Anaesth Analg. 1993; 77:362 –379.
16 Dr. Paul Townsley, Dr James French, Transversus Abdominis Plane Block. Anaesthesia Tutorial Of The Week 239, ATOTW 239; 2011; 1 -12 L. A.
17 Kato N, Fujiwara Y, Harato M et al. “ Serum concentration of lidocaine after transversus abdominis plane block”, British journal of Anaesthesia 2009: vel. 23, no 2: pg:298 - 300.
18 Chetwood A, Agarwal S, Hrouda D et al(2011) Laparoscopic assisted transversus abdominus plane block: a novel insertion technique during laparascopic nephrectomy. Anesthesia 66: 317 - 318.
19 Araco A, Pooney J, Araco F, Gravente G. Tranversus abdominis plane block reduces the analgesic requirements after abdominoplasty with flank liposuction. Annals plast surg.
2010;65(4):385 -388.
20 Bhoi, Sanjeev, Amit Chandra, and Sagar Galwankar. “Ultrasound-Guided Nerve Blocks in the Emergency Department.” Journal of Emergencies, Trauma and Shock 3.1 (2010): 82–88.
21 Penelope Allisy-Roberts, Jerry\ Williams. Farr’s Physics of Medical Imaging, Ed 2. Pg. 147 - 149.
22 Curry TS III, Dowdey JE, Murray RC: Ultrasound in Christensen’s Physics of Diagnostic Radiology, Ed.4. Philadelphia, LEA & Febiger, 1990. Pg 323 -371.
23 Goldstein A: The effect of acoustic velocity on phantom measurements. Ultrasound Med Biol 2000 ;26:1133;1143.
24 Moore DC, Bridenbaugh LD, Bridenbaugh PO, Tucker GT. Bupivacaine. A review of 2,077 cases. JAMA. 1970 Oct 26;214(4):713–718.
25 Hansen TG. Ropivacaine: A pharmacological review. Expert Rev Neurother. 2004;4:781–91.
26 Schmidt A, Bjorkman S, Akeson J Preoperative rectal diclofenac versus paracetamol for tonsillectomy: effects on pain and bloodloss. Acta Anaesthesiol Scand. 2001;45(1):48-52.
27 Salmann AR. "The history of diclofenac". Am. J. Med.2008; 80 (48):29-33.
28 Dutta NK, Annadurai S, Mazumdar K, Dastidar SG, Kristiansen JE, Molnar J, Martins M, Amaral L "The anti-bacterial action of diclofenac shown by inhibition of DNA synthesis". Int. J.
Antimicrob. Agents 2000; 14 (3): 249-51
