A Randomized Controlled Trial of Comparing Ultrasound-Guided Transversus Abdominis Plane Block with Local Anesthetic Infiltration in Peritoneal Dialysis Catheter Implantation

Abstract

Background: The ultrasound-guided transversus abdominis plane (TAP) block has been demonstrated as a useful analgesia technique in lower-abdomen surgeries. We hypothesized that it could be the principal anesthesia technique for end-stage renal disease (ESRD) patients undergoing peritoneal dialysis (PD) catheter (PDC) implantation using the open dissection method. Methods: This was a single-center, prospective, randomized, and double-blinded study. All eligible patients were randomized into 2 groups: the TAP block group (n = 20) and the local anesthetic infiltration (LAI) group (n = 20). Results: Compared with the LAI group, the TAP block group revealed a remarkably lower visual analogue score, lower switching rate into general anesthesia, higher satisfaction rate, and less rescuing analgesic consumption during operation (p < 0.05). Both PD- and anesthesia-related complications were rare in the 4-week follow-up. Conclusions: The ultrasound-guided TAP block had better analgesic effect than LAI and can be used as a principal anesthesia technique for PDC implantation in ESRD patients without previous abdominal surgery.

Anesthetic management with subcostal transversus abdominis plane block in recessive dystrophic epidermolysis bullosa for peritoneal dialysis catheter replacement: a case report

“…1) should have been avoided. Li et al [12] reported superior analgesia and patient satisfaction with TAPB than with local anesthesia during the placement of a peritoneal dialysis catheter. It is possible that bilateral subcostal TAPB would have improved the quality of analgesia in the present case.…”

Transversus Abdominis Plane Block versus Wound Infiltration with Conventional Local Anesthetics in Adult Patients Underwent Surgery: A Systematic Review and Meta‐analysis of Randomized Controlled Trials

“…The details of the methodological risk of bias assessment are presented in graphic and summary forms (Figures 2 and 3). In summary, 7 RCTs [10,15,17,20,[22][23][24] had a low risk of bias, and 8 RCTs [11-14, 16, 18, 19, 21] had an unclear risk of bias. The main reasons for the 8 RCTs having an unclear risk of bias were due to a failure to mention the following factors: randomization sequence generation, allocation concealment, blinding of participants and personnel, and blinding of outcome assessment.…”

“…In the subgroup analyses of nonlaparoscopic surgery, compared with WI, TAP block was associated with lower pain scores at rest at 2 h (MD = −0:69, 95% CI (-1.23, -0.16), I 2 = 4%), 6 h (MD = −0:79, 95% CI (-1.22, -0.36), I 2 = 0%), and 24 h (MD = −0:58, 95% CI (-0.90, -0.26), I 2 = 15%) but not at 1 h (MD = −0:32, 95% CI (-1.15, -0.52), I 2 = 64%), and in the subgroup analyses of laparoscopic surgery, compared with WI, TAP block was also associated with lower pain scores at rest at 2 h (MD = −0:94, 95% CI (-1.79, -0.08), I 2 = 2%), 6 h (MD = −0:89, 95% CI (-1.13, -0.65), I 2 = 0%), and 24 h (MD = −0:53, 95% CI (-0.75, -0.31), I 2 = 10%) but not at 1 h (MD = −0:30, 95% CI (-0.63, 0.03), I 2 = 44%) ( Fig S1 to Fig S4). Moreover, in the subgroup analyses of the surgical site in the upper abdomen, compared with WI, TAP block was associated with lower pain scores at rest at 2 h (MD = −0:94, 95% CI (-1.79, -0.08), I 2 = 2%), 12 h (MD = −0:74, 95% CI (-1.28, -0.20), I 2 = 1%), and 24 h (MD = −0:69, 95% CI (-1.00, -0.39), I 2 = 0%) but not 3 [12,17,23], no study reported postoperative pain scores during movement at 12 h, and five studies reported postoperative pain scores during movement at 24 h [14,15,17,23,24]. Compared with WI, TAP block was associated with lower pain scores during movement at 2 h (MD = −1:47, 95% CI (-2.32, 0.62), P = 0:0007), 4 h (MD = −0:65, 95% CI (-1.24, 0.06), P = 0:03), 6 h (MD = −0:73, 95% CI (-1.23, 0.24), P = 0:004), and 24 h (MD = −0:85, 95% CI (-1.16, 0.53), P < 0:00001) but not at 1 h (MD = −1:04, 95% CI (-2.07, 0.00), P = 0:05), and there were low levels of heterogeneity in five analyses (for 1 h: I 2 = 4%; for 2 h: I 2 = 0%; for 4 h: I 2 = 0%; for 6h: I 2 = 0%; and for 24h: I 2 = 0%) ( Figures 10-14).…”

“…BioMed Research International including general surgeries [10][11][12][13][14][15][16], gynecological and obstetric surgeries [17][18][19][20][21][22], urinary surgeries [23], and nephrology surgeries [24].…”

“…Rest at 1, 2, 4, 6, 12, and 24 H. Five studies reported postoperative pain scores at rest at 1 h [10,11,17,21,23], five studies reported postoperative pain scores at rest at 2 h [10,11,17,23,24], three studies reported postoperative pain scores at rest at 4 h [10,17,23], five studies reported postoperative pain scores at rest at 6 h [12,17,19,21,23], four studies reported postoperative pain scores at rest at 12 h [10,12,19,21], and eight studies reported postoperative pain scores at rest at 24 h [10, 14-17, 21, 23, 24]. Compared with WI, TAP was associated with lower pain scores at rest at 2 h (MD = −0:76, 95% CI (-1.22, 0.31), P = 0:001), 4 h (MD = −0:57, 95% CI (-1.11, 0.03), P = 0:04), 6 h (MD = −0:87, 95% CI (-1.08, 0.65), P < 0:00001), 12 h (MD = −0:78, 95% CI (-0.91, 0.65), P < 0:00001), and 24 h (MD = −0:55, 95% CI (-0.73, 0.37), P < 0:00001) but not at 1 h (MD = −0:32, 95% CI (-0.87, 0.24), P = 0:26), and there were low to moderate levels of heterogeneity in six analyses (for 1 h: I 2 = 37%; for 2 h: I 2 = 0%; for 4 h: I 2 = 0%; for 6 h: I 2 = 0%; for 12 h: I 2 = 17%; and for 24 h: I 2 = 0%) ( Figures 4-9).…”