Pain related to robotic cholecystectomy with lower abdominal ports

Choi, Jong Bum; Lee, Sook Young; Kim, Wook Hwan; Baek, Nam Hyun; Kim, Jayoun; Park, Chu Kyung; Lee, Yeon Ju; Park, Sung Yong

doi:10.1097/md.0000000000004445

Cited by 12 publications

(6 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 15 ] In the present study and in Bakshis study, [ 13 ] the RSB injections were readministered at every 4 h indicating that the 8 h dosing interval in Padmanabhan's study [ 15 ] may have been too long to provide constant analgesic efficacy. In agreement with our data, Kim et al [ 16 ] found no opioid sparing efficacy and pain scores were lower only at 1 h after a single-dose RSB block but not thereafter compared with control group with no block.…”

Section: Discussionsupporting

confidence: 93%

A prospective, randomized, open label, controlled study investigating the efficiency and safety of 3 different methods of rectus sheath block analgesia following midline laparotomy

et al. 2018

View full text Add to dashboard Cite

Background:There is a controversy regarding the efficacy of rectus sheath block (RSB). The aim of the present study was to evaluate analgesic efficacy and safety of three different methods of RSB in postoperative pain management after midline laparotomy.Methods:A prospective, randomized, controlled, open-label clinical trial with 4 parallel groups was conducted in a tertiary care hospital in Finland. A total of 57 patients undergoing midline laparotomy were randomized to the control group (n = 12) or to 1 of the 3 active RSB analgesia groups: single-dose (n = 16), repeated-doses (n = 12), or continuous infusion (n = 17). Opioid consumption with iv-patient-controlled analgesia pump was recorded, and pain scores and patients’ satisfaction were surveyed on an 11-point numeric rating scale for the first 48 postoperative h. Plasma concentrations of oxycodone and levobupivacaine were analyzed. All adverse events during the hospital stay were recorded.Results:Oxycodone consumption was less during the first 12 h in the repeated-doses and in the continuous infusion groups (P = .07) and in numerical values up to 48 h in the repeated-doses group. Plasma oxycodone concentrations were similar in all 4 groups. Pain scores were lower in the repeated-doses group when coughing during the first 4 h (P = .048 vs. control group), and at rest on the first postoperative morning (P = .034 vs. the other 3 groups) and at 24 h (P = .006 vs. the single-dose group). All plasma concentrations of levobupivacaine were safe. The patients’ satisfaction was better in the repeated-doses group compared with the control group (P = .025). No serious or unexpected adverse events were reported.Conclusions:RSB analgesia with repeated-doses seems to have opioid sparing efficacy, and it may enhance pain relief and patients’ satisfaction after midline laparotomy.

show abstract

Section: Discussionsupporting

confidence: 93%

A prospective, randomized, open label, controlled study investigating the efficiency and safety of 3 different methods of rectus sheath block analgesia following midline laparotomy

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Studies on the preemptive effect of RSB in patients undergoing laparoscopic surgery are limited, and some are contrary to our results. First, Kim et al reported that bilateral RSB decreased the intensity of superficial pain only during the first hour after robotic cholecystectomy, compared with a placebo group [35]. Second, Jin et al reported that there was no significant difference in the pain, analgesic requirements, or time to first rescue analgesic after transabdominal gynecological surgery between the pre-RSB and post-RSB groups [36].…”

Section: Discussionmentioning

confidence: 99%

Preoperative versus Postoperative Rectus Sheath Block for Acute Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomized Controlled Study

Jeong

Kim

Choi

et al. 2019

JCM

View full text Add to dashboard Cite

Background: Pain after laparoscopic cholecystectomy (LC) is multifactorial and usually not effectively treated. Rectus sheath block (RSB) has been proven to reduce the pain from midline abdominal incision and laparoscopic surgery. We investigated the preemptive analgesic effect of RSB after LC. Methods: In this prospective, randomized, single-center trial, 200 patients undergoing LC were randomized into preoperative RSB (pre-RSB) or postoperative RSB (post-RSB) group. An ultrasound-guided RSB was performed before skin incision in the pre-RSB group or after skin closure in the post-RSB group. The primary outcome was total rescue analgesic consumption at 24 h post-surgery. The secondary outcomes were cumulated rescue analgesic consumption and postoperative pain measured by numerical rating scale (NRS) at 0, 1, 2, 6, 9, 18, and 24 h post-surgery. Results: Total rescue analgesic consumption at 24 h post-surgery was significantly lower in the pre-RSB group than in the post-RSB group (p = 0.020). The cumulated rescue analgesic consumption was significantly lower in the pre-RSB group than in the post-RSB group at 1 h (p = 0.023), 9 h (p = 0.020) and 18 h (p = 0.002) post-surgery. NRS was significantly lower in the pre-RSB group than in the post-RSB group at 0 h post-surgery (p = 0.023). Conclusion: The pre-RSB reduced the analgesic requirements in patients undergoing LC compared with the post-RSB.

show abstract

“…The findings of Gurnaney et al were confirmed by the work of Kim and colleagues, who compared 2 groups of adult patients who underwent robotic cholecystectomies. They found that the RSA group had better pain scores, lower doses of opioid requirements, and higher satisfaction scores ( 17 ). The finding of Kamei and colleagues did not differ so much when they used RSA in a group of patients who underwent single incision laparoscopic cholecystectomies; they emphasized that analgesia could have lasted for 6 hours postoperatively ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it can provide adequate postoperative analgesia in 97% of patients in their trial that aimed at detection of the local anesthetic spread and the effectiveness for surgical anesthesia of RSA ( 26 ). Unlike the previously mentioned trials ( 16 , 17 , 24 - 26 ), we used extended duration RSA for postoperative 72 hours through catheter embedded in rectus sheath bilaterally after completion of surgeries. There is lack of sufficiently designed prospective randomized controlled trials that compare the opioid sparing properties of extended time RSA against placebo or TEA ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…Local anesthetic instillation within the posterior rectus sheath bilaterally provides intense analgesia for the middle anterior wall from the xiphoid process to the symphysis pubis in adults ( 14 ) and in pediatric population ( 15 , 16 ). Nonetheless, it devoid the ability to control visceral pain, which could be severe in the early 12 - 36 hours postoperatively ( 2 , 17 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Analgesic Efficiency of Ultrasound-Guided Rectus Sheath Analgesia Compared with Low Thoracic Epidural Analgesia After Elective Abdominal Surgery with a Midline Incision: A Prospective Randomized Controlled Trial

2017

View full text Add to dashboard Cite

BackgroundUltrasound-guided rectus sheath blockade has been described to provide analgesia for midline abdominal incisions. We aimed to compare thoracic epidural analgesia (TEA) and rectus sheath analgesia (RSA) with respect to safety and efficacy.MethodsSixty patients who underwent elective laparotomies through a midline incision were assigned randomly to receive either continuous TEA (TEA group, n = 31) or intermittent RSA (RSA group, n = 29). The number of patients who required analgesia, the time to first request analgesia, the interval and the cumulative morphine doses consumption during 72 hours postoperatively, and pain intensity using visual analog score (VAS) at rest and upon coughing were reported in addition to any side effects related to both techniques or administered drugs.ResultsWhile 17 (54.84 %) patients were in the TEA group, 25 (86.21%) patients in the RSA group required analgesia postoperatively, P = 0.008. Cumulative morphine consumed during the early 72 hours postoperatively median (interquartile range) = 33 mg (27 - 39 mg), 95% confidence interval (28.63 - 37.37 mg) for the TEA group. While in the RSA group, it was 51 mg (45 - 57 mg), 95% CI (47.4 - 54.6 mg), P < 0.001. The time for the first request of morphine was 256.77 ± 73.45 minutes in the TEA group versus 208.82 ± 64.65 min in the RSA group, P = 0.031. VAS at rest and cough were comparable in both groups at all time points of assessment, P > 0.05. The time to the ambulation was significantly shorter in the RSA group (38.47 ± 12.34 hours) as compared to the TEA group (45.89 ± 8.72 hours), P = 0.009. Sedation scores were significantly higher in the RSA group, only at 12 hours and 24 hours postoperatively than in TEA group, with P = 0.041 and 0.013, respectively. The incidence of other morphine-related side effects, time to pass flatus, and patients satisfaction scores were comparable between both groups.ConclusionsContinuous TEA had better opioid sparing effects markedly during the early 72 hours postoperatively than that of intermittent RSA with catheters inserted under real-time ultrasound guidance, both had comparable safety perspectives, and RSA had the advantage of early ambulation. RSA could be used as an effective alternative when TEA could not be employed in patients undergoing laparotomies with an extended midline incision, especially after the first postoperative day.

show abstract

Pain related to robotic cholecystectomy with lower abdominal ports

Cited by 12 publications

References 28 publications

A prospective, randomized, open label, controlled study investigating the efficiency and safety of 3 different methods of rectus sheath block analgesia following midline laparotomy

A prospective, randomized, open label, controlled study investigating the efficiency and safety of 3 different methods of rectus sheath block analgesia following midline laparotomy

Preoperative versus Postoperative Rectus Sheath Block for Acute Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomized Controlled Study

The Analgesic Efficiency of Ultrasound-Guided Rectus Sheath Analgesia Compared with Low Thoracic Epidural Analgesia After Elective Abdominal Surgery with a Midline Incision: A Prospective Randomized Controlled Trial

Contact Info

Product

Resources

About