Journal of Anaesthesiology Clinical Pharmacology

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 35  |  Issue : 1  |  Page : 58--64

Patient-controlled analgesia with and without transverse abdominis plane and rectus sheath space block in cirrhotic patients undergoing liver resection


Khaled Yassen1, Maha Lotfy1, Ashraf Miligi2, Ahmed Sallam3, Eman Abdel Razik Hegazi1, Mohamed Afifi2 
1 Department of Anaesthesia, Liver Institute, Menoufia University, Egypt
2 Department of Anaesthesia, Faculty of Medicine, Menoufia University, Egypt
3 Department of Surgery, Liver Institute, Menoufia University, Egypt

Correspondence Address:
Khaled Yassen
Department of Anaesthesia, Liver Institute, Menoufiya University, Shebeen El Kom City
Egypt

Background and Aims: Optimal pain control can be a challenge in cirrhotic patients. The aim was to compare the analgesic efficacy and side effects of intravenous fentanyl patient-controlled analgesia (PCA) with and without bupivacaine boluses in transversus abdominis plane (TAP) and rectus sheath space (RSB) in cirrhotics undergoing liver surgery. Material and Methods: A double-blinded randomized controlled trial (n = 55, child's A) was conducted. Catheters were inserted surgically in TAP and rectal sheath space during surgical closure. Fentanyl PCA + TAP + RSB group (gp) (n = 30): (0.2 ml/kg of 0.25% bupivacaine, 8 hourly) was compared with fentanyl PCA gp (n = 25): [0.2 ml/kg of saline (placebo) injected in catheters 8 hourly] for 48 h postoperatively. Plasma bupivacaine was measured with an enzyme-linked immunosorbent assay at 10 min, 30 min, 1 h, 2 h, and 4 h after each injection and 30 min before next injection. Results: Fentanyl consumption was reduced in (PCA + TAP + RSB) gp compared to PCA gp (Day 1: 325.4 ± 169.1 vs. 1034 ± 231.7, Day 2: 204.44 ± 62.9 vs. 481.6 ± 158.3 μg, P < 0.05). Both groups demonstrated effective pain control at rest [Visual Analog Scales (VAS) <3), but on movement pain control with bupivacaine was better (P < 0.05). Increased demand for rescue opioids was observed prior to next scheduled bupivacaine injection in 10/30 patients on Day 1 and 2/30 on Day 2, in association with a reduced bupivacaine serum levels compared to 10 min after injection (47.6 ± 22.7 vs. 93.6 ± 61.0 ng/ml, respectively, P < 0.05). Bupivacaine did not exceed referred toxic levels. Conclusion: Repeated bupivacaine TAP and RSB with PCA fentanyl improved pain control, reduced opioids demand with no toxicity. Time interval between injections needs to be reduced to avoid breakthrough pain.


How to cite this article:
Yassen K, Lotfy M, Miligi A, Sallam A, Razik Hegazi EA, Afifi M. Patient-controlled analgesia with and without transverse abdominis plane and rectus sheath space block in cirrhotic patients undergoing liver resection.J Anaesthesiol Clin Pharmacol 2019;35:58-64


How to cite this URL:
Yassen K, Lotfy M, Miligi A, Sallam A, Razik Hegazi EA, Afifi M. Patient-controlled analgesia with and without transverse abdominis plane and rectus sheath space block in cirrhotic patients undergoing liver resection. J Anaesthesiol Clin Pharmacol [serial online] 2019 [cited 2020 Oct 24 ];35:58-64
Available from: https://www.joacp.org/article.asp?issn=0970-9185;year=2019;volume=35;issue=1;spage=58;epage=64;aulast=Yassen;type=0