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Pain related to robotic cholecystectomy with lower abdominal ports: effect of the bilateral ultrasound-guided split injection technique of rectus sheath block in female patients: A prospective randomised trial.

Kim JS, Choi JB, Lee SY, Kim WH, Baek NH, Kim J, Park CK, Lee YJ, Park SY - Medicine (Baltimore) (2016)

Bottom Line: Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group.Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours.This limited benefit should be balanced against the time and risks entailed in performing RSB.

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Anesthesiology and Pain Medicine bDepartment of Surgery cOffice of Biostatistics, Ajou University, School of Medicine, Suwon, Korea.

ABSTRACT

Background: Robotic cholecystectomy (RC) using port sites in the lower abdominal area (T12-L1) rather than the upper abdomen has recently been introduced as an alternative procedure for laparoscopic cholecystectomy. Therefore, we investigated the time course of different components of pain and the analgesic effect of the bilateral ultrasound-guided split injection technique for rectus sheath block (sRSB) after RC in female patients.

Methods: We randomly assigned 40 patients to undergo ultrasound-guided sRSB (RSB group, n = 20) or to not undergo any block (control group, n = 20). Pain was subdivided into 3 components: superficial wound pain, deep abdominal pain, and referred shoulder pain, which were evaluated with a numeric rating scale (from 0 to 10) at baseline (time of awakening) and at 1, 6, 9, and 24 hours postoperatively. Consumption of fentanyl and general satisfaction were also evaluated 1 hour (before discharge from the postanesthesia care unit) and 24 hours postoperatively (end of study).

Results: Superficial wound pain was predominant only at awakening, and after postoperative 1 hour in the control group. Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group. The cumulative postoperative consumption of fentanyl at 6, 9, and 24 hours was not significantly different between groups.

Conclusions: After RC with lower abdominal ports, superficial wound pain predominates over deep intra-abdominal pain and shoulder pain only at the time of awakening. Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours. Bilateral ultrasound-guided sRSB was effective only during the first hour. This limited benefit should be balanced against the time and risks entailed in performing RSB.

No MeSH data available.


Related in: MedlinePlus

The characteristics of postoperative pain. Superficial incisional pain was significantly more severe than deep pain immediately after the operation. Superficial incisional and deep pains were both significantly greater than shoulder pain during the first 1 hour postoperatively. (∗) P < 0.05 compared with deep pain; (†, ‡) P < 0.05 compared with shoulder pain.
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Figure 3: The characteristics of postoperative pain. Superficial incisional pain was significantly more severe than deep pain immediately after the operation. Superficial incisional and deep pains were both significantly greater than shoulder pain during the first 1 hour postoperatively. (∗) P < 0.05 compared with deep pain; (†, ‡) P < 0.05 compared with shoulder pain.

Mentions: The characteristics of postoperative pain during first 24 hours after RCNP in the control group are shown in Fig. 3. The time course and intensity of the different components of pain after RCNP seemed to differ significantly (P < 0.001). Superficial incisional pain scores were highest immediately after the operation and decreased significantly throughout the first 6 postoperative hours. Immediately after the operation, superficial incisional pain scores were significantly higher than were scores for the other pain components (P < 0.001 vs deep pain, P < 0.001 vs shoulder pain). Deep pain scores were significantly higher than shoulder pain scores as well at immediately after the operation (P < 0.001). One hour postoperatively, superficial incisional pain scores and deep pain scores were significantly higher than shoulder pain scores (P < 0.001 and P < 0.001, respectively). Superficial incisional and deep pain intensity fell throughout the first 6 postoperative hours, at which point there were no significant differences in pain scores among the 3 pain components.


Pain related to robotic cholecystectomy with lower abdominal ports: effect of the bilateral ultrasound-guided split injection technique of rectus sheath block in female patients: A prospective randomised trial.

Kim JS, Choi JB, Lee SY, Kim WH, Baek NH, Kim J, Park CK, Lee YJ, Park SY - Medicine (Baltimore) (2016)

The characteristics of postoperative pain. Superficial incisional pain was significantly more severe than deep pain immediately after the operation. Superficial incisional and deep pains were both significantly greater than shoulder pain during the first 1 hour postoperatively. (∗) P < 0.05 compared with deep pain; (†, ‡) P < 0.05 compared with shoulder pain.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979826&req=5

Figure 3: The characteristics of postoperative pain. Superficial incisional pain was significantly more severe than deep pain immediately after the operation. Superficial incisional and deep pains were both significantly greater than shoulder pain during the first 1 hour postoperatively. (∗) P < 0.05 compared with deep pain; (†, ‡) P < 0.05 compared with shoulder pain.
Mentions: The characteristics of postoperative pain during first 24 hours after RCNP in the control group are shown in Fig. 3. The time course and intensity of the different components of pain after RCNP seemed to differ significantly (P < 0.001). Superficial incisional pain scores were highest immediately after the operation and decreased significantly throughout the first 6 postoperative hours. Immediately after the operation, superficial incisional pain scores were significantly higher than were scores for the other pain components (P < 0.001 vs deep pain, P < 0.001 vs shoulder pain). Deep pain scores were significantly higher than shoulder pain scores as well at immediately after the operation (P < 0.001). One hour postoperatively, superficial incisional pain scores and deep pain scores were significantly higher than shoulder pain scores (P < 0.001 and P < 0.001, respectively). Superficial incisional and deep pain intensity fell throughout the first 6 postoperative hours, at which point there were no significant differences in pain scores among the 3 pain components.

Bottom Line: Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group.Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours.This limited benefit should be balanced against the time and risks entailed in performing RSB.

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Anesthesiology and Pain Medicine bDepartment of Surgery cOffice of Biostatistics, Ajou University, School of Medicine, Suwon, Korea.

ABSTRACT

Background: Robotic cholecystectomy (RC) using port sites in the lower abdominal area (T12-L1) rather than the upper abdomen has recently been introduced as an alternative procedure for laparoscopic cholecystectomy. Therefore, we investigated the time course of different components of pain and the analgesic effect of the bilateral ultrasound-guided split injection technique for rectus sheath block (sRSB) after RC in female patients.

Methods: We randomly assigned 40 patients to undergo ultrasound-guided sRSB (RSB group, n = 20) or to not undergo any block (control group, n = 20). Pain was subdivided into 3 components: superficial wound pain, deep abdominal pain, and referred shoulder pain, which were evaluated with a numeric rating scale (from 0 to 10) at baseline (time of awakening) and at 1, 6, 9, and 24 hours postoperatively. Consumption of fentanyl and general satisfaction were also evaluated 1 hour (before discharge from the postanesthesia care unit) and 24 hours postoperatively (end of study).

Results: Superficial wound pain was predominant only at awakening, and after postoperative 1 hour in the control group. Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group. The cumulative postoperative consumption of fentanyl at 6, 9, and 24 hours was not significantly different between groups.

Conclusions: After RC with lower abdominal ports, superficial wound pain predominates over deep intra-abdominal pain and shoulder pain only at the time of awakening. Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours. Bilateral ultrasound-guided sRSB was effective only during the first hour. This limited benefit should be balanced against the time and risks entailed in performing RSB.

No MeSH data available.


Related in: MedlinePlus