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Elnabtity AM et al, 2016: Unilateral versus bilateral ultrasound-guided transversus abdominis plane blocks during ureteric shock wave lithotripsy: A prospective randomized trial.

Elnabtity AM, Shabana WM.
Department of Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Department of Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Abstract

BACKGROUND: Ultrasound-guided transversus abdominis plane (TAP) block has been used for intra- and post-operative analgesia during abdominal operations and for ureteric shock wave lithotripsy (SWL) as well.AIM: This study aimed at comparing ultrasound-guided unilateral versus bilateral TAP blocks as analgesic techniques for unilateral ureteric SWL. SETTINGS AND DESIGN: Prospective randomized comparative study.
PATIENTS AND METHODS: Sixty patients scheduled for unilateral ureteric SWL were randomly allocated into two groups: Group (U) received unilateral TAP block in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg), and Group (B) received bilateral TAP blocks in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg) on each side.
STATISTICAL ANALYSIS: This was performed using SPSS program version 19 ((IBM Corp., Armonk, NY, USA) and EP 16 program.
RESULTS: The mean values of intra- and post-procedural visual analog scale at different time intervals were around (30), which was statistically insignificant between groups (P > 0.05). There were no significant differences between groups regarding cardiopulmonary stability, postanesthesia care unit time, the total amount of rescue fentanyl and patient satisfaction scores (P > 0.05). There were no significant side effects in both groups.
CONCLUSION: Ultrasound-guided unilateral TAP block is as safe and effective analgesic technique as bilateral TAP blocks during unilateral ureteric SWL. It can be used as the sole analgesic technique during ureteric SWL. 

Urol Ann. 2016 Jul-Sep;8(3):265-9. doi: 10.4103/0974-7796.184893.

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Kommentare 1

Hans-Göran Tiselius am Freitag, 03. Februar 2017 11:48

Local anaesthesia can be of clinical value as it does not require administration of powerful analgesics and sedatives.

The purpose of this study was to compare unilateral and bilateral TAP-blockade (transversus abdominis plane block) in reducing or eliminating pain during SWL of ureteral stones. It is thereby understood that the patients with ureteral stones regularly are treated with shockwaves administered trans-abdominally. This is, however, not always the case even if the stones in this study only were located in the middle or distal ureter. Intestinal gas covering stones might interfere with the shockwave. When it becomes necessary to change patient position and for proximal ureteral stones TAP is obviously not a good alternative.

It is of note that fentanyl also was administered to both groups.

Nevertheless TAP seems to be an interesting alternative for anaesthesia in selected patients and for those readers (like myself) who are unfamiliar with this method the following two articles give additional information [1,2].

References

1. Kuppuvelumani P, Jaradi H, Delilkan A.
Abdominal nerve blockade for postoperative analgesia after caesarean section.
Asia Oceania J Obstet Gynaecol. 1993 19:165-169.

2. Aveline C, Le Hetet H, Le Roux A, Vautier P, Cognet F, Vinet E, Tison C, Bonnet F.
Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair.
Br J Anaesth. 2011 106:380-386.

Local anaesthesia can be of clinical value as it does not require administration of powerful analgesics and sedatives. The purpose of this study was to compare unilateral and bilateral TAP-blockade (transversus abdominis plane block) in reducing or eliminating pain during SWL of ureteral stones. It is thereby understood that the patients with ureteral stones regularly are treated with shockwaves administered trans-abdominally. This is, however, not always the case even if the stones in this study only were located in the middle or distal ureter. Intestinal gas covering stones might interfere with the shockwave. When it becomes necessary to change patient position and for proximal ureteral stones TAP is obviously not a good alternative. It is of note that fentanyl also was administered to both groups. Nevertheless TAP seems to be an interesting alternative for anaesthesia in selected patients and for those readers (like myself) who are unfamiliar with this method the following two articles give additional information [1,2]. References 1. Kuppuvelumani P, Jaradi H, Delilkan A. Abdominal nerve blockade for postoperative analgesia after caesarean section. Asia Oceania J Obstet Gynaecol. 1993 19:165-169. 2. Aveline C, Le Hetet H, Le Roux A, Vautier P, Cognet F, Vinet E, Tison C, Bonnet F. Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. Br J Anaesth. 2011 106:380-386.
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