R Kargar1,2, V Minas3, A Gorgin-Karaji1,2, K Shadjoo1,2, R Padmehr1,2, A Mohazzab1,2, A Enzevaei1,2, S Samimi-Sadeh4, K Kamali5, S Khazali1,2,3,6. 1. Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran. 2. Avicenna Center for Endometriosis and Minimally Invasive Gynaecology, ACECR, Tehran, Iran. 3. Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG), Ashford and St. Peter's Hospitals NHS Foundation Trust, Chertsey, UK. 4. Department of Anaesthesiology, Mohebe Yas Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 5. Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran. 6. Royal Holloway - University of London, London, UK.
Abstract
OBJECTIVE: To compare the efficiency of laparoscopically guided transversus abdominis plane block (LTAP) versus port-site local anaesthetic infiltration (LAI) in reducing postoperative pain following laparoscopic excision of endometriosis. DESIGN: A prospective, double-blind randomised controlled trial. SETTING: A tertiary referral centre for endometriosis and minimally invasive gynaecological surgery. POPULATION: Women undergoing laparoscopic excision of endometriosis from December 2015 through July 2016. METHODS: Participants were randomised to receive: port-site infiltration with bupivacaine and placebo LTAP (LAI group, n = 21); placebo port-site infiltration and LTAP with bupivacaine (LTAP group, n = 24); placebo port-site infiltration and placebo LTAP (placebo group, n = 25). MAIN OUTCOME MEASURES: Post-operative pain at 2-4, 6-8, 10-12 and 24 hours, analgesic requirements, TAP block-related complications and opioid-related adverse effects. RESULTS: There were no differences in patient characteristics between the groups. In comparison with placebo, both LTAP and LAI groups had significantly less pain at 2-4, 6-8, and 10-12 hours (median 3, 3, 3.5 versus 3, 6, 4 versus 8, 8, 7 for LTAP, LAI, and placebo, respectively, P < 0.05). Median differences (and 95% confidence intervals) were as follows; LTAP versus placebo -5 (-6 to -4), -4 (-5 to -3), -3 (-4 to -0.5); LAI versus placebo -4 (-5 to -2), -2 (-3 to -0.5), -1 (-4 to -0.5) at 2-4, 6-8 and 10-12 hours, respectively. There were no statistically significant differences between the LTAP and LAI groups. CONCLUSIONS: Laparoscopically guided transversus abdominis plane block and LAI both reduce postoperative pain in patients undergoing laparoscopic excision of endometriosis, compared with placebo. We found no differences in effect between LTAP and LAI. TWEETABLE ABSTRACT: TAP block and port-site local infiltration are both effective in reducing postoperative pain in major gynaecological laparoscopic surgery.
OBJECTIVE: To compare the efficiency of laparoscopically guided transversus abdominis plane block (LTAP) versus port-site local anaesthetic infiltration (LAI) in reducing postoperative pain following laparoscopic excision of endometriosis. DESIGN: A prospective, double-blind randomised controlled trial. SETTING: A tertiary referral centre for endometriosis and minimally invasive gynaecological surgery. POPULATION: Women undergoing laparoscopic excision of endometriosis from December 2015 through July 2016. METHODS: Participants were randomised to receive: port-site infiltration with bupivacaine and placebo LTAP (LAI group, n = 21); placebo port-site infiltration and LTAP with bupivacaine (LTAP group, n = 24); placebo port-site infiltration and placebo LTAP (placebo group, n = 25). MAIN OUTCOME MEASURES: Post-operative pain at 2-4, 6-8, 10-12 and 24 hours, analgesic requirements, TAP block-related complications and opioid-related adverse effects. RESULTS: There were no differences in patient characteristics between the groups. In comparison with placebo, both LTAP and LAI groups had significantly less pain at 2-4, 6-8, and 10-12 hours (median 3, 3, 3.5 versus 3, 6, 4 versus 8, 8, 7 for LTAP, LAI, and placebo, respectively, P < 0.05). Median differences (and 95% confidence intervals) were as follows; LTAP versus placebo -5 (-6 to -4), -4 (-5 to -3), -3 (-4 to -0.5); LAI versus placebo -4 (-5 to -2), -2 (-3 to -0.5), -1 (-4 to -0.5) at 2-4, 6-8 and 10-12 hours, respectively. There were no statistically significant differences between the LTAP and LAI groups. CONCLUSIONS: Laparoscopically guided transversus abdominis plane block and LAI both reduce postoperative pain in patients undergoing laparoscopic excision of endometriosis, compared with placebo. We found no differences in effect between LTAP and LAI. TWEETABLE ABSTRACT: TAP block and port-site local infiltration are both effective in reducing postoperative pain in major gynaecological laparoscopic surgery.
Authors: Leonard K Welsh; Gerardo Davalos; Ramon Diaz; Andres Narvaez; Juan Esteban Perez; Melissa Castro; Maragatha Kuchibhatla; Thomas Risoli; Dana Portenier; Alfredo D Guerron Journal: J Laparoendosc Adv Surg Tech A Date: 2020-07-14 Impact factor: 1.878
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