Ultrasound-guided Transverses Abdominis Plane block using bupivacaine with or without hyaluronidase in laparoscopic cholecystectomy

Document Type : Original Article

Authors

Anesthesiology, surgical intensive care and pain management, Beni-Suef University Hospital, Beni-Suef University, Egypt.

Abstract

Aim: The purpose of this study is to compare the efficacy of of Bupivacaine 0.25% alone versus the Bupivacaine 0.25% with Hyaluronidase 1500 I.U during ultrasound guided transversus abdominis plane block in elective laparoscopic cholecystectomy under general anesthesia. Patients and methods: This Randomized Controlled-double-blind study was conducted on 60 Patients randomized into two groups. Group A (30 patients), TAP block was performed using Bupivacaine 0.25% 20 ml on each side of abdominal wall. Group B (30 patients), TAP block was performed using a combination of 18 ml of Bupivacaine 0.25% and 2 ml of Hyaluronidase 750 I.U on each side of abdominal wall. This study was carried out in the department of Anesthesiology, surgical intensive care and pain management in Beni-Suef University hospital. Results: Regarding the total analgesic amount requirements, this study showed that there was no statistically significant difference between both groups regarding the dose of analgesia after 2, 4, 6, 12, 16, 20, and 24 postoperatively. There was a statistically significant longer mean time to 1st request of analgesia being 10.2±3.1 hours in bupivacaine and hyaluronidase group than bupivacaine only group being 5.2±1.9 hours. According to the NSR pain score, there was no statistically significant difference between bupivacaine and hyaluronidase group and bupivacaine only group after 2, 4, 6, 8, 12, 16, 20, and 24 of the operation. Conclusion: Using hyaluronidase as an adjuvant to bupivacaine in sonar-guided TAP block after laparoscopic cholecystectomy offered good postoperative analgesia, postponed the need for analgesia, and decreased analgesic intake early postoperatively.

Keywords

Main Subjects

References

  1. Mitra, S., Khandelwal, P., Roberts, K., Kumar, S., & Vadivelu, N. (2012). Pain relief in laparoscopic cholecystectomy—a review of the current options. Pain Practice, 12(6), 485-496.
  2. Walter, C. J., Maxwell-Armstrong, C., Pinkney, T. D., Conaghan, P. J., Bedforth, N., Gornall, C. B., & Acheson, A. G. (2013). A randomised controlled trial of the efficacy of ultrasound-guided transversus abdominis plane (TAP) block in laparoscopic colorectal surgery. Surgical endoscopy, 27(7), 2366-2372.
  3. Ma, N., Duncan, J. K., Scarfe, A. J., Schuhmann, S., & Cameron, A. L. (2017). Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis. Journal of anesthesia, 31(3), 432-452.
  4. Mostafa, T. A. H., Abo Hagar, A. M., & Omara, A. F. A. S. (2021). Effect of hyaluronidases added to different concentrations of bupivacaine on quality of ultrasound-guided supraclavicular brachial plexus block. Egyptian Journal of Anaesthesia, 37(1), 9-14.
  5. Litz, R. J., Popp, M., Stehr, S. N., & Koch, T. (2006). Successful resuscitation of a patient with ropivacaine‐induced asystole after axillary plexus block using lipid infusion. Anaesthesia, 61(8), 800-801.
  6. Woodfore, B. (1971). Correlation between verbal scale and visual analogue scale and pressure algometer. J of Psychosom. Res., 16, 173-178.
  7. Ergin, A., Aydin, M.T., Çiyiltepe, H., Karip, A.B., Fersahoğlu, M.M., Özcabi, Y., Ağca, B., İşcan, A.Y., Güneş, Y., Ar, A.Y. and Taşdelen, İ. (2021): Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial. International Journal of Surgery, 95: 106134.
  8. Shim, J.W., Ko, J., Bae, J.H., Park, J., Lee, H.M., Kim, Y.S., Moon, Y.E., Hong, S.H. and Chae, M.S. (2022): Pre-emptive multimodal analgesic bundle with transversus abdominis plane block enhances early recovery after laparoscopic cholecystectomy. Asian Journal of Surgery, 45(1): 250-256.
  9. Marzouk, M.M., Said, A.M., Abdelaziz, A.A., Selima, W.Z. and Yousef, M.W. (2020): Comparative Study of Ultrasound Guided Transversus Abdominis Plane Block Using Bupivacaine with and without Hyaluronidase in Laparoscopic Bariatric Surgery. Ain Shams Medical Journal, 71 (3): 647-658.
  10. Bhaskar, S.B. and Balasubramanya, H. (2016): The transversus abdominis plane block: Case for optimal tap. Indian Journal of Anaesthesia, 60 (4): 231.
  11. Vrsajkov, V., Mančić, N., Mihajlović, D., Milićević, S.T., Uvelin, A. and Vrsajkov, J.P. (2018): Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy. Revista Brasileira de Anestesiologia, 68: 149-153.
  12. Mohaned, S., Badawi, F., Ali, H.M. and Refat, G. (2017): Postoperative analgesic efficacy of bupivacaine with hyalourindase in TAP block for lower abdominal surgeries. Sohag Medical Journal, 21 (3): 295-300.
  13. Elsayed, S., Ahmed, F.M. and Khalifa, O.Y. (2019): Hyaluronidase versus adrenaline as an adjuvant to bupivacaine in ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries. Research and Opinion in Anesthesia and Intensive Care, 6 (2): 206.
  14. Petkar, J., Naik, S.S. and Devi, S. (2020): A randomized controlled trial to study the effect of hyaluronidase as adjuvant in ultrasound-guided transversus abdominis plane block for postoperative analgesia in total abdominal hysterectomy. Journal on Recent Advances in Pain, 6 (3): 27.
  15. Hakim, K.Y. and Ahmed, M.A.A.S. (2017): Effect of addition of hyaluronidase as an adjuvant to local anesthetics in ultrasound-guided supraclavicular brachial plexus block. Ain-Shams Journal of Anaesthesiology, 10 (1): 213.
  16. Koh, W.U., Min, H.G., Park, H.S., Karm, M.H., Lee, K.K., Yang, H.S. and Ro, Y.J. (2015): Use of hyaluronidase as an adjuvant to ropivacaine to reduce axillary brachial plexus block onset time: a prospective, randomised controlled study. Anaesthesia, 70 (3): 282-289.
  17. Petkar, J., Naik, S.S. and Devi, S. (2020): A randomized controlled trial to study the effect of hyaluronidase as adjuvant in ultrasound-guided transversus abdominis plane block for postoperative analgesia in total abdominal hysterectomy. Journal on Recent Advances in Pain, 6 (3): 27.
  18. Chaudhari AV, Chaudhari VP (2013): Local anaesthetic agents along with hyaluronidase for inguinal hernia block provides excellent analgesia: A double blind study. Int J Basic Clin Pharmacol, 2: 466-9.
  19. Abdelaziz, F.M. and Abd Elghany, R.A.E. (2021): The advantage of hyaluronidase in rectus sheath block for pain control in laparoscopic cholecystectomy. Al-Azhar International Medical Journal, 2 (9): 59 – 63.
  20. Mittal, T., Dey, A., Siddhartha, R., Nali, A., Sharma, B. and Malik, V. (2018): Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic gastric sleeve resection: a randomized single blinded case control study. Surgical Endoscopy, 32 (12): 4985-4989.
  21. Ruiz-Tovar, J., Garcia, A., Ferrigni, C., Gonzalez, J., Levano-Linares, C., Jimenez-Fuertes, M., Llavero, C. and Duran, M. (2018): Laparoscopic-guided transversus abdominis plane (TAP) block as part of multimodal analgesia in laparoscopic Roux-en-Y gastric bypass within an enhanced recovery after surgery (ERAS) program: a prospective randomized clinical trial. Obesity surgery, 28 (11): 3374-3379.
  22. Marzouk, M.M., Said, A.M., Abdelaziz, A.A., Selima, W.Z. and Yousef, M.W. (2020): Comparative Study of Ultrasound Guided Transversus Abdominis Plane Block Using Bupivacaine with and without Hyaluronidase in Laparoscopic Bariatric Surgery. Ain Shams Medical Journal, 71 (3): 647-658.
  23. Baytar, Ç., Yılmaz, C., Karasu, D. and Topal, S. (2019): Comparison of ultrasound-guided subcostal transversus abdominis plane block and quadratus lumborum block in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical study. Pain Research and Management, 2019: 1-6.
  24. Karasu, D., Yilmaz, C., Ozgunay, S.E., Yalcin, D. and Ozkaya, G. (2021): Ultrasound-guided transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy: A retrospective study. Northern Clinics of İstanbul, 8 (1): 88.
  25. Kupiec, A., Zwierzchowski, J., Kowal-Janicka, J., Goździk, W., Fuchs, T., Pomorski, M., Zimmer, M. and Kübler, A. (2018): The analgesic efficiency of transversus abdominis plane (TAP) block after caesarean delivery. Ginekologia polska, 89(8), pp.421-424.
  26. Zahra, A.A., Abo-Elenin, K.M., El-Fiky, E.M., Kasemy, Z.A. and Helwa, A.M. (2021): Intra Peritoneal Instillation of Bupivacaine or Bupivacaine plus Magnesium Sulphate or Bupivacaine plus Dexamethasone on Post-Operative Pain after Laparoscopic Cholecystectomy: A Randomized Controlled Study. The Egyptian Journal of Hospital Medicine, 84 (1): 2655-2662.
  27. Khan, A.I., Fischer, M., Pedoto, A.C., Seier, K., Tan, K.S., Dalbagni, G., Donat, S.M. and Arslan-Carlon, V. (2020): The impact of pre-induction fluid optimisation on post-induction hypotension. Anaesthesia, 75 (5): 634.
  28. Olapour, A., Akhondzadeh, R., Rashidi, M., Gousheh, M. and Homayoon, R. (2020): Comparing the effect of bupivacaine and ropivacaine in cesarean delivery with spinal anesthesia. Anesthesiology and Pain Medicine, 10 (1): 94155.
  29. Trabelsi, B., Charfi, R., Bennasr, L., Marzouk, S.B., Eljebari, H., Jebabli, N., Sassi, M.B., Trabelsi, S. and Maghrebi, H. (2017): Pharmacokinetics of bupivacaine after bilateral ultrasound-guided transversus abdominis plane block following cesarean delivery under spinal anesthesia. International journal of obstetric anesthesia, 32: 17-20.
  30. Jung, H. (2020): Hyaluronidase: an overview of its properties, applications, and side effects. Archives of Plastic Surgery, 47 (4): 297.
  31. Baker, B.W., Villadiego, L.G., Lake, Y.N., Amin, Y., Timmins, A.E., Swaim, L.S. and Ashton, D.W. (2018): Transversus abdominis plane block with liposomal bupivacaine for pain control after cesarean delivery: a retrospective chart review. Journal of Pain Research, 11: 3109.
  32. Rahimzadeh, P., Faiz, S.H.R., Latifi-Naibin, K. and Alimian, M. (2022): A Comparison of effect of preemptive versus postoperative use of ultrasound-guided bilateral transversus abdominis plane (TAP) block on pain relief after laparoscopic cholecystectomy. Scientific Reports, 12 (1): 1-7.

Files

Share

How to cite

Statistics