Transversus Abdominis Plane Block Reduces Intraoperative Opioid Consumption in Patients Undergoing Periacetabular Osteotomy

Overview

Journal J Clin Med

Specialty General Medicine

Date 2022 Sep 9

PMID 36078890

Authors

Jannis Lochel

Georgi I Wassilew

Michael Kramer

Christopher Kohler

Robert Karl Zahn

Vincent Justus Leopold

Affiliations

Soon will be listed here.

Abstract

Background: Administering intraoperative analgesia in patients undergoing periacetabular osteotomy (PAO) is challenging due to both the relevant surgical approach and osteotomies, which are associated with pain. The aim of this study was to assess the effect of the transversus abdominis plane block (TAPb) on intraoperative opioid consumption and circulation parameters in PAO patients.

Patients And Methods: We conducted a two-group randomized-controlled trial involving 42 consecutive patients undergoing PAO for symptomatic developmental dysplasia of the hip (DDH) in our department. Patients assigned to the study group received an ultrasound-guided TAPb with 0.75% ropivacaine before the beginning of the surgery and after general anesthesia induction. Patients assigned to the control group did not receive a TAPb. General anesthesia was conducted according to a defined study protocol. The primary endpoint of the study was the intraoperative opioid consumption, measured in morphine equivalent dose (MED). Secondary endpoints were the assessment of intraoperative heart rate, mean arterial pressure (MAP), need for hypotension treatment, and length of hospital stay (LOHS). A total of 41 patients ( = 21 TAPb group, = 20 control group) completed the study; of these, 33 were women (88.5%) and 8 were men (19.5%). The mean age at the time of surgery was 28 years (18-43, SD ± 7.4). All operations were performed by a single high-volume surgeon and all TAPb procedures were performed by a single experienced senior anesthesiologist.

Results: We observed a significantly lower intraoperative opioid consumption in the TAPb group compared to the control group (930 vs. 1186 MED per kg bodyweight; = 0.016). No significant differences were observed in the secondary outcome parameters. We observed no perioperative complications.

Conclusion: Ultrasound-guided TAPb significantly reduces intraoperative opioid consumption in patients undergoing PAO.

Citing Articles

Peri-Operative Management of Periacetabular Osteotomy: A Report of Current Practices from the Anchor Group, Supporting Literature, and Areas for Future Investigation.

Willey M, Spiker A, Schmitz M, Belzile E, Sierra R, Clohisy J Iowa Orthop J. 2024; 44(1):159-166.

PMID: 38919350 PMC: 11195894.

Analgesic effect of ultrasound-guided bilateral transversus abdominis plane block in laparoscopic gastric cancer.

Wang Y, Fu H World J Gastrointest Surg. 2023; 15(10):2171-2178.

PMID: 37969718 PMC: 10642456. DOI: 10.4240/wjgs.v15.i10.2171.

References

Novais E, Kestel L, Carry P, Sink E, Strupp K . Local Infiltration Analgesia Compared With Epidural and Intravenous PCA After Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in Adolescents. J Pediatr Orthop. 2016; 38(1):9-15. PMC: 4970959. DOI: 10.1097/BPO.0000000000000725. View

Rafi A . Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001; 56(10):1024-6. DOI: 10.1046/j.1365-2044.2001.02279-40.x. View

Tubog T, Harenberg J, Mason-Nguyen J, Kane T . Opioid-Sparing Effects of Transversus Abdominis Plane Block in Elective Hysterectomy: A Systematic Review and Meta-Analysis. AANA J. 2019; 86(1):41-55. View

Lochel J, Janz V, Perka C, Hofer A, Zimmerer A, Wassilew G . A New Rectus and Sartorius Sparing Approach for Periacetabular Osteotomy in Patients with Developmental Dysplasia of the Hip. J Clin Med. 2021; 10(4). PMC: 7915261. DOI: 10.3390/jcm10040601. View

Christie I, McCabe S . Major complications of epidural analgesia after surgery: results of a six-year survey. Anaesthesia. 2007; 62(4):335-41. DOI: 10.1111/j.1365-2044.2007.04992.x. View

Clohisy J, Schutz A, St John L, Schoenecker P, Wright R . Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009; 467(8):2041-52. PMC: 2706361. DOI: 10.1007/s11999-009-0842-6. View

Mujukian A, Truong A, Tran H, Shane R, Fleshner P, Zaghiyan K . A Standardized Multimodal Analgesia Protocol Reduces Perioperative Opioid Use in Minimally Invasive Colorectal Surgery. J Gastrointest Surg. 2019; 24(10):2286-2294. DOI: 10.1007/s11605-019-04385-9. View

Lerch T, Steppacher S, Liechti E, Tannast M, Siebenrock K . One-third of Hips After Periacetabular Osteotomy Survive 30 Years With Good Clinical Results, No Progression of Arthritis, or Conversion to THA. Clin Orthop Relat Res. 2016; 475(4):1154-1168. PMC: 5339143. DOI: 10.1007/s11999-016-5169-5. View

Brogi E, Kazan R, Cyr S, Giunta F, Hemmerling T . Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials. Can J Anaesth. 2016; 63(10):1184-1196. DOI: 10.1007/s12630-016-0679-x. View

10.

Nishiwaki T, Oya A, Fukuda S, Nakamura S, Nakamura M, Matsumoto M . Curved periacetabular osteotomy via a novel intermuscular approach between the sartorius and iliac muscles. Hip Int. 2018; 28(6):642-648. DOI: 10.1177/1120700018772047. View

11.

Choi P, Bhandari M, Scott J, Douketis J . Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev. 2003; (3):CD003071. PMC: 10710280. DOI: 10.1002/14651858.CD003071. View

12.

Pereira J, Lawlor P, Vigano A, DORGAN M, Bruera E . Equianalgesic dose ratios for opioids. a critical review and proposals for long-term dosing. J Pain Symptom Manage. 2001; 22(2):672-87. DOI: 10.1016/s0885-3924(01)00294-9. View

13.

Ganz R, Klaue K, Vinh T, Mast J . A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res. 1988; (232):26-36. View

14.

Zarate Rodriguez J, Edgley C, Lee S, Leigh N, Wolfe R, Sanford D . Preoperative transversus abdominis plane block decreases intraoperative opiate consumption during minimally invasive cholecystectomy. Surg Endosc. 2022; 37(3):2209-2214. DOI: 10.1007/s00464-022-09445-x. View

15.

Bech R, Ovesen O, Lindholm P, Overgaard S . Local anesthetic wound infiltration for pain management after periacetabular osteotomy. A randomized, placebo-controlled, double-blind clinical trial with 53 patients. Acta Orthop. 2014; 85(2):141-6. PMC: 3967255. DOI: 10.3109/17453674.2014.899840. View

16.

Young M, Gorlin A, Modest V, Quraishi S . Clinical implications of the transversus abdominis plane block in adults. Anesthesiol Res Pract. 2012; 2012:731645. PMC: 3270549. DOI: 10.1155/2012/731645. View

17.

Shibata Y, Sato Y, Fujiwara Y, Komatsu T . Transversus abdominis plane block. Anesth Analg. 2007; 105(3):883. DOI: 10.1213/01.ane.0000268541.83265.7d. View

18.

Samuel L, Munim M, Acuna A, Sultan A, Kamath A . Modified iliac spine wafer osteotomy for exposure during Bernese periacetabular osteotomy. J Hip Preserv Surg. 2020; 6(4):421-425. PMC: 6990385. DOI: 10.1093/jhps/hnz061. View

19.

Liu P, Wu Y, Liang Z, Deng Y, Meng Q . Comparing the efficacy of pain managements after total hip arthroplasty: A network meta-analysis. J Cell Biochem. 2018; 120(3):4342-4354. DOI: 10.1002/jcb.27720. View

20.

Ahmad S, Giebel G, Perka C, Meller S, Pumberger M, Hardt S . Survival of the dysplastic hip after periacetabular osteotomy: a meta-analysis. Hip Int. 2021; 33(2):306-312. PMC: 9978864. DOI: 10.1177/11207000211048425. View