Role of regional anesthesia for placement of peritoneal dialysis catheter under ultrasound guidance: Our experience with 52 end-stage renal disease patients.
Chatterjee Smaranjit,Bain Jayanta,Christopher Somita,Gopal Tirupati Venkata Swamy,Raju Kalidindi Prasad,Mathur Piyush
Saudi journal of anaesthesia
AIM:The number of patients with end-stage renal disease (ESRD) has shown a consistent rise in India in recent years. Continuous ambulatory peritoneal dialysis (CAPD) remains one of the safe and effective forms of treatment. In this study, we have tried to assess the effectiveness of field block technique for analgesia during catheter placement surgery until 24 h postoperatively, also, if it can obviate the need for general anesthesia in these high-risk patients. MATERIALS AND METHODS:We studied 52 ESRD patients from 2010 to 2012 who were posted for CAPD catheterization in the Department of Urology, Care Hospital, Hyderabad, India. Under ultrasound guidance, "unilateral posterior" and "unilateral subcostal" transversus abdominis plane block anesthesia were given for the placement of CAPD catheter. Patient's intra-operative pain and post-operative pain were recorded with visual analog scores (VAS) and analyzed. RESULTS:All patients in our study belonged to American Society of Anesthesiologists category 2 or 3 with multiple co-morbidities. 41 out of 52 patients required no supplemental analgesia during the procedure; 8 patients needed additional infiltration of local anesthetic during skin incisions. Three patients required supplemental analgesia and were considered as failure. A VAS of two was noted in 30 patients and 1 in 19 Patients. No Patient had significant pain 24 h post operatively. No local complication was noted in any patient. CONCLUSION:CAPD Catheterization under regional field block remains safe and effective options for ESRD patients.
10.4103/1658-354X.152838
Peritoneal Dialysis Catheter Placement Using an Ultrasound-Guided Transversus Abdominis Plane Block.
Markić Dean,Vujičić Božidar,Ivanovski Mladen,Krpina Kristian,Gršković Antun,Živčić-Ćosić Stela,Župan Željko,Maričić Anton,Valenčić Maksim,Rački Sanjin
Blood purification
BACKGROUND:Peritoneal dialysis (PD) catheter placement is usually performed using general or local anesthesia. We present our PD catheter placement experience using an ultrasound-guided transversus abdominis plane (TAP) block, which is a regional anesthesia technique. METHODS:In this study, we analyzed 33 patients from our center with ESRD who underwent PD catheter placement using a TAP block between June 2011 and April 2014. RESULTS:The TAP block was successful for 29/33 (87.9%) patients. Four patients (12.1%) had pain at the incision site and required general anesthesia. There were no anesthesia-, surgery- or catheter-related complications. CONCLUSION:ESRD patients have a substantial number of comorbidities that can be negatively influenced by general anesthesia. Because regional anesthesia has no systemic effect, this procedure could be recommended for this group of patients. A TAP block is an effective, safe method and can be used as the principal anesthesia technique for PD catheter placement.
10.1159/000381005
Ultrasound-Guided Unilateral Transversus Abdominis Plane Combined with Rectus Sheath Block versus Subarachnoid Anesthesia in Patients Undergoing Peritoneal Dialysis Catheter Surgery: A Randomized Prospective Controlled Trial.
Journal of pain research
BACKGROUND:Peritoneal dialysis catheter placement can be performed under general anesthesia, local anesthesia or subarachnoid anesthesia (SA). Recently, studies have reported the successful placement of peritoneal dialysis catheters using a transversus abdominis plane (TAP) block and rectus sheath (RS) block. This study compared the TAP + RS block with SA for patients undergoing peritoneal dialysis catheter placement. METHODS:Sixty patients were randomly divided into two groups, with 30 receiving unilateral ultrasound-guided TAP + RS block anesthesia and 30 receiving SA. The demographic characteristics, anesthesia efficacy, indicators related to anesthesia or operation, hemodynamic index, postoperative pain numeric rating score (NRS), postoperative recovery indicators, complications related to anesthesia or surgery, and dosage of sedative or analgesic medication were analyzed. RESULTS:Anesthesia operation time was significantly shorter in the TAP + RS block group than in the SA group (<0.001), while there was no significant difference in success rates (TAP + RS 93.33% [95% confidence interval, 95% CI, 83.9-102.8%] vs SA 100.00% [95% CI, 100-100%], =0.472). Two patients in the TAP + RS group needed extra analgesia, although the dermatome pinprick sensation test gave negative results for all patients. Patients who received the TAP + RS block expressed significantly less pain on movement or at rest at 4 h and 8 h postoperative. Fewer patients needed rescue analgesia with tramadol in the postoperative period in the TAP + RS block group than in the SA group (<0.05). The intraoperative MAP was more stable (<0.05) in the TAP + RS group compared to the SA group. CONCLUSION:The TAP + RS block is a safe, effective method for use as the principal anesthesia technique in PD catheter placement. Compared to SA, it has the advantages of less influence on hemodynamics and a better postoperative analgesic effect.
10.2147/JPR.S264255
Transversus abdominis plane block as the primary anesthetic for peritoneal dialysis catheter surgery.
Henshaw Daryl S,Baker Matthew L,Weller Robert S,Reynolds Jon Wellington,Jaffe Jonathan Douglas
Journal of clinical anesthesia
STUDY OBJECTIVE:The primary goal of this study was to determine whether transversus abdominis plane (TAP) blocks were effective as the primary anesthetic technique for insertion and/or removal of peritoneal dialysis catheters. DESIGN:This study is a descriptive case series investigation. SETTING:Operating rooms at a tertiary care academic medical center. PATIENTS:Twenty-four patients, American Society of Anesthesiologists (ASA) physical status 3 and 4, were included in this study. INTERVENTIONS:Patients who had received a TAP block preoperatively for open surgical insertion or removal of a peritoneal dialysis catheter over a 26-month period with the intent of the block to serve as the primary anesthetic were included in this study. MEASUREMENTS:Preoperative and intraoperative sedative medications and local anesthetic medications were analyzed. The primary outcome of the study was the ability of the TAP block to provide surgical anesthesia as determined by a lack of need to convert to general anesthesia (defined by placement of an airway device, use of volatile anesthetics, intraoperative propofol infusion dose equal to or greater than 100 μg kg(-1) min(-1)). Secondary outcomes included analysis of any complications from the higher concentrations of local anesthetics required for surgical block. MANI RESULTS:Of 24 patients, 21 underwent the procedure without conversion to general anesthesia as defined above. No complications related to local anesthetics were found. CONCLUSION:Transversus abdominis plane blockade can be successful at serving as the primary anesthetic modality for the insertion and/or removal of a peritoneal dialysis catheter by open-surgical approach. There were no systemic toxic effects or other complications recorded.
10.1016/j.jclinane.2016.01.028
Peritoneal Dialysis Catheter Surgery using Transversus Abdominis Plane Block.
Markić Dean,Vujičić Božidar,Ivanovski Mladen,Krpina Kristian,Gršković Antun,Rahelić Dražen,Rubinić Nino,Župan Željko,Lasić Hrvoje,Materljan Mauro,Rački Sanjin
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis
BACKGROUND:Peritoneal dialysis (PD) catheter surgery can be performed using regional anesthesia. We present our PD catheter placement and extraction experience using ultrasound-guided transversus abdominis plane (TAP) block. METHODS:In the present study, we analyzed 74 patients from our center with end-stage renal disease (ESRD) who underwent PD catheter placement (60 patients) and removal (14 patients) using a TAP block between June 2011 and December 2015. RESULTS:The TAP block was successful for 55/60 (91.7%) patients (insertion) and 13/14 (92.9%) patients (extraction). Other patients had pain at the incision site and required general anesthesia. There were no anesthesia-, surgery- or PD catheter-related complications. CONCLUSION:The TAP block is a safe and effective technique not only for high-risk ESRD patients but for all patients undergoing PD catheter placement or extraction.
10.3747/pdi.2016.00198
Ultrasound-guided left lateral transversus abdominis plane block combined with rectus sheath block in peritoneal dialysis catheter placement.
Dai Wei,Lu Yao,Liu Jia,Tang Lili,Mei Bin,Liu Xuesheng
Journal of anesthesia
This study assessed the utility of ultrasound-guided lateral transversus abdominis plane (TAP) block combined with rectus sheath (RS) block for peritoneal dialysis catheter placement surgery. Thirty consecutive patients with end-stage renal disease scheduled to have peritoneal dialysis catheter placement received a left lateral TAP block combined with RS block performed under ultrasound guidance. The TAP and RS blocks were, respectively, conducted with 15 ml of 0.5% ropivacaine and 10 ml of 0.5% ropivacaine. Pain intensity was evaluated by verbal rating scale during operation, and the degree of patient and surgeon satisfaction was qualified by a categorical scale. Twenty-nine patients received successful blocks without any other adjuvant anesthetic drugs. One patient required rescue analgesia with lidocaine infiltration. No complications related to regional anesthesia were noted. Ultrasound-guided left lateral TAP block combined with RS block can serve as the primary anesthetic modality for peritoneal dialysis catheter placement surgery.
10.1007/s00540-018-2528-2
Single-Injection Ultrasound-Guided Thoracic Paravertebral Block versus Local Anesthetic Infiltration in Peritoneal Dialysis Catheter Surgeries: A Randomized Controlled Trial.
Zhang Hai-Yan,Jiang Xiao-Juan,Li Qi,Tang Xiao-Hong,Zhu Tao
Blood purification
INTRODUCTION:Ultrasound-guided thoracic paravertebral block (US-TPVB) is generally used for postoperative analgesia. We hypothesized that single-injection US-TPVB could be used as the principal anesthetic technique for a peritoneal dialysis catheter (PDC) procedure (implantation or removal). The anesthetic effect and venous ropivacaine level after a TPVB would be compared with that after local anesthetic infiltration (LAI). METHODS:Patients undergoing PDC procedures were randomized into Group LAI or TPVB. In Group LAI, 40 mL of 0.25% ropivacaine were used. In Group TPVB, single-injection of US-TPVB at T10-T11 level was performed with 20 mL of 0.25% ropivacaine. The quality of anesthesia, visual analogue scale of pain, and venous total plasma ropivacaine level were compared between the 2 groups. RESULTS:Seventy-four eligible patients were enrolled and 38 in Group TPVB. Thirty patients in Group TPVB and 26 patients in Group LAI underwent PDC procedures successfully. Higher satisfaction rates by nephrologists and patients (76.3 and 78.9%) were reported in Group TPVB (44.4 and 44.4% in Group LAI, respectively). The peak venous total plasma ropivacaine concentrations were below the reported toxic threshold in the 2 groups. CONCLUSIONS:A single-injection US-TPVB with 20 mL of 0.25% ropivacaine at T10-T11 could be the principal anesthetic technique for PDC procedures, which provided a comparable anesthetic effect to that of LAI with 40 mL ropivacaine. Higher satisfaction rates by nephrologists and patients were observed in Group TPVB. The 20 mL dose of 0.25% ropivacaine used for an US-TPVB was safe in end-stage renal diseases patients.
10.1159/000505259
Ultrasound-Guided Oblique Sub-Costal Transversus Abdominis Plane Block as the Principal Anesthesia Technique in Peritoneal Dialysis Catheter Implantation and Plasma Ropivacaine Concentration Evaluation in ESRD Patients: A Prospective, Randomized, Double-Blinded, Controlled Trial.
Li Zi,Tang Xiao Hong,Li Qi,Zhang Wen-Juan,Tao Tian,Zhu Tao
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis
BACKGROUND:The ultrasound-guided transversus abdominis plane (TAP) block is generally used for analgesia but not for anesthesia. A TAP block has a partial analgesic effect on the parietal peritoneum in abdominal surgeries. We hypothesized that an ultrasound-guided oblique subcostal TAP block, used as the principal anesthesia technique, could provide a better anesthetic effect on peritoneum stimulation in peritoneal dialysis catheter (PDC) implantation in end-stage renal diseases (ESRD) patients than local anesthetic infiltration (LAI). METHODS:End-stage renal disease patients undergoing PDC implantation were randomized into 3 groups: LAI Group, unilateral TAP group (Uni-TAP Group) and bilateral TAP group (Bi-TAP Group). A 40-mL dose of 0.25% ropivacaine was used for the regional block (LAI or TAP). The quality of anesthesia, visual analogue scale (VAS) of pain, cumulative rescuing sufentanil consumption, and venous plasma ropivacaine concentrations were compared among the 3 groups. RESULTS:Sixty-nine patients were enrolled, and higher 'Satisfied' anesthesia rates from nephrologists and patients were recorded in the 2 TAP groups, compared with the LAI Group. Significantly lower VAS scores were observed in the Uni-TAP Group at a majority of time points compared with the LAI Group. Less cumulative rescuing sufentanil was used in the 2 TAP groups (2.5 ± 2.7 and 3.0 ± 2.8 μg, respectively) compared with the LAI Group (5.8 ± 2.6 μg, < 0.05). The median peak venous plasma ropivacaine concentrations were below the reported toxic threshold in all 3 groups. CONCLUSIONS:As the principal anesthesia technique, an ultrasound-guided unilateral oblique subcostal TAP block with 40 mL of 0.25% ropivacaine provided better anesthetic effect in PDC implantations in ESRD patients than LAI.
10.3747/pdi.2017.00222
Comparison of single-injection ultrasound-guided thoracic paravertebral block with transversus abdominis plane block in peritoneal dialysis catheter implantation: a randomized controlled trial.
Jiang Xiao-Juan,Li Zi,Li Qi,Zhang Hai-Yan,Tang Xiao-Hong,Zhu Tao
Trials
BACKGROUND:Previous study indicated that transversus abdominis plane (TAP) block could be the principal anesthetic technique for peritoneal dialysis catheter (PDC) implantations. However, a TAP block could not provide an optimal anesthetic effect on catheter exit site during PDC implantation. We hypothesized that single-injection ultrasound-guided thoracic paravertebral block (US-TPVB) could be the principal anesthetic technique with better pain relief at catheter exit site during PDC implantation, compared to a TAP block. And anesthesia quality of a single-injection US-TPVB was compared with that of a TAP block and local anesthetic infiltration (LAI). METHODS:Patients undergoing PDC implantations were randomized into groups TPVB or TAP or LAI. In group TPVB, single-injection US-TPVB at T10-T11 level was performed with 20 ml of 0.25% ropivacaine. In group TAP, oblique subcostal TAP block was performed with 20 ml of 0.25% ropivacaine. In group LAI, 40 ml of 0.25% ropivacaine was used. Anesthesia quality was compared among the three groups, including general anesthesia conversion rate, cumulative rescuing sufentanil consumption, and satisfaction rate by nephrologists and patients. RESULTS:Eighty-eight eligible patients were enrolled. Visual analogue scale (VAS) at most time points (except for the catheter exit site) were lower in group TAP, compared with group TPVB. VAS at parietal peritoneum manipulation was 6 (5, 7), 3 (0, 6), and 7 (4.75, 9) in groups TPVB, TAP, and LAI, respectively (P < 0.001). VAS at catheter exit site was 4 (3, 4), 5.5 (4, 8), and 5 (3, 7.25) in groups TPVB, TAP, and LAI, respectively (P = 0.005). Lower general anesthesia conversion rate, less cumulative rescuing sufentanil consumption, and higher satisfaction rates by nephrologists and patients were recorded in group TAP, compared with groups TPVB and LAI. CONCLUSIONS:Single-injection US-TPVB provided a better pain relief at catheter exit site. The quality and reliability of anesthesia after a single-injection US-TPVB was comparable to that of LAI, but not better than that of an oblique subcostal TAP block for PDC implantation. TRIAL REGISTRATION:TCTR20160911002 . Registered on 8 September 2016.
10.1186/s13063-021-05223-7