Original article
Efficacy of ultrasound-guided transversus abdominis plane block in laparoscopic hysterectomy. Clinical trial
Ensayo clínico de eficacia del bloqueo del plano transverso del abdomen ecoguiado en la histerectomía laparoscópica
D.S. Guardabassi
, S. Lupi, R. Agejas, J.M. Allub, G. García-Fornari
Corresponding author
Servicio de Anestesiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Read
2
Timeswas read the article
1
Total PDF
1
Total HTML
Share statistics
array:24 [ "pii" => "S2341192917300458" "issn" => "23411929" "doi" => "10.1016/j.redare.2016.12.003" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "773" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2017;64:257-61" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "PDF" => 1 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935617300026" "issn" => "00349356" "doi" => "10.1016/j.redar.2016.12.004" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "773" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Anestesiol Reanim. 2017;64:257-61" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 136 "formatos" => array:2 [ "HTML" => 108 "PDF" => 28 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Ensayo clínico de eficacia del bloqueo bloqueo del plano transverso del abdomen ecoguiado en la histerectomía laparoscópica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "257" "paginaFinal" => "261" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Efficacy of ultrasound-guided transversus abdominis plane block in laparoscopic hysterectomy. Clinical trial" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D.S. Guardabassi, S. Lupi, R. Agejas, J.M. Allub, G. García-Fornari" "autores" => array:5 [ 0 => array:2 [ "nombre" => "D.S." "apellidos" => "Guardabassi" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Lupi" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Agejas" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Allub" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "García-Fornari" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192917300458" "doi" => "10.1016/j.redare.2016.12.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917300458?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617300026?idApp=UINPBA00004N" "url" => "/00349356/0000006400000005/v1_201704060046/S0034935617300026/v1_201704060046/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S234119291730046X" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.03.004" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "774" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2017;64:262-72" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Mortality in isolated coronary artery bypass surgery in elderly patients. A retrospective analysis over 14 years" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "262" "paginaFinal" => "272" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mortalidad de nla cirugía coronaria aislada en octogenarios. Análisis restrospectivo de 14 años" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1164 "Ancho" => 1658 "Tamanyo" => 164074 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of coronary surgery (off-pump and on-pump) in octogenarians during the study period.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Carmona García, E. Mateo, F. Hornero, M. López Cantero, I. Zarragoikoetxea" "autores" => array:5 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Carmona García" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Mateo" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Hornero" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "López Cantero" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Zarragoikoetxea" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617300038" "doi" => "10.1016/j.redar.2016.12.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617300038?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234119291730046X?idApp=UINPBA00004N" "url" => "/23411929/0000006400000005/v1_201704260038/S234119291730046X/v1_201704260038/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192917300446" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.03.003" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "772" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2017;64:250-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Base excess, a useful marker in the prognosis of chest trauma in the geriatric population" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "250" "paginaFinal" => "256" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Exceso de bases, un marcador útil en el pronóstico del traumatismo torácico en la población geriátrica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1219 "Ancho" => 1633 "Tamanyo" => 87289 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation of systolic blood pressure and base excess with mortality. Multivariate analysis showing OR and 95% CIs.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Y. Peñasco, A. González-Castro, J.C. Rodríguez-Borregán, J. Llorca" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Y." "apellidos" => "Peñasco" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "González-Castro" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Rodríguez-Borregán" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Llorca" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617300014" "doi" => "10.1016/j.redar.2016.11.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617300014?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917300446?idApp=UINPBA00004N" "url" => "/23411929/0000006400000005/v1_201704260038/S2341192917300446/v1_201704260038/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Efficacy of ultrasound-guided transversus abdominis plane block in laparoscopic hysterectomy. Clinical trial" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "257" "paginaFinal" => "261" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D.S. Guardabassi, S. Lupi, R. Agejas, J.M. Allub, G. García-Fornari" "autores" => array:5 [ 0 => array:4 [ "nombre" => "D.S." "apellidos" => "Guardabassi" "email" => array:2 [ 0 => "guardabassidiego@hotmail.com" 1 => "diego.guardabassi@hospitalitaliano.org.ar" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Lupi" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Agejas" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Allub" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "García-Fornari" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ensayo clínico de eficacia del bloqueo del plano transverso del abdomen ecoguiado en la histerectomía laparoscópica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Total laparoscopic hysterectomy is a common procedure in gynaecological practice. This approach is associated with a lower pain score compared to the conventional procedure. Even so, it generates multifactorial, moderate to severe postoperative pain that requires a multimodal treatment regimen capable of providing optimal analgesic efficacy while minimising the adverse effects of the drugs administered.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Somatic pain, derived from the innervation of the abdominal wall, is an important factor in the pathophysiology of postoperative pain in these procedures.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> Transverse abdominis plane (TAP) block is the regional anaesthesia technique that blocks the sensory innervation (T8-L1) of the anterolateral wall of the abdomen. The technique is safe and simple when performed with ultrasound guidance to precisely locate the plane.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The effectiveness of the block in providing postoperative analgesia has been tested in numerous studies and different populations and procedures, such as colonic resection,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> abdominal caesarean,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> retropubic prostatectomy,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> total abdominal hysterectomy,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> and laparoscopic cholecystectomy.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> Despite the promising results reported in these studies, in most cases the technique was performed blindly using widely differing anatomical approaches,<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6,7,11</span></a> and complications related to needle position have been reported in subsequent studies.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> The effectiveness of this technique has seldom been investigated in laparoscopic hysterectomy.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This study was performed with the primary objective of analysing whether the use of ultrasound-guided TAP block associated with an intravenous (iv) analgesia protocol in patients undergoing total laparoscopic hysterectomy reduces opioid requirements and pain scale score in the first 24 postoperative hours.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This is a controlled, single blind study in 40 patients scheduled for total laparoscopic hysterectomy. Patients were randomised to one of two groups: TAP block<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>iv analgesia vs. iv analgesia.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Inclusion criteria were: patients aged between 18 and 70 years; ASA I–II; BMI under 35; scheduled for total laparoscopic hysterectomy. Exclusion criteria were: known allergy to local anaesthetics; psychiatric/dementia disorders; infection of the abdominal wall; chronic analgesic use; chronic pain syndrome; diagnosed peripheral neuropathy; known allergy to analgesics or corticosteroids.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study protocol was approved by the Committee for Education and Research and the Bioethics Committee of the Hospital Italiano in Buenos Aires. The study was performed at our institution between January 2014 and December 2015. Forty patients scheduled for laparoscopic hysterectomy were included.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients were selected using a consecutive non-probability sampling technique. After signing the informed consent form, selected patients were randomised to one or other treatment group using the sealed envelope system.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study protocol was as follows:</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the pre-anaesthesia visit, a trained investigator instructed the patients in the use of the verbal numeric rating scale (NRS) to evaluate postoperative pain and the use of a patient-controlled anaesthesia (PCA) device.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In both groups</span>: an iv access was placed while patients were in the pre-op holding area, and the patient was reminded how to use the NRS and the PCA system. Intravenous midazolam 0.02<span class="elsevierStyleHsp" style=""></span>mg/kg and iv cefazolin 1<span class="elsevierStyleHsp" style=""></span>g was administered (in the case of known allergies, iv clindamycin 600<span class="elsevierStyleHsp" style=""></span>mg was used instead).</p><p id="par0060" class="elsevierStylePara elsevierViewall">Once in the operating room, standard monitoring was established. Balanced general anaesthesia with sevoflurane and remifentanil was administered.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In patients randomised to receive TAP block, after general anaesthesia induction and endotracheal intubation, the block was performed bilaterally under ultrasound-guidance using a 6–13<span class="elsevierStyleHsp" style=""></span>MHz linear transducer (SonoSite M-Turbo<span class="elsevierStyleSup">®</span> portable ultrasound; SonoSite, Inc. Bothell, WA, USA). An 80<span class="elsevierStyleHsp" style=""></span>mm SonoTAP (SonoTAP needle; Pajunk<span class="elsevierStyleSup">®</span>, Geisingen, Germany) needle was inserted in-plane between the iliac crest and the costal margin, at the level of the mid-axillary line. Once the tip of the needle had reached the plane between the internal oblique muscle and the transversus abdominis, and after negative aspiration for blood, 15<span class="elsevierStyleHsp" style=""></span>mL of ropivacaine 0.5% was injected. The same procedure was repeated contralaterally. All blocks were performed by an anaesthetist with experience in regional anaesthesia. The local anaesthetic solution used was prepared by a single anaesthetist. Patients were also given iv dexamethasone 0.1<span class="elsevierStyleHsp" style=""></span>mg/kg and iv diclofenac 1<span class="elsevierStyleHsp" style=""></span>mg/kg at the start of the procedure, and slow iv infusion of a 0.1<span class="elsevierStyleHsp" style=""></span>mg/kg morphine bolus after extraction of the surgical specimen.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Patients randomised to receive iv analgesia were also given iv dexamethasone 0.1<span class="elsevierStyleHsp" style=""></span>mg/kg and iv diclofenac 1<span class="elsevierStyleHsp" style=""></span>mg/kg at the start of the procedure, and slow iv infusion of a 0.1<span class="elsevierStyleHsp" style=""></span>mg/kg morphine bolus after extraction of the surgical specimen.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Both groups received antiemetic prophylaxis with iv ondansetron 4<span class="elsevierStyleHsp" style=""></span>mg.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the postoperative period, all patients remained in the recovery room for at least 2<span class="elsevierStyleHsp" style=""></span>h. They were given an iv morphine PCA programmed to administer 0.03<span class="elsevierStyleHsp" style=""></span>mg/kg boluses with a lock-out interval of 15<span class="elsevierStyleHsp" style=""></span>min. Postoperative analgesia with iv diclofenac 1<span class="elsevierStyleHsp" style=""></span>mg/kg every 12<span class="elsevierStyleHsp" style=""></span>h was prescribed (maximum dose 150<span class="elsevierStyleHsp" style=""></span>mg/day). Patients presenting nausea or vomiting were given iv ondansetron 4<span class="elsevierStyleHsp" style=""></span>mg (up to 2 doses) or metoclopramide 10<span class="elsevierStyleHsp" style=""></span>mg (up to 2 rescue doses). If patients presented 2 or more episodes of nausea and/or vomiting, they were given metoclopramide 10<span class="elsevierStyleHsp" style=""></span>mg every 6<span class="elsevierStyleHsp" style=""></span>h, in accordance with the established Anaesthesiology Department protocol for treating postoperative nausea and vomiting.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The primary outcome variables collected were:</p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Opioid consumption</span>: amount of morphine (mg) consumed within the first 24 postoperative h.</p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Postoperative pain</span>: evaluated at 60<span class="elsevierStyleHsp" style=""></span>min, 2, 8 and 24<span class="elsevierStyleHsp" style=""></span>h after surgery by the same observer using an NVS of 0–10, where 0 is no pain and 10 is the worse imaginable pain.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Secondary outcome variables were:</p><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Adverse effects</span>: the presence of nausea and vomiting, pruritus, sedation on the Ramsay scale, and presence of ileus.</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sleep quality</span>: evaluated by the same observer by asking the patient a series of questions: (1) Did you sleep? yes/no; (2) How many times were you woken up during the night by pain.</p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Time to discharge</span>: the days spent in hospital, taking as day 1 the day of admission for surgery.</p><p id="par0120" class="elsevierStylePara elsevierViewall">All data were collected in a specially designed evaluation form. Patients were coded according to their randomisation number.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Rationale for sample size</span><p id="par0125" class="elsevierStylePara elsevierViewall">The sample size was calculated on the basis of morphine consumption (mg) in the first 24<span class="elsevierStyleHsp" style=""></span>h after surgery using data obtained from previous similar studies. A 95% confidence interval and an 80% power were also factored into the calculation, estimating that around 10% of patients initially included would be lost.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0130" class="elsevierStylePara elsevierViewall">Statistical analysis was performed on a standard statistical analysis programme (Stata). Data were tested for normality using the Kolmogorov–Smirnov test. Continuous quantitative variables were analysed using Student's <span class="elsevierStyleItalic">t</span>-test or Mann–Whitney, according to their distribution. Categorical variables were analysed using the chi-square test or Fisher's exact test. Changes in the postoperative pain NVS and sedation levels were evaluated using a general linear model for repeated measures at 1, 2, 8 and 24<span class="elsevierStyleHsp" style=""></span>h. A multiple generalised linear model was used to adjust for potential confounders. All results were calculated with a 95% confidence interval. Normally distributed data are presented as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation, non-normally distributed data are shown as median (range), and categorical data as raw data and frequencies.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0135" class="elsevierStylePara elsevierViewall">Forty patients were included in the study, 20 in each study group. No protocol violations were recorded, and no patients were lost to follow up, so all the data collected could be analysed.</p><p id="par0140" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the comparison of results by group. The average consumption of morphine in the first 24<span class="elsevierStyleHsp" style=""></span>h was 10<span class="elsevierStyleHsp" style=""></span>mg (4–14) for the TAP block<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>iv analgesia group, and 7<span class="elsevierStyleHsp" style=""></span>mg (2–13) for the iv analgesia group; the difference was not statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.2). NRS pain score at 60 and 120<span class="elsevierStyleHsp" style=""></span>min and at 8 and 24<span class="elsevierStyleHsp" style=""></span>h after surgery were similar in both groups, with no statistical significance (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.1 for all time points). It is interesting to note that both protocols achieved good postoperative pain control 2<span class="elsevierStyleHsp" style=""></span>h after exit from the operating room. No significant differences were found in the rest of the study variables (sedation scale, adverse effects, pain-induced awakenings and time to discharge).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">In this study we found that the addition of bilateral ultrasound-guided TAP block to the standard postoperative multimodal analgesia protocol in laparoscopic hysterectomy does not help reduce opioid consumption and pain intensity measured by NRS in the first 24 postoperative hours. In was interesting to note that consumption of morphine was slightly, although not significantly, higher in the TAP block group. We found no explanation for this observation, since other factors that can affect the intensity of postoperative pain were not analysed. In turn, the nerve block was not associated with a statistically significant decrease in the adverse effects of morphine use. Another observation that caught our attention is that Group 2 patients, who received on average fewer opioids, showed a trend (though not statistically significant) towards increased postoperative nausea and vomiting (PONV). As we did not analyse the different risk factors for PONV, we are unable to provide a feasible explanation for this finding. We believe that these last 2 points are one of the limitations of this study.</p><p id="par0150" class="elsevierStylePara elsevierViewall">TAP blockade has been studied in numerous publications. As part of a multimodal analgesic protocol, it has been reported to contribute to the management of postoperative pain in both open and laparoscopic abdominal surgery in terms of reducing pain intensity, opioid consumption and adverse effects.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7–10</span></a> However, these studies are quite heterogeneous in terms of the populations studied and the techniques used, and it is therefore difficult to draw a comparison with our study. Some of the studies mentioned used an oral multimodal postoperative analgesia strategy in the context of outpatient surgery. This differs widely from our protocol, which included hospitalisation and administration of morphine via PCA. As far as TAP blockade is concerned, some studies do not describe the procedure in detail, nor the level of expertise of the anaesthetists performing the block. We consider this to be a strong point of our study, where all blocks were performed by anaesthetists experienced in regional anaesthesia (at least 50 previous TAP blocks), and the technique was clearly appropriately. It is also important to point out that a comparison with other abdominal plane blocks (ilioinguinal, iliohypogastric, rectus sheath) or other TAP block approaches (posterior, quadratus lumborum) was not included in the design and was not one of the objectives of our research.</p><p id="par0155" class="elsevierStylePara elsevierViewall">These surgeries are usually performed in middle-aged, female patients who, in addition to physical considerations, experience their conditions as a psychological and emotional burden, and in our setting require a multimodal analgesia plan that includes strong opioids for postoperative pain control. These characteristics are unique to this patient group, and it is inappropriate to compare outcomes in this population to those in other, quite dissimilar, groups.</p><p id="par0160" class="elsevierStylePara elsevierViewall">We believe our study to be robust from a methodological standpoint, with a sufficiently large and representative sample size. All evaluations were made by an independent observer, eliminating the possibility of observer bias.</p><p id="par0165" class="elsevierStylePara elsevierViewall">There are, however, some limitations in our study. First, we did not consider including risk factors for PONV or increased postoperative pain (e.g., surgical technique, time of surgery, use of antidepressants) in our analysis. This might have helped explain some of the paradoxical findings mentioned above.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Another point of criticism is the pain use of the NRS pain assessment scale. While we believe that the visual analogue scale would have been more appropriate, the NRS is more widely used in our setting to evaluate postoperative pain, and this is why it was included in our protocol.</p><p id="par0175" class="elsevierStylePara elsevierViewall">The third limitation is the absence of double-blinding, as the control group did not receive a placebo blockade. This decision was determined by ethical considerations.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Finally, this type of surgery is performed on an outpatient basis in many hospitals, using an oral multimodal analgesia regimen for postoperative pain control. In our case, all patients remained hospitalized for 24<span class="elsevierStyleHsp" style=""></span>h with iv PCA morphine. This is the protocol used in our hospital, and it allowed us to accurately assess and compare opioid consumption between the two groups. We believe this will be an important limiting factor when comparing our study with others performed in different contexts.</p><p id="par0185" class="elsevierStylePara elsevierViewall">In conclusion, then, our study shows that TAP block does not contribute any benefit with respect to PCA-type opioid analgesia protocols used in gynaecological laparoscopic surgery. Due to the limitations of this study, we cannot rule out the possibility that another study with a different design might show more positive results in terms of opioid consumption and postoperative pain.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Although TAP block is a safe and simple technique and an ideal strategy to improve postoperative care in a great many surgical procedure, we believe its indication in laparoscopic surgery should be reviewed and investigated in further studies.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical responsibilities</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal rights</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Data confidentiality</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols implemented in their place of work regarding the use of patient data in publications.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of all patients and/or subjects included in this manuscript. The informed consent forms can be obtained from the author for correspondence.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0210" class="elsevierStylePara elsevierViewall">None of the authors have any conflict of interest in respect of this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres833124" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec829033" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres833123" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec829032" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Rationale for sample size" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal rights" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-09-05" "fechaAceptado" => "2016-12-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec829033" "palabras" => array:6 [ 0 => "Regional anaesthesia" 1 => "Transversus abdominal plane block" 2 => "Laparoscopy" 3 => "Postoperative pain" 4 => "Postoperative analgesia" 5 => "Opioid consumption" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec829032" "palabras" => array:6 [ 0 => "Anestesia regional" 1 => "Bloqueo del plano transverso abdominal" 2 => "Cirugía laparoscópica" 3 => "Dolor postoperatorio" 4 => "Analgesia postoperatoria" 5 => "Consumo de opioides" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transversus abdominis plane block is a regional anaesthesia technique that has proven to be effective for postoperative pain reduction in different abdominal surgical procedures. This study evaluated its efficacy on post laparoscopic hysterectomy pain intensity and analgesic consumption.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Randomized controlled trial which included 40 patients scheduled for laparoscopic hysterectomy, enrolled in 2 groups: transversus abdominis plane block<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>systemic analgesia (Group 1; n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20) versus systemic analgesia (Group 2; n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20). Opioid consumption within the first 24 postoperative hours, pain intensity scores at 60<span class="elsevierStyleHsp" style=""></span>min, 2, 8 and 24<span class="elsevierStyleHsp" style=""></span>h after surgery, adverse events related to systemic analgesia and time to hospital discharge were evaluated and registered.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We found no differences between both groups in opioid consumption (10<span class="elsevierStyleHsp" style=""></span>mg vs. 7<span class="elsevierStyleHsp" style=""></span>mg; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.2) and pain scores (NVS) within the first 24 postoperative hours, at 60<span class="elsevierStyleHsp" style=""></span>min (3 vs. 5; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.65), 120<span class="elsevierStyleHsp" style=""></span>min (0 vs. 2; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.15), 8 and 24<span class="elsevierStyleHsp" style=""></span>h (0 vs. 0; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.50) for the last 2 points in time analysed. Adverse events related to medication and time to hospital discharge showed similar results.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Adding a transversus abdominis plane block technique to opioid PCA does not seem to improve postoperative pain management in laparoscopic hysterectomy. Patient preparation time and costs could be incremented and complications (although rare) related to the technique could appear.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El bloqueo del plano transverso abdominal es una técnica de anestesia regional que demostró ser efectiva en cirugía abdominal abierta y laparoscópica como parte de un esquema de tratamiento del dolor postoperatorio. La presente investigación evaluó su eficacia en cirugía de histerectomía total laparoscópica.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El estudio fue diseñado como un ensayo clínico controlado, aleatorizado en 2 ramas: grupo protocolo bloqueo del plano transverso abdominal<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>analgesia intravenosa (Grupo 1; n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20) versus grupo protocolo analgesia intravenosa (Grupo 2; n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20), simple ciego que incluyó a 40 pacientes sometidas a una histerectomía total laparoscópica programada. Consumo de opioides en las primeras 24<span class="elsevierStyleHsp" style=""></span>h del postoperatorio (mg de morfina), intensidad del dolor por escala verbal numérica a los 60<span class="elsevierStyleHsp" style=""></span>min, 2, 8 y 24<span class="elsevierStyleHsp" style=""></span>h posteriores a la cirugía, efectos adversos relacionados con la medicación administrada, calidad del sueño en la primera noche poscirugía y tiempo hasta el alta hospitalaria fueron evaluados y registrados.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">No hubo diferencias estadísticamente significativas entre ambos grupos en cuanto al consumo de opioides (10<span class="elsevierStyleHsp" style=""></span>mg vs. 7<span class="elsevierStyleHsp" style=""></span>mg; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,2) y en las escalas de dolor por EVN postoperatorias a los 60<span class="elsevierStyleHsp" style=""></span>min (3 vs. 5; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,65), 120<span class="elsevierStyleHsp" style=""></span>min (0 vs. 2; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,15), 8 y 24<span class="elsevierStyleHsp" style=""></span>h (0 vs. 0; p<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0,50), en estos 2 últimos puntos de tiempo evaluados. Tampoco se hallaron diferencias respecto a la incidencia de efectos adversos, calidad de sueño en la primera noche después de la cirugía ni en el tiempo hasta el alta hospitalaria.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El bloqueo del plano transverso abdominal parece no aportar ningún beneficio adicional respecto a un plan de analgesia con opioides tipo PCA empleado en cirugía laparoscópica ginecológica, prolongando los tiempos de preparación del paciente, agregando un riesgo eventual (aunque bajo) de complicaciones e incrementando los costos.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guardabassi DS, Lupi S, Agejas R, Allub JM, García-Fornari G. Ensayo clínico de eficacia del bloqueo del plano transverso del abdomen ecoguiado en la histerectomía laparoscópica. Rev Esp Anestesiol Reanim. 2017;64:257–261.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Data are shown as median (range) or % (n).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (41–49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (42–49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Morphine consumption at 24<span class="elsevierStyleHsp" style=""></span>h, mg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (4–14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (2–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NRS at 60<span class="elsevierStyleHsp" style=""></span>min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (0–8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.65 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NRS at 120<span class="elsevierStyleHsp" style=""></span>min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NRS at 8<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.65 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NRS at 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ramsay scale at 0<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.95 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ramsay scale at 8<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ramsay scale at 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pruritus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nausea and vomiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ileus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Amount of vomiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pain-induced awakening \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time to discharge, hours \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (24–48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (24–48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403316.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparison of Group 1 (TAP block<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>intravenous analgesia) and Group 2 (intravenous analgesia) patients undergoing laparoscopic hysterectomy (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dose requirements, efficacy and side effects of morphine and pethidine delivered by patient-controlled analgesia after gynaecological surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Stanley" 1 => "B. Appadu" 2 => "M. Mead" 3 => "D.J. Rowbotham" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "1996" "volumen" => "76" "paginaInicial" => "484" "paginaFinal" => "486" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8652316" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0075" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of duration of dose delivery with patient-controlled analgesia on the incidence of nausea and vomiting after hysterectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Woodhouse" 1 => "L.E. Mather" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Clin Pharmacol" "fecha" => "1998" "volumen" => "45" "paginaInicial" => "57" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9489595" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0080" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine after total abdominal hysterectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Ng" 1 => "A. Swami" 2 => "G. Smith" 3 => "A.C. Davidson" 4 => "J. Emembolu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2002" "volumen" => "95" "paginaInicial" => "158" "paginaFinal" => "162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12088961" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0085" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Back and spinal cord" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.H. Netter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Atlas of Human Anatomy" "paginaInicial" => "145" "paginaFinal" => "155" "serieFecha" => "1989" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0090" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transversus abdominis plane block: a cadaveric and radiological evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.G. McDonnell" 1 => "B.D. O’Donnell" 2 => "T. Farrell" 3 => "N. Gough" 4 => "D. Tuite" 5 => "C. Power" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rapm.2007.03.011" "Revista" => array:6 [ "tituloSerie" => "Reg Anesth Pain Med" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "399" "paginaFinal" => "404" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17961838" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0095" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.G. McDonnell" 1 => "B.D. O’Donnell" 2 => "G. Curley" 3 => "A. Heffernan" 4 => "C. Power" 5 => "J.G. Laffey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/01.ane.0000250223.49963.0f" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2007" "volumen" => "104" "paginaInicial" => "193" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17179269" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0100" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.G. McDonnell" 1 => "G. Curley" 2 => "J. Carney" 3 => "A. Benton" 4 => "J. Costello" 5 => "C.H. Maharaj" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/01.ane.0000290294.64090.f3" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2008" "volumen" => "106" "paginaInicial" => "186" "paginaFinal" => "191" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18165577" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0105" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The transversus abdominis plane (TAP) block in open retropubic prostatectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.D. O’Donnell" 1 => "J.G. McDonnell" 2 => "A.J. McShane" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rapm.2005.10.006" "Revista" => array:5 [ "tituloSerie" => "Reg Anesth Pain Med" "fecha" => "2006" "volumen" => "31" "paginaInicial" => "91" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16418039" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0110" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Carney" 1 => "M.B. McDonnell" 2 => "A. Ochana" 3 => "R. Bhinder" 4 => "J.G. Laffey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ane.0b013e3181871313" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2008" "volumen" => "107" "paginaInicial" => "2056" "paginaFinal" => "2060" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19020158" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0115" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. El-Dawlatly" 1 => "A. Turkistani" 2 => "S. Kettner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aep067" "Revista" => array:7 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2009" "volumen" => "102" "paginaInicial" => "763" "paginaFinal" => "767" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19376789" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0025619613000773" "estado" => "S300" "issn" => "00256196" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0120" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transversus abdominis plane block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Shibata" 1 => "Y. Sato" 2 => "Y. Fujiwara" 3 => "T. Komatsu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/01.ane.0000268541.83265.7d" "Revista" => array:5 [ "tituloSerie" => "Anesth Analg" "fecha" => "2007" "volumen" => "105" "paginaInicial" => "883" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17717265" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0125" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of liver trauma with a blunt regional anesthesia needle while performing transversus abdominis plane block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Farooq" 1 => "M. Carey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rapm.2007.11.009" "Revista" => array:7 [ "tituloSerie" => "Reg Anesth Pain Med" "fecha" => "2008" "volumen" => "33" "paginaInicial" => "274" "paginaFinal" => "275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18433683" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0025619615005054" "estado" => "S300" "issn" => "00256196" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0130" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A qualitative systematic review of incisional local anaesthesia for postoperative pain relief after abdominal operations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Moiniche" 1 => "S. Mikkelsen" 2 => "J. Wetterslev" 3 => "J.B. Dahl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "1998" "volumen" => "81" "paginaInicial" => "377" "paginaFinal" => "383" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9861124" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006400000005/v1_201704260038/S2341192917300458/v1_201704260038/en/main.assets" "Apartado" => array:4 [ "identificador" => "34051" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006400000005/v1_201704260038/S2341192917300458/v1_201704260038/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917300458?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2017 September | 0 | 1 | 1 |
