Regional Anesthesia and Pain Control Comparison Between the Analgesic Efficacy of Transversus Abdominis Plane (TAP) Block and Placebo in Open Retropubic Radical Prostatectomy: A Prospective, Randomized, Double-Blinded Study

A lthough systemic opioids and neuraxial analgesia have been used for pain control after retropubic radical prostatectomy (RRP), their adverse effects are troublesome and can potentially limit their value. The transversus abdominis plane (TAP) block has been usedto block the sensory afferents of the anterior abdom- inal wall (T7-L1), and its sensory distribution should cover the incisional pain of open prostatectomy. This prospective, random- ized, double-blind study was undertaken to compare the efficacy of ultrasound-guided TAP block with placebo for postoperative analgesia after RRP. Patients in the TAP group received the block with 20 mL of 0.5% bupivacaine bilaterally after induction of general anesthesia. The control subjects received 20 mL normal saline bilaterally after induction. Induction was with fentanyl (1 – 2 μ g/kg) and propofol (1 – 2 mg/kg), with vecuronium (0.1 mg/kg) used to facilitate tracheal C ontroversy surrounds the role of anesthesia technique and peripheral nerve blocks (PNBs) in inpatient falls (IFs) after orthopedic procedures. This study characterized cases of IF and non-IFs, identified risk factors, and examined the role of PNBs and anesthesia technique in IF risk in total knee arthroplasty (TKA) patients. Participants were patients from the national Premier Perspective database (Premier Inc, Charlotte, NC, 2006 – 2010; n = 191,570, > 400 acute care hospitals). The primary outcome was IF. Patient- and health care system – related characteristics, anesthesia associated with notable muscle weakness, delaying mobilization and perhaps increasing the likelihood of falls. This study is 1 of the first ran- domized clinical trials to compare the effectiveness of ACBs to FNBs for TKA patients within the context of a multimodal an- algesia protocol. All patients received preoperative and postoperative nonsteroidal anti-inflammatory drugs, acetaminophen, and systemic opioids; all but 3 subjects received low-dose epidural patient-controlled analgesia with bupivacaine and hydromor- phone postoperatively. P ostoperative pain after total hip arthroplasty (THA) can af- fect recovery and lead to delayed mobilization and prolonged hospitalization. Typically, pain is managed by epidural analgesia, peripheral nerve blocks, and parenteral or spinal opioids. Adverse effects of these methods require new pain management options after THA. Local infiltration analgesia (LIA) is based on a systematic infiltration of ropivacaine, ketorolac, and epinephrine into the tissue around the surgical field. The catheter is left in place, and although early mobilization and reduced hospital stay have been reported, re- sults have not all been positive. This prospective, randomized, double-blind, parallel-group study was undertaken to compare in- trathecal morphine (ITM) with LIA using a noninferiority design. P ersistent postoperative pain (PPP) has a high prevalence and severity but is often ignored because of limited treatment options. Blocking nociceptive impulses over time leads to PPP be- cause central sensitization is a comprehensive stepwise process. Blocking nociception during the perioperative period may prevent persistent pain postoperatively, but randomized controlled trials (RCTs) have not had consistent results. This systematic review and meta-analysis were performed to compare regional anesthesia and conventional analgesia for preventing PPP. The Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and CINAHL were searched for RCTs that studied adults and children undergoing elective surgical procedures and compared local anesthetics or regional anesthesia with conven- tional pain control. Outcomes at 6 or 12 months were pain versus no pain, pain or use of pain medications, or both versus no pain. The summary statistic for the dichotomous primary outcome was the odds ratio (OR) with 95% confidence intervals (CIs). Number needed to treat was calculated for subgroups of thoracotomy and breast cancer surgery. From 144 full-text articles, 23 studies were included in the analysis. Randomized controlled trials were clustered in catego- ries of thoracotomy, limb amputation, breast surgery, laparotomy, and other. Data were pooled from 250 participants in 3 trials after thoracotomy and data from conventional an- algesia in preventing PPP at 6 to 12 months after surgery. After a diligent literature search, 23 RCTs were included. Studies were categorized by surgical intervention such as thoracotomy, limb amputation, breast surgery, laparotomy, and others. The authors, after meticulous analysis, offer us some positive findings. They suggest that epidural anesthesia reduces the risk of PPP in 1 of 4 patients treated; likewise, they us that paravertebral block contributes to reducing chronic pain in 1 of 5 patients. For the remaining categories, the data were inadequate for evidence synthesis. Although the coauthors caution us not to extrapolate these results and apply them to other types of surgeries, we acknowledge their contribution to evidence-based recommendations. We look forward to future studies exploring other clinical scenarios for averting PPP, as well as research directed at the prevention of dev-astating chronic pain in children. cells, NKT cells, T H cells (C4 + ), and cytotoxic T lymphocytes (CTLs; CD8 + ) during the perioperative period may have huge implications for postoperative outcomes. Regional anesthesia has ben- eficial effects on the immune system by restoring the T H 1 and T H 2 balance. Whether the function of NK cells is preserved after lung cancer surgery is uncertain. This observational study was undertaken to investigate the acute change in the percentage and function of NK cells and the percentage of NKT cells, T H cells, and CTLs in patients with non – small cell lung cancer before and after surgery under general anesthesia and postoperative thoracic epidural analgesia.Recruited patients were between 18 and 85 years old; had stage I, II, or III non – small cell lung cancer; and were scheduled to undergo thoracotomy. They had not received chemotherapy or radiation preoperatively. General anesthesiawas induced with fentanyl and propofol and maintained with sevoflurane in 80% oxy- gen adjusted with nitrogen to maintain a bispectral index of 40 to 60. Lung isolation was used during tumor resection in all pa- tients. Perioperative epidural analgesia was provided with a bolus of 6 to 9 mL 0.1 to 0.25% bupivacaine followed by a postoperative infusion of 0.1% to 0.2% bupivacaine with or without 2 μ g/mL fentanyl at a rate of 6 to 9 mL/h. Pain scores were recorded 24 hours postoperatively. Plasma levels of interleukin 2 (IL-2), IL-4, and interferon γ (IFN- γ ) were measured. The T H 1/T H 2 bal- ance was determined by calculating the IL-2/IL-4 ratio. Prism 5 (GraphPad was used for all statis- tical analyses, and P < 0.05 indicated statistical significance.