Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .
Ultrasound-guided continuous transverse abdominis plane block for abdominal surgery
Introduction : Transversus abdominis plane ( TAP ) block is a new regional analgesic technique for postoperative pain in abdominal surgery . Its efficacy is not clear , and thus it needs to be explored for its regular utilisation on prolonged period . The objective was to study the continuous local anaesthetic infusion effect on postoperative analgesia . Continuous use of TAP block as an analgesic technique has not been evaluated prospect ively in clinical trials . This study evaluates the efficacy of ultrasound-guided TAP block in comparison with PCA fentanyl in major abdominal surgery . Material s and Methods : There were 20 patients in the study , allocated to TAP and control groups . The parameters measured were pain scores on a numerical rating scale ( NRS ) of 0 - 10 at various time intervals and the amount of fentanyl used as rescue analgesia . Patient satisfaction scores were recorded in the TAP block group and along with any complications related to the block . Results : The postoperative median pain scores on coughing on day one were 6.0 for control group and 2.0 for the TAP group ( P = 0.02 ) ; on day two , the equivalent scores were 7.0 and 2.0 ( P = 0.01 ) . The fentanyl requirement at one hour was 203 μ for the control group and 78 μg for the TAP group ( P = 0.03 ) ; at day one , the control and TAP requirements were 1237 μg and 664 μg respectively ( P = 0.01 ) . Three TAP patients rated their satisfaction as ‘ excellent ’ , four as ‘ satisfied , and two as ‘ poor ’ . Conclusion : TAP block is a promising technique for postoperative analgesia in major abdominal surgeries . Our study demonstrated lower pain scores in the TAP group with reduced fentanyl requirement . Further , a large scale study is needed to establish the efficacy of TAP block in this setting
Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .