Ultrasound Guided Rectus Sheath Block and Transversus Abdominis Plane Block
Condition: Cholecystitis; Appendicitis
MeSH terms: Appendicitis; Cholecystitis
Study type: Interventional

Summary: 
      The current study aimed to assess the efficacy of Dexmedetomidine (DEX) and Dexamethasone as
      an adjuvant to ultrasound guided TAP and RS block to prolongation of postoperative analgesia
      and better pain control in children undergoing laparoscopic surgeries
    

Detailed description: 
      Laparoscopic surgeries are one of the most frequently performed paediatric surgeries .
      Although minimally invasive, this technique is still associated with a significant amount of
      pain and anxiety in children . Indeed, children who are highly anxious prior to surgery tend
      to have more postoperative pain, delayed hospital discharge, and higher incidence of
      emergence delirium, sleep disturbances, and other mal-adaptive behaviour changes that can
      last up to a few weeks following surgery . To improve analgesia and decrease postoperative
      anxiety in children undergoing laparoscopic appendectomies multimodal approach for pain
      control can be employed.

      Over the past years, the concept of pain management has extended from simply decreasing pain
      intensity to optimizing patient's condition. The goal is to decrease pain scores, stress
      response that should be avoided in patients, particularly cardiac patients, together with a
      decrease in analgesics-related adverse effects like nausea, vomiting, retention of urine and
      over sedation. By achieving these goals, we can certainly facilitate patient recovery and
      minimize the hospital stay. Improved pain control can be achieved by a combination of
      different types of regional analgesia with systemic analgesics. The main contributor to pain
      post abdominal operations is the pain from abdominal wall incision .

      Many procedures were followed to decrease this intense postoperative pain such as, epidural
      catheter analgesia, transversus abdominis plane (TAP) block, local wound infiltration,
      Patient-Controlled Analgesia (PCA), peripheral nerve blocks, in addition to systemic
      administration of Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) or opioids .

      The transversus abdominis plane (TAP) block is a regional anesthetic technique that provides
      analgesia to the parietal peritoneum as well as to the skin and muscles of the anterior
      abdominal wall (9-10). Despite a relatively low risk of complications and a high success rate
      using modern techniques, TAP block remains overwhelmingly underused. Although the technique
      is technically straightforward, it has not been adopted in clinical practice .

      Moreover, The Rectus Sheath Block (RSB) is one of these regional techniques that are suitable
      for operations with a midline incision or laparoscopic surgery with the main incision at the
      umbilical port. A previous study showed the analgesic efficacy of ultrasound guided rectus
      sheath block for laparoscopic appendectomy compared to a control group injected with saline
      instead of a local anesthetic Generally, in laparoscopic surgeries, the sites of port
      incision are associated with considerable postoperative discomfort. Thus, we performed TAP
      and RS block to ameliorate postoperative pain and improve patient outcomes. In addition to
      the usefulness of traditional local anesthetics to provide analgesia during the course of the
      postoperative period is restricted by their short duration of action .

      Dexmedetomidine (DEX) and Dexamethasone has been shown as a valuable additives to local
      anesthetics in neuraxial blocks and peripheral nerve blocks leading to prolongation of
      postoperative analgesia and better pain control .

      Dexmedetomidine (DEX) α-2 adrenergic receptor consists of three α-2 isoreceptors (α-2a, α-2b
      and α-2c), which regulate the various pharmacodynamic effects of this drug . The α-2a
      receptor seems to promote sedation and anxiolysis in the locus coeruleus, as well as to
      generate bradycardia and peripheral vasodilation by stimulation of the cerebral vasomotor
      center. The α-2b receptor prevents tremor, generates analgesia in the dorsal horns of the
      spinal cord and determines peripheral vasoconstriction. The α-2c receptor modulates the
      mental state .

      Dexamethasone, a high-potency, long-acting glucocorticoid, has been shown to prolong
      peripheral nerve blockade . Dexamethasone binds to glucocorticoid receptors and inhibits
      potassium conductance, which decreases nociceptive C-fiber activity . Dexamethasone may also
      extend the duration of analgesia via local vasoconstrictive and systemic anti-inflammatory
      effects .

      Thus, we performed TAP and RS block to ameliorate postoperative pain and improve patient
      outcomes.

      .
    

Intervention name(s): Dexmedetomidine
Intervention type(s): Drug
Intervention description(s): Ninety patients were randomized to receive ultrasound-guided RSB&tap block After the induction of anesthesia and patient stabilization, the abdomen was sterilized and draped. Then, under complete aseptic conditions, ultrasound-guided Bilateral Rectus Sheath Block & tap block was performed
Other intervention name(s): Dexamethasone; Bupivacaine
Intervention MeSH terms: Dexamethasone; Dexmedetomidine; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Age: 8-12years.
Weight: 20-60 kg.
Sex: both males and females.
ASA physical status: I-II.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: us guided rectus sheath block&tap block; laparscopic surgery; regional anesthesia