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Intravenous Patient-controlled Fentanyl With And Without Transversus Abdominis Plane Block In Cirrhotic Patients Post Liver Resection
Author: Serag Eldin M, Mahmoud F, El Hassan R, Abdel Raouf M, Afifi Mh, Yassen K, Morad W
Publisher: Derivative Works
11 pages
One time payment: €0.00
Required subscription: Free
Type of publication: Article
ISBN/ISSN: 1124-8882
DOI: 10.2147/60966
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Background: Coagulation changes can complicate liver resection, particularly in patients with cirrhosis. The aim of this prospective hospital-based comparative study was to compare the postoperative analgesic efficacy of intravenous fentanyl patient-controlled analgesia (IVPCA) with and without transversus abdominis plane (TAP) block. Methods: Fifty patients with Child’s A cirrhosis undergoing liver resection were randomly divided into two groups for postoperative analgesia, ie, an IVPCA group receiving a 10 µg/mL fentanyl bolus of 15 µg with a 10-minute lockout and a maximum hourly dose of 90 µg, and an IVPCA + TAP group that additionally received TAP block (15 mL of 0.375% bupivacaine) on both sides via a posterior approach with ultrasound guidance before skin incision. Postoperatively, bolus injections of bupivacaine 0.375% were given every 8 hours through a TAP catheter inserted by the surgeon in the open space during closure of the inverted L-shaped right subcostal with midline extension (subcostal approach) guided by the visual analog scale score (,3, 5 mL; 3 to ,6, 10 mL; 6–10, 15–20 mL) according to weight (maximum 2 mg/kg). The top-up dosage of local anesthetic could be omitted if the patient was not in pain. Coagulation was monitored using standard coagulation tests. Results: Age, weight, and sex were comparable between the groups (P.0.05). The visual analog scale score was significantly lower at 12, 18, 24, 48, and 72 hours (P,0.01) in IVPCA + TAP group. The Ramsay sedation score was lower only after 72 hours in the IVPCA + TAP group when compared with the IVPCA group (1.57±0.74 versus 2.2±0.41, respectively, P,0.01). Heart rate, systolic blood pressure, and fentanyl consumption were lower in the IVPCA + TAP group at 24, 48, and 72 hours (P,0.05). Intensive care unit stays were significantly shorter with TAP (2.61±0.74 days versus 4.35±0.79 days, P,0.01). Prothrombin time and International Normalized Ratio indicated temporary hypocoagulability in both groups.

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