Can surgical approach affect postoperative analgesic requirements following laparoscopic nephrectomy: Transperitoneal versus retroperitoneal? A prospective clinical study.
Can surgical approach affect postoperative analgesic requirements following laparoscopic nephrectomy: Transperitoneal versus retroperitoneal? A prospective clinical study. Arch Esp Urol. 2017 Jul;70(6):603-611 Authors: Savran-Karadeniz M, Kisa I, Salviz EA, Ozkan-Seyhan T, Tefik T, Sanli O, Tugrul KM Abstract OBJECTIVES: We performed this prospective clinical study to compare the postoperative recovery profile of our patients after transperitoneal (Group T) and retroperitoneal (Group R) laparoscopic nephrectomy approaches. Our primary hypothesis was that epidural analgesic consumption in Group R would be higher at the end of the first postoperative day. METHODS: Forty-four patients scheduled for elective transperitoneal or retroperitoneal laparoscopic nephrectomies were enrolled. All patients in both groups received epidural catheter and general anesthesia induction. At the end of the operation, patients were given 10 ml 0.25% bupivacaine through epidural catheters and extubated. Postoperatively, patients started to receive a continuous infusion of 0.1% bupivacaine and 1μg/ml fentanyl 5ml/h with patient-controlled boluses of an additional 4ml through a patient controlled epidural analgesia (PCEA) device. They were prescribed IV tramadol 1mg/kg as a rescue analgesic VAS≥4). Total analgesic consumption from PCEA devices and VAS scores during the first 24 postoperative hours were recorded as well as number of patients who required analgesic rescue....
AbstractPurpose of ReviewLaparoscopic kidney surgery is commonly used for living donor, partial, and total tumor nephrectomy. The successful emergence of laparoscopic technique was justified by the many benefits offered such as reduced blood loss, tissue trauma, pain, and hospital stay. However, this comes at the expense of physiologic changes and complications secondary to pneumoperitoneum, surgical technique, and patient positioning with significant challenges in anesthetic management.Recent FindingsA variety of laparoscopic approaches (transperitoneal, retroperitoneal, hand-assisted, robotic) are used with some having a...
CONCLUSIONS: There are situations during laparoscopic surgery where a better communication between surgeon and anesthesiologist may improve patient's outcome. Moreover, clinical research has now to identify which additional procedures and type of patients may benefit most from this new deep block concept and ultimately, whether the implementation of a routine deep neuromuscular block may affect patient's outcome. PMID: 29239154 [PubMed - as supplied by publisher]
CONCLUSION: AT treatments require patient's comprehension, excellent coordination of the partnership between urologist and radiologist and relevant choices during intervention. PMID: 28942001 [PubMed - as supplied by publisher]
Gaurav Sindwani, Sandeep Sahu, Aditi Suri, Zakia SaeedSaudi Journal of Anaesthesia 2017 11(4):513-514
ConclusionsPerioperative pregabalin added to a multimodal analgesic regimen was opioid‐sparing, but made no difference to pain intensity score 0–48 h after surgery. Pregabalin may reduce incisional hyperalgesia on the first day after surgery.
Quadratus lumborum block (QLB) is a new abdominal wall block which has shown promising results in the post-operative pain management of patients undergoing abdominal surgeries . Using ultrasound it can be given in four different ways . QLB is a deep muscle plane block making it difficult even for an experienced anesthesiologist to perform it accurately using ultrasound. Presence of excess fat in obese patients adds to this challenge . We would thus like to present a unique technique wherein, laparoscopic guided continuous type 1 QLB was successfully performed to manage the post-operative pain in a series of five p...
ConclusionOur study shows that LRN has equivalent perioperative outcomes and safety in larger and locally advanced renal tumours.
Conclusions: We objectively confirm that although there is acute injury to the retained kidney in the donor after LDN due to the CO2pneumoperitoneum, the renal function improves and reaches close to the pre-operative level within 24 h after surgery.
There are two windows of protection for remote ischemic preconditioning (RIPC), an early (ERIPC) and a late-phase (LRIPC). While ERIPC has been well studied, works on LRIPC are relatively scarce, especially for the kidneys. We aimed to compare the effects of early-phase versus late-phase RIPC in patients with laparoscopic partial nephrectomy (LPN).
CONCLUSIONS: Multimodal analgesia with TAP block did not show a significant clinical benefit compared with trocar site infiltration in laparoscopic nephrectomies. PMID: 28551059 [PubMed - as supplied by publisher]