1.A comparison of analgesic efficacy between oblique subcostal transversus abdominis plane block and intravenous morphine for laparascopic cholecystectomy. A prospective randomized controlled trial.
Chee Kean CHEN ; Peter Chee Seong TAN ; Vui Eng PHUI ; Shu Ching TEO
Korean Journal of Anesthesiology 2013;64(6):511-516
BACKGROUND: The ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block provides a wider area of sensory block to the anterior abdominal wall than the classical posterior approach. We compared the intra-operative analgesic efficacy of OSTAP block with conventional intravenous (IV) morphine during laparoscopic cholecystectomy. METHODS: Forty adult patients undergoing laparoscopic cholecystectomy under standard general anesthesia, were randomly assigned for either bilateral OSTAP block using 1.5 mg/kg ropivacaine on each side (n = 20) or IV morphine 0.1 mg/kg (n = 20). The intra-operative pulse rate, systolic and diastolic blood pressure and mean arterial blood pressure were monitored every five minutes. Repetitive boluses of IV fentanyl 0.5 microg/kg were given as rescue analgesia when any of the above-mentioned parameters rose more than 15% from the baseline values. Time to extubation was documented. Additional boluses of IV morphine 0.05 mg/kg were administered in the recovery room if the recorded visual analogue score (VAS) was more than 4. Nausea and vomiting score, as well as sedation score were recorded. RESULTS: The morphine group required more rescue fentanyl as compared to the OSTAP block group but the difference was not significant statistically. Time to extubation was significantly shorter in the OSTAP block group (mean [SD] 10.4 [2.60] vs 12.4 [2.54] min; P = 0.021). Both methods provided excellent analgesia and did not differ in postoperative morphine requirements. No between-group differences in sedation score and incidence of nausea and vomiting were demonstrated. CONCLUSIONS: Ultrasound-guided OSTAP block has an important role as part of balanced anesthesia. It is as efficacious as IV morphine in providing effective analgesia during laparoscopic cholecystectomy.
Abdominal Wall
;
Adult
;
Amides
;
Analgesia
;
Anesthesia, General
;
Arterial Pressure
;
Balanced Anesthesia
;
Blood Pressure
;
Cholecystectomy
;
Cholecystectomy, Laparoscopic
;
Fentanyl
;
Heart Rate
;
Humans
;
Incidence
;
Morphine
;
Nausea
;
Prospective Studies
;
Recovery Room
;
Vomiting
2.The impact on patients’ time-to-theatre following colour coding classification in emergency operation theatre, Sarawak General Hospital
Khaw Soon Keong ; Teo Shu Ching ; Mohamad Adam Bujang
The Medical Journal of Malaysia 2020;75(4):379-384
Introduction: A proper prioritisation system of emergency
cases allows appropriate timing of surgery and efficient
allocation of resources and staff expertise. The aim of this
study was to determine the impact of colour coding
classification on Time-to- theatre (TTT) of patients in
comparison with the normal practice.
Method: Categorisation was a surgical judgment call after
thorough clinical assessment. There were 4 levels of urgency
with their respective TTT; Red (2 hours), Yellow (8 hours),
Green (24 hours), Blue (72 hours). Caesarean cases were
excluded in colour coding due to pre - existing classification.
The data for mean TTT was collected 4 weeks before the
implementation (Stage 1), and another 4 weeks after
implementation (Stage II). As there was a violation in the
assumption for parametric test, Mann Whitney U test was used
to compare the means between these two groups. Using
logarithmic (Ln) transformation for TTT, Analysis of
Covariance (ANCOVA) was conducted for multivariate
analysis to adjust the effect of various departments. The mean
TTT for each colour coding classification was also calculated.
Results: The mean TTT was reduced from 13 hours 48 min to
10 hours, although more cases were completed in Stage II (428
vs 481 cases). Based on Mann-Whitney U test, the difference in
TTT for Stage I (Median=6.0, /IQR=18.9) and Stage II
(Median=4.2, IQR=11.5) was significantly different (p=0.023).
The result remained significant (p=0.039) even after controlled
for various department in the analysis. The mean/median TTT
after colour coding was Red- 2h 24min/1h, Yellow- 8h
26min/3h 45 min, Green- 15h 8min/8h 15min, and Blue- 13h
46min/13h 5min.
Conclusion: Colour coding classification in emergency
Operation (OT) was effective in reducing TTT of patients for
non-caesarean section cases.