Postoperative Nausea and Vomiting, Postoperative Pain
Conditions
Keywords
Ropivacaine, Transversus abdominis plane block, opioid consumption, Dexamethasone
Brief summary
To explore and compare Ultrasound-Guided Transversus Abdominis Plane Block on Postoperative nausea and vomiting and Early Outcome After Laparoscopic Bariatric Surgery To evaluate and examine TAPB can reduce the application of intraoperative and postoperative opioids and the duration of analgesia
Detailed description
Poor postoperative nausea and vomiting control is a leading factor that hinders the physical rehabilitation, and causes acute cognitive impairment and chronic pain syndrome. Recently, the multimodal analgesia strategies to minimise opioid-related side effects are highly desirable in open surgical procedures. The transversus abdominis plane block is a novel technique involving injection of local anaesthetic between the internal oblique and the transversus abdominis muscles of the abdominal wall. Although ropivacaine is most commonly used for this technique, the analgesic duration remains not dissatisfied. Herein, investigators will evaluate the efficacy of ultrasound-guided transversus abdominis plane(USG- TAP) block with ropivacaine in Laparoscopic Bariatric Surgery.
Interventions
DRUGNormal saline
Before the induction of anesthesia, normal saline is used for bilateral transversus abdominis plane block in a volume of 20 mL of each side
DRUGRopivacaine at high concentration
Before the induction of anesthesia,0.375% ropivacaine is used for bilateral transversus abdominis plane block in a volume of 20 mL of each side
Before the induction of anesthesia, 0.375% Ropivacaine and 5.0mg dexamethasone are used for bilateral transversus abdominis plane block in a volume of 20 mL of each side
Sponsors
Tianjin Medical University General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
Double (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
1. Subject is scheduled to undergo Laparoscopic Bariatric Surgery 2. Subject's American Society of Anesthesiologists physical status is I-III. 3. BMI\>35kg/m2 4. The subject's parent/legally authorized guardian has given written informed consent to participate
Exclusion criteria
1. Subject has a diagnosis of renal or liver failure. 2. Subject has a diagnosis of mental illness 3. Subject is allergy and contraindication to Ropivacaine. 4. Subject has a history of chronic pain, a history of alcohol or opioid abuse, pre-existing therapy with opioids, intake of any analgesic drug within 48 hours before surgery. 5. Subject has any contraindication for the use 6. Subject is pregnant or breast-feeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative nausea and vomiting | 72 hours after surgery | The Apfel score was recorded for evaluating risk for developing postoperative nausea and vomiting (PONV). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| cumulative Sufentanyl Consumption after surgery | 48 hours after surgery | Each patient was administered analgesics using a PCA pump containing sufentanil (100μg) in normal saline at a totalvolume of 100 ml after leaving PACU. This device was set to deliver a basal infusion of 2 ml/h and bolus doses of 0.5ml with a 15-min lockout period. Sufentanyl cumulative consumption is recorded 24 hours postoperative |
| Time of First Postoperative Analgesic Requiremen | 1hour after surgery | First postoperative pain (NRS≥5) is initially controlled by titration of sufentany |
| Total Dose of First Postoperative Analgesic Requirement | 1hour after surgery | First postoperative pain (NRS≥5) is initially controlled by titration of sufentanyl. |
| The incidence of Side Effects | 48 hours after surgery | The number of patients with side effects including nausea, vomiting, dizziness, headache, shivering, and pruritus is recorded for 48 hours postoperatively |
| cumulative Sufentanyl Consumption during surgery | during surgery | Each patient was administered sufentanil for analgesic during surgery |
| Time to ambulation | 12 hours after surgery | The obesity's time to ambulation after surge |
| Mean time until passage of flatus | 72 hours after surgery | Gastrointestinal motility was evaluated by recording mean time until passage of flatus |
| Diffusion area of local anesthetics after transversus abdominis plane block | 30 minutes after transversus abdominis plane block | Diffusion area of local anesthetics after transversus abdominis plane block was calculated under ultrasound assistance. |
| Normalized Area of Hyperalgesia Around the Incision | 48 hours after surgery | The skin around the incision is stimulated in steps of 5 mm at intervals of 1 s starting outside of the hyperalgesic area in the direction of the incision. The distance from the incision to the first point where a 'painful', 'sore' or 'sharper'feeling occurred is measured and noted. This measurement is repeated at predefined radial lines around the incision. To eliminate the variable length of incision, this length is subtracted from the longer diameter leaving four radial distances from the end and from the middle of the incision. The normalized area of hyperalgesia is calculated by summing up the areas of the remaining four triangles measured by and Von Frey filament. |
| Apfel score | The 1 day before the surgery | The Apfel score was recorded for evaluating risk for developing postoperative nausea and vomiting (PONV). |
Contacts
Primary ContactGuolin Wang, MD
Outcome results
None listed