Journal of anesthesia
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Journal of anesthesia · Jun 2017
Review Meta AnalysisClinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis.
Transversus abdominis plane (TAP) blocks can provide analgesia postoperatively for a range of surgeries. Abundant clinical trials have assessed TAP block showing positive analgesic effects. This systematic review assesses safety and effectiveness outcomes of TAP block in all clinical settings, comparing with both active (standard care) and inactive (placebo) comparators. ⋯ Postoperative pain within 24 h was reduced or at least equivalent in TAP block compared to its comparators. Therefore, TAP block is a safe and effective procedure compared to standard care, placebo and other analgesic techniques. Further research is warranted to investigate whether the TAP block technique can be improved by optimizing dose and technique-related factors.
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Journal of anesthesia · Jun 2017
Case ReportsParavertebral block catheter breakage by electrocautery during thoracic surgery.
Advantages of thoracic paravertebral analgesia (TPA) include placement of the catheter closer to the surgical field; however, the catheter can become damaged during the operation. We experienced a case of intraoperative TPA catheter breakage that prompted us to perform an experiment to investigate possible causes. A 50-year-old male underwent a thoracoscopic lower lobectomy under general anesthesia with TPA via an intercostal approach. ⋯ In contrast, breakage occurred in only 3 and occlusion in none in the reinforced group, with the 5 without breakage remaining connected only by the spring coil. Furthermore, in 7 of the reinforced catheters, electric arc-induced thermal damage was observed at the tip of the catheter. A TPA catheter for thoracic surgery should be inserted via the median approach, or it should be inserted after surgery to avoid catheter damage during surgery.
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Journal of anesthesia · Jun 2017
ReviewPerioperative risk factors for death among patients with symptomatic pulmonary thromboembolism.
Perioperative pulmonary thromboembolism (PTE) is a fatal complication that may occur in patients who are undergoing surgery. This study aimed to identify risk factors for PTE-related death. This study evaluated data for the most recent 5-year period (2007-2011) from the Japanese Society of Anesthesiologists' database of patients who experienced perioperative PTE. ⋯ Logistic regression analyses revealed that male sex, an age of ≥ 80 years, bedridden status, heart failure, and the non-use of anticoagulant therapy were independent risk factors for PTE-related death. We found that male sex, an age of ≥ 80 years, bedridden status, heart failure, and the non-use of anticoagulant therapy were independent risk factors for perioperative PTE-related death. Therefore, appropriate interventions for bedridden patients and thromboprophylaxis using anticoagulants may help reduce the incidence of perioperative PTE-related mortality.