The application of transversus abdominis plane block anesthesia in peritoneal dialysis catheter implantation: a randomized controlled trial_Chinese Journal of Evidence-Based Medicine

Authors：

TAO Tian ¹ ,  LI Zi ¹ , ZHANG Wenjuan ² , LI Qi ² , TANG Xiaohong ¹ , ZHANG Jie ¹

1. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

LI Zi, Email: lizihx@163.com

Keywords：

Peritoneal dialysis catheter implantation; Local filtration anesthesia; Transversus abdominis plane block anesthesia; Randomized controlled trial; Double blinding

DOI：

10.7507/1672-2531.201606026

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Objective To investigate the efficacy and safety of ultrasound-guided TAP block for the anesthesia in peritoneal dialysis (PD) catheter implantation. Methods Patients with end-stage renal disease who intended to receive PD catheter implantation in the West China Hospital of Sichuan University were enrolled from April 2015 to February 2016. Those who met the inclusion criteria were randomly divided into two groups: the local filtration anesthesia (LF) group and the TAP group. The two groups got the ultrasound guided TAP block (The LF group got a shame TAP block by making the skin wheal and just inserting the needle into the TAP with the guidance of ultrasound), then the LF group received local filtration anesthesia twenty minutes later, with the TAP group had sham LF anesthesia by injection of saline at the incision subcutaneously. The anesthetist generated the random allocation sequence and performed all TAP/sham blocks according to the allocation of each patient. The patients, investigators were all blind to the allocation. The follow-up time was 3 months. The primary outcomes were the rate of alteration to general anesthesia and the VAS score during and after the surgery. The dosages of sufentanil for analgesia during and after were recorded. The satisfaction to the effect anesthesia by the operation doctors, PD catheter related complications and adverse events related to TAP block or anesthetic agent were also recorded. Statistic analysis was conducted using SPSS 19.0 software. Results A total of 36 patients were included, 12 cases in the LF group and 24 cases in the TAP group. The rate of alteration to general anesthesia in the TAP group was 4.12% and was significantly lower than that in the LF group (33.3%) (P=0.034). The VAS scores at the time points of incision of skin, division of subcutaneous tissue and anterior rectus sheath, opening the peritoneum, insertion of PDC, suture of skin, 2 hours and 24 hours after operation were significantly lower in the TAP group compared to the LF group (P values=0.001, 0.037, 0.000, 0.001, 0.029, 0.035, and 0.000, respectively). The TAP group consumed less sufentanil during the operation and showed a higher satisfaction of the operation doctors. There were no significant differences in the PD catheter related complications and adverse events between the two groups. Conclusion The ultrasound-guided TAP block can be an effective and safe anesthesia method for PD catheter implantation. Because of the limitation of small sample size of this study, a multiple center study with larger sample size is suggested.

Citation： TAO Tian, LI Zi, ZHANG Wenjuan, LI Qi, TANG Xiaohong, ZHANG Jie. The application of transversus abdominis plane block anesthesia in peritoneal dialysis catheter implantation: a randomized controlled trial. Chinese Journal of Evidence-Based Medicine, 2017, 17(1): 7-12. doi: 10.7507/1672-2531.201606026 Copy

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8.	Barrington MJ, Ivanusic JJ, Rozen WM,et al. Spread of injectate after ultrasound guided subcostal transversus abdominis plane block: a cadaveric study. Anaesthesia, 2009, 64(7): 745-750.
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10.	彭裕文, 劉樹偉, 李瑞錫. 局部解剖學. 第七版. 北京: 人民衛生出版社, 1979: 80-86.
11.	Kagwa S, Hoeft MA, Firth PG,et al. Ultrasound guided transversus abdominis plane versus sham blocks after caesarean section in an Ugandanvillage hospital: a prospective, randomised, double-blinded, single-centre study. Lancet, 2015, 385 (Suppl 2): S36.
12.	Lissauer J, Mancuso K, Merritt C,et al. Evolution of the transversus abdominis plane block and its role in postoperative analgesia. Best Pract Res Clin Anaesthesiol, 2014, 28(2): 117-126.
13.	Lancaster P, Chadwick M. Liver trauma secondary to ultrasound-guided transversus abdominis plane block. Br J Anaesth, 2010, 104 (4): 509-510.
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1. ?Asif A. Peritoneal dialysis access-related procedures by nephrologists. Semin Dial, 2004, 17 (5): 398-406.
2. Borley N. Anterior abdominal wall, posterior abdominal wall and retroperitoneum. In. Standring S. Gray’s Anatomy. 40th edtion. New York: Churchill.
3. Marki? D, Vuji?i? B, Ivanovski M,et al. Peritoneal Dialysis Catheter Placement Using an Ultrasound Guided Transversus Abdominis Plane Block. Blood Purif, 2015, 39 (4): 274-280.
4. Chatterjee S, Bain J, Christopher S,et al. Role of regional anesthesia for placement of peritoneal dialysis catheter under ultrasound guidance: Our experience with 52 end-stage renal disease patients. Saudi J Anaesth, 2015, 9(2): 132-135.
5. Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia, 2001, 56 (10): 1024-1026.
6. Mc Donnell JG, O'Donnell BD, Farrell T,et al. Transversus abdominis plane block: a cadaveric and radiological evaluation. Reg Anesth Pain Med, 2007, 32 (5): 399-404.
7. Tran TM, Ivanusic JJ, Hebbard P,et al. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth, 2009, 102 (1): 123-127.
8. Barrington MJ, Ivanusic JJ, Rozen WM,et al. Spread of injectate after ultrasound guided subcostal transversus abdominis plane block: a cadaveric study. Anaesthesia, 2009, 64(7): 745-750.
9. Yamamoto H, Shido A, Sakura S,et al. Monitored anesthesia care based on ultrasound guided subcostal transversus abdominis plane block for continuous ambulatory peritoneal dialysis catheter surgery: case series. J Anesth, 2016, 30(1): 156-160.
10. 彭裕文, 劉樹偉, 李瑞錫. 局部解剖學. 第七版. 北京: 人民衛生出版社, 1979: 80-86.
11. Kagwa S, Hoeft MA, Firth PG,et al. Ultrasound guided transversus abdominis plane versus sham blocks after caesarean section in an Ugandanvillage hospital: a prospective, randomised, double-blinded, single-centre study. Lancet, 2015, 385 (Suppl 2): S36.
12. Lissauer J, Mancuso K, Merritt C,et al. Evolution of the transversus abdominis plane block and its role in postoperative analgesia. Best Pract Res Clin Anaesthesiol, 2014, 28(2): 117-126.
13. Lancaster P, Chadwick M. Liver trauma secondary to ultrasound-guided transversus abdominis plane block. Br J Anaesth, 2010, 104 (4): 509-510.
14. Hecquet E, Bonamy C, Levesque C,et al. Peritoneal dialysis catheter insertion under TAP block procedure: A pilot study. Nephrol Ther, 2015, 11 (3): 164-168.

Chinese Journal of Evidence-Based Medicine

The application of transversus abdominis plane block anesthesia in peritoneal dialysis catheter implantation: a randomized controlled trial

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