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CNAA / Theses / 2018 / July /

The postoperative analgesia by transverse abdominal plane block: anatomical argumentation and clinical efficiency


Author: Chesov Ion
Degree:doctor of medicine
Speciality: 14.00.37 - Anaesthesiology and Reanimathology
Year:2018
Scientific adviser: Belîi Adrian
doctor habilitat, professor
Scientific consultant: Gheorghe Rojnoveanu
doctor habilitat, associate professor (docent), Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 9 July, 2018
Approved by NCAA on the 23 November, 2018

Abstract

Adobe PDF document0.67 Mb / in romanian

Thesis

CZU 617.55-089.5

Adobe PDF document 4.29 Mb / in romanian
191 pages


Keywords

Postoperative pain, postoperative analgesia, multimodal analgesia, TAP block, abdominal surgery, hysterectomy, white line hernia

Summary

The research area: 321.19 - Anaesthesiology and Intensive care.

Study aim. Evaluation of postoperative analgesic efficiency and clinical feasibility of the transverse abdominal plane block in patients undergoing abdominal surgery. Study objectives. Assessment of cephalo-caudal and medio-lateral spread pattern of methilen blue dye depending on the volume injected under ultrasound guidance in the transverse abdominal plane on fresh unfixed cadavers; comparative analysis of transverse abdominal plane block and systemic intravenous analgesia efficiency in patients undergoing abdominal surgery; evaluating clinical changes and postoperative complications according to the used method of analgesia; assessment of periincisional sensorial changes, relevant to clinical efficiency of the TAP block and systemic intravenous analgesia, at different post-operative time intervals; developing recommendations for clinical use of abdominal transverse abdominal plane block with the purpose of postoperative analgesia in patients undergoing abdominal surgery.

The novelty and the scientific originality.The complex prospective randomized, anatomic and clinical study allowed a comparative assessment of analgesic efficiency of preincisional ultrasound-guided transverse abdominal plane block for postoperative analgesia in patients undergoing abdominal surgery. The cadaveric study has allowed the investigation of the extent and the pattern of methilen blue dye spread, injected under ultrasound guidance in the transverse abdominal plane on fresh unfixed cadavers, depending on the administered volume.

The solved scientific issue. This research represents a focus of existing concerns regarding the management of postoperative pain after abdominal surgery, methods and techniques of postoperative analgesia. It has been demonstrated that ultrasound-guided TAP block provides better postoperative analgesia in patients after abdominal surgery, lower opioid consumption and patients’ faster recovery. The anatomic study results allowed the calculation of local anesthetic volumes injected during the TAP block in patients undergoing abdominal surgery.

The theoretical significance. The present research addresses the problem of treating postoperative pain in patients undergoing abdominal surgery in a context that goes beyond the limits of the traditional anesthesia framework, namely from the perspective of the abdominal transversal plane bock utility as a component of multimodal analgesia.

The application value of the study. The practical importance of the present scientific research is to demonstrate the usefulness of the ultrasound-guided TAP block in promoting postoperative analgesia in patients undergoing abdominal surgery. Based on the performed cadaveric study results, calculation of the local anesthetic volumes injected during ultrasound-guided TAP block in patients undergoing abdominal surgery was argued, regardless patients anatomical characteristics and constitution.

Implementation of scientific results. The study results were implemented in clinical work, teaching process and research at IMSP Emergency Medicine Institute, IMSP Clinical Hospital No.1 (Chisinau), Department of Anaesthesiology and Reanimatology No 1 of „Nicolae Testemitanu” State University of Medicine and Pharmacy (Implementation certificate - Annex 8)