Evaluation of the effect of rectus sheath block and transversus abdominis plan block on sevoflurane and fentanyl consumption in laparoscopic cholecystectomy: A randomized controlled study

Abstract

Objectives: We aimed to compare the total amount of inhalation anesthesia consumed and the amount of fentanyl used as an additional dose in cases where transversus abdominis plane and rectus sheath blocks were applied for postoperative analgesia.

Methods: Eighty patients aged 18-75 years, classified as ASA I-II, who were scheduled for laparoscopic cholecystectomy, were included. The patients were divided into two groups: those who received a combination of transversus abdominis and rectus sheath blocks under general anesthesia (Group B, n=40), and those who received analgesia with tramadol under general anesthesia (Group C, n=40). Throughout the procedure, both groups were monitored to maintain the entropy target value between 40-60 with a maximum MAC value of 1.3. At the end of the procedure, the total amount of inhalation agent consumed, and the additional need for superficial anesthesia/analgesia, as well as the total amount of fentanyl added as an extra dose, were recorded.

Results: Comparing the total amount of inhalation agent consumed throughout the case, it was found to be 27.05±7.43 mL in Group C (Control group) and 12.25±4.34 mL in Group B (Block group), with a statistically significant difference between the groups. There was a significant difference in the need for additional intraoperative and the total amount of fentanyl consumed between the groups (P<0.05).

Conclusions: In laparoscopic cholecystectomy cases, we observed that the use of transversus abdominis plane block and rectus sheath block combined with standardized general anesthesia monitored by entropy reduced the amount of inhalation agent consumed, as well as the need for additional intraoperative and total opioid consumption.

Keywords

• Transversus abdominis plane block
• rectus sheath block
• entropy
• sevoflurane
• fentanyl

References

1. 1. Karaman T, Ozsoy AZ, Karaman S, et al. [The effects of transversus abdominis plane block on analgesic and anesthetic consumption during total abdominal hysterectomy: a randomized controlled study]. Braz J Anesthesiol. 2018;68(3):285-291. doi: 10.1016/j.bjan.2017.12.005. [Article in Portuguese]
2. 2. Seitsonen ER, Korhonen IK, van Gils MJ, Huiku M, Lötjönen JM, Korttila KT, et al. EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia. Acta Anaesthesiol Scand. 2005;49(3):284-292. doi: 10.1111/j.1399-6576.2005.00654.x.
3. 3. McCulloch TJ, Sanders RD. Depth of anaesthesia monitoring: time to reject the index? Br J Anaesth. 2023;131(2):196-199. doi: 10.1016/j.bja.2023.04.016.
4. 4. Roche D, Mahon P. Depth of Anesthesia Monitoring. Anesthesiol Clin. 2021;39(3):477-492. doi: 10.1016/j.anclin.2021.04.004.
5. 5. Klein AA, Meek T, Allcock E, et al. Recommendations for standards of monitoring during anaesthesia and recovery 2021: Guideline from the Association of Anaesthetists. Anaesthesia. 2021;76(9):1212-1223. doi: 10.1111/anae.15501.
6. 6. Rajasekhar M, Yadav M, Kulkarni D, Gopinath R. Comparison of hemodynamic responses to laryngoscopy and intubation using Macintosh or McCoy or C-MAC laryngoscope during uniform depth of anesthesia monitored by entropy. J Anaesthesiol Clin Pharmacol. 2020;36(3):391-397. doi: 10.4103/joacp.JOACP_281_19.
7. 7. Vanluchene AL, Vereecke H, Thas O, Mortier EP, Shafer SL, Struys MM. Spectral entropy as an electroencephalographic measure of anesthetic drug effect: a comparison with bispectral index and processed midlatency auditory evoked response. Anesthesiology. 2004;101(1):34-42. doi: 10.1097/00000542-200407000-00008.
8. 8. Dinu AR, Rogobete AF, Popovici SE, et al. Impact of General Anesthesia Guided by State Entropy (SE) and Response Entropy (RE) on Perioperative Stability in Elective Laparoscopic Cholecystectomy Patients-A Prospective Observational Randomized Monocentric Study. Entropy (Basel). 2020;22(3):356. doi: 10.3390/e22030356.

9. 9. Luebbert E, Rosenblatt MA. Postoperative Rebound Pain: Our Current Understanding About the Role of Regional Anesthesia and Multimodal Approaches in Prevention and Treatment. Curr Pain Headache Rep. 2023;27(9):449-454. doi: 10.1007/s11916-023-01136-z.
10. 10. Epstein RH, Dexter F, Maguire DP, Agarwalla NK, Gratch DM. Economic and Environmental Considerations During Low Fresh Gas Flow Volatile Agent Administration After Change to a Nonreactive Carbon Dioxide Absorbent. Anesth Analg. 2016;122(4):996-1006. doi: 10.1213/ANE.0000000000001124.
11. 11. Biro P. Calculation of volatile anaesthetics consumption from agent concentration and fresh gas flow. Acta Anaesthesiol Scand. 2014;58(8):968-972. doi: 10.1111/aas.12374.
12. 12. Van Norman GA, Jackson S. The anesthesiologist and global climate change: an ethical obligation to act. Curr Opin Anaesthesiol. 2020;33(4):577-583. doi: 10.1097/ACO.0000000000000887.
13. 13. Onishi E, Saito K, Kumagai M, et al. Evaluation of contrast-enhanced ultrasonography with Sonazoid® in visualization of local anesthetic distribution in rectus sheath block: a prospective, clinical study. J Anesth. 2022;36(3):405-412. doi: 10.1007/s00540-022-03063-6.
14. 14. Gürkan Y, Kuş A. Fascial Plane Blocks in Regional Anaesthesia and New Approaches. Turk J Anaesthesiol Reanim. 2017;45(2):85-86. doi: 10.5152/TJAR.2017.040401.
15. 15. El-Dawlatly AA, Turkistani A, Kettner SC, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth. 2009;102(6):763-767. doi: 10.1093/bja/aep067.
16. 16. Çevikkalp E, Narmanlı M, Özgüç H, Ocakoğlu G. Bilateral 4-quadrant laparoscopic-assisted transversus abdominis plane block reduces early postoperative pain after laparoscopic cholecystectomy: A prospective, single-blind, randomized study. Saudi Med J. 2023;44(2):145-154. doi: 10.15537/smj.2023.44.2.20220407.
17. 17. Rahimzadeh P, Faiz SHR, Salehi S, Imani F, Mueller AL, Sabouri AS. Unilateral Right-Sided Ultrasound-Guided Erector Spinae Plane Block for Post-Laparoscopic Cholecystectomy Analgesia: A Randomized Control Trial. Anesth Pain Med. 2022;12(6):e132152. doi: 10.5812/aapm-132152.
18. 18. Peker K, Akçaboy ZN, Aydın G, et al. The Effect of Erector Spinae Plane Block on Laparoscopic Cholecystectomy Anesthesia: Analysis of Opioid Consumption, Sevoflurane Consumption, and Cost. J Laparoendosc Adv Surg Tech A. 2020;30(7):725-729. doi: 10.1089/lap.2019.0809.
19. 19. Kokulu S, Bakı ED, Kaçar E, et al. Effect of transversus abdominis plane block on cost of laparoscopic cholecystectomy anesthesia. Med Sci Monit. 2014;20:2783-7. doi: 10.12659/MSM.892055.
20. 20. Bhattacharjee S, Ray M, Ghose T, Maitra S, Layek A. Analgesic efficacy of transversus abdominis plane block in providing effective perioperative analgesia in patients undergoing total abdominal hysterectomy: A randomized controlled trial. J Anaesthesiol Clin Pharmacol. 2014;30(3):391-396. doi: 10.4103/0970-9185.137274.
21. 21. Barash PG, Cahalan MK, Cullen BF, et al, editors. Barash’s Clinical Anesthesia. 8th ed., Philadelphia, PA: Lippincott Williams & Wilkins (LWW), 2017.
22. 22. Liang T, Wu F, Wang B, Mu F. PRISMA: accuracy of response entropy and bispectral index to predict the transition of consciousness during sevoflurane anesthesia: A systematic review and meta-analysis. Medicine (Baltimore). 2021;100(17):e25718. doi: 10.1097/MD.0000000000025718.
23. 23. Watts N, Amann M, Arnell N, et al. The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come. Lancet. 2018;392(10163):2479-2514. doi: 10.1016/S0140-6736(18)32594-7.
24. 24. Wyssusek KH, Keys MT, van Zundert AAJ. Operating room greening initiatives - the old, the new, and the way forward: A narrative review. Waste Manag Res. 2019;37(1):3-19. doi: 10.1177/0734242X18793937.
25. 25. McGain F, Sheridan N, Wickramarachchi K, Yates S, Chan B, McAlister S. Carbon Footprint of General, Regional, and Combined Anesthesia for Total Knee Replacements. Anesthesiology. 2021;135(6):976-991. doi: 10.1097/ALN.0000000000003967.
26. 26. Struys MMRF, Eckelman MJ. Environmental Footprint of Anesthesia: More than Inhaled Anesthetics! Anesthesiology. 2021;135(6):937-939. doi: 10.1097/ALN.0000000000004050.
27. 27. White SM, Shelton CL, Gelb AW, et al; representing the World Federation of Societies of Anaesthesiologists Global Working Group on Environmental Sustainability in Anaesthesia. Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists. Anaesthesia. 2022;77(2):201-212. doi: 10.1111/anae.15598.
28. 28. Ryan SM, Nielsen CJ. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. 2010;111(1):92-98. doi: 10.1213/ANE.0b013e3181e058d7.