SP437COMPARISON BETWEEN ULTRASOUND-GUIDED TRANSVERSUS ABOMINIS PLANE BLOCK TECHNIQUE AND LOCAL FILTRATION ANESTHESIA IN PERITONEAL DIALYSIS CATHETER IMPLANTATION: A RANDOMIZED CONTROLLED TRIAL

Abstract

Introduction and Aims: Peritoneal dialysis (PD) catheter placement is usually performed using general anesthesia (GA) or local filtration anesthesia (LA). Although GA reduces the pain, but use of it in patients with ESRD, who have severe coexisting medical problems, may put them at risk. LA may inevitably cause pain and discomfort. The Ultrasound (US)-guided transversus abdominis plane (TAP) block is a useful analgesic technique for lower abdominal surgeries. Therefore we tried to use this method in PD catheter implantation and evaluate the usefulness and safety of this technique compared with LA. Methods: A randomized, double-blinded, parallel-group, controlled clinical trial was conducted in a total of 30 consecutive ESRD patients who intended to have PD catheter implantation in our department. All the patients were randomized into three groups: LA group (N=10), unilateral TAP (Uni-TAP) group (N=10) and bi-lateral TAP (Bi-TAP) group (N=10). The primary outcome was the switching rate from LA/TAP to general anesthesia. Visual analogue score (VAS) was recorded at different time point, including anesthesia procedure, skin incision, peritoneal manipulation, catheter placement, catheter tunneling, skin suture and 24 hours after PD catheter implantation. The relaxation of rectus abdominis, time of anesthesia procedure and degree of satisfactory to the anesthesia effect by the nephrologist were also compared among the three groups as well. The vital signs during PD catheter implantation, the complication of PD catheter were also recorded. Results: There were 5 patients switched to GA in LA group, one patient in Uni-TAP and 1 patient in Bi-TAP switched to GA, respectively. The switching rate to GA was higher in the LA group compared to the two TAP groups (P< 0.05). Both the Uni-TAP and Bi-TAP group had a lower VAS from the time point of skin incision to catheter placement than the LA group (P< 0.05). There were no significant differences of VAS between the three groups at other time points during the operation. The two TAP groups reduced postoperative pain more effectively than the LA group (P<0.05). The VAS between the two TAP groups had no significant difference. The nephrologist was more satisfied with the anesthesia effect of TAP than LA. All the procedures of PD catheter implantation were accomplished successfully and the complications of PD catheter after operation were comparable in the three groups. Conclusions: US-guided TAP block had a better effect than local filtration anesthesia and could be a useful and safety anesthesia technique for PD placement procedure. The anesthestic effect of Uni-TAP and Bi-TAP has no significant difference and Uni-TAP is recommended due to less time consuming.