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Postoperative Analgesic Effects of Ultrasound-Guided Bilateral Rectus Sheath Block for Laparoscopic Gynecologic Surgery
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S136–S190
S157
Table 2 The Mean Levels of Ovarian Reserve Markers Before and After Single-port and Conventional Laparoscopic Cystectomy
AMH Level (ng/ml) Before the operation After the operation (4 weeks) Change of AMH level (ng/ml) Post-operative ovarian volume (cm3) (4 weeks) Treated ovary Normal ovary
SLC group (n=34)
CLC group (n=37)
P value
Mean difference (95% Confidence Interval)
3.94 1.53 3.37 1.24 0.60 0.47
3.99 1.75 3.43 1.52 0.54 0.37
0.884 0.856 0.562
-0.06 (-0.84 - 0.72) -0.06 (-0.71 - 0.60) -0.59 (-0.14 - 0.26)
6.22 3.14 10.86 2.30
7.51 2.86 10.31 2.60
0.074 0.374
-1.30 (-2.73 - 0.13) 0.55 (-0.61 -1.71)
Conclusion: Our study demonstrated that SLC has advantages compared with CLC, including requiring less time to retrieve specimens, a lower chance of the endobag rupturing or requiring an elongated wound, and less postoperative pain. Moreover, using SLC provides an ovarian reserve that is similar to using CLC.
514 OpQual Project: A Patient Centred Approach to Promote Safety and Improved Outcomes of Laparoscopic Hysterectomy through Collegial Audit Chittenden BG,1 Tan AL,2 Mcconnell D.3 1Obstetrics and Gynaecology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, Bay of Plenty, New Zealand; 2Ascot Hospital, Remeura, Auckland, New Zealand; 3 Southern Cross Hospital, Wellington, Wellington City, New Zealand Study Objective: We present a group practice model of surgical audit that emphasises the patient perspective when interpreting and reporting effectiveness and safety of laparoscopic hysterectomy. The results of postoperative anonymous patient questionnaires are used to construct a group profile. Key indicators are serious adverse events and patient satisfaction. Surgeons are the owners of their individual data and retain patient identifiers within their database. An independent group acts as the custodian and guardian of anonymous amalgamated data. Interpretation of the data allows for the fostering of collegiality amongst surgeons. The principle of encouraging regression to the mean for outliers is used in feedback loops with individual surgeons. Design: A questionnaire is posted to women six weeks after laparoscopic hysterectomy. The patient completes details of length of stay, recovery, complications, satisfaction rates and reasons for dissatisfaction. The questionnaire is returned to a neutral third party that interprets and amalgamates the data for the group.The sensitivity and specificity of serious adverse events is addressed by involving the surgeon in regular data stringency feedback loops. Outcomes and comparison to the group mean are then distributed periodically to individual participating surgeons. Setting: Four public and private hospitals in New Zealand. Patients: All women where the intention to treat was laparoscopic hysterectomy. Intervention: Patient questionnaire. Measurements and Main Results: The results of patient satisfaction, duration of hospital stay, and serious adverse event data will be presented. Analysis of the sensitivity and specificity of patient-based reporting of serious adverse event data will be presented. This data confirms that patient reporting of serious adverse events lack specificity, but is highly sensitive. Conclusion: Our patient centric model allows surgeons to measure their performance through their patients interpretation of their procedure. The design of the project fosters collegiality amongst surgeons and develops a network that is able to provide mentorship and support to surgeons performing laparoscopic hysterectomy.
515 Postoperative Analgesic Effects of Ultrasound-Guided Bilateral Rectus Sheath Block for Laparoscopic Gynecologic Surgery Cho S,1 Park SY,2 Kim YJ,1 Jeong K.2 1Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea; 2Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea Study Objective: To evaluate the postoperative analgesic efficacy of ultrasound-guided bilateral rectus sheath block (BRSB) for laparoscopic gynecologic surgery. Design: Prospective randomized clinical trial. Setting: Ewha Womans University Mokdong Hospital, Seoul, Korea. Patients: Forty six women aged 15 to 55 years undergoing laparoscopic gynecologic surgery were enrolled and randomly assigned to BRSB group (n=23) and control group (n=23). Intervention: After induction of general anesthesia, 30 ml of 0.25% ropivacaine administered as ultrasound-guided BRSB in the BRSB group. Same dose of intravenous patient controlled anesthesia (IV-PCA) was applied to all patients of both groups for 48 hours postoperatively. Measurements and Main Results: Total and bolus infusion volume of IVPCA and number of PCA attempt were assessed for pain at 1, 3, 6, 12, 24, 36 and 48 hours postoperatively. The both groups were similar in age. Although total and bolus infusion volume of IV-PCA and number of PCA attempt showed a downward tendency in BRSB group compared to control group, there were no significant differences in infusion volume of IV-PCA and number of PCA attempt for postoperative pain control. Conclusion: Ultrasound-guided BRSB with IV-PCA has no significant additional analgesic effect after the laparoscopic gynecologic surgery compared with IV-PCA only pain control. Further studies in large scale will be warranted to identify the postoperative analgesic efficacy of BRSB.
Fig. 1. Comparison of total and bolus infusion volume of IV-PCA and number of PCA attempt between BRSB group and control.
S157
Table 2 The Mean Levels of Ovarian Reserve Markers Before and After Single-port and Conventional Laparoscopic Cystectomy
AMH Level (ng/ml) Before the operation After the operation (4 weeks) Change of AMH level (ng/ml) Post-operative ovarian volume (cm3) (4 weeks) Treated ovary Normal ovary
SLC group (n=34)
CLC group (n=37)
P value
Mean difference (95% Confidence Interval)
3.94 1.53 3.37 1.24 0.60 0.47
3.99 1.75 3.43 1.52 0.54 0.37
0.884 0.856 0.562
-0.06 (-0.84 - 0.72) -0.06 (-0.71 - 0.60) -0.59 (-0.14 - 0.26)
6.22 3.14 10.86 2.30
7.51 2.86 10.31 2.60
0.074 0.374
-1.30 (-2.73 - 0.13) 0.55 (-0.61 -1.71)
Conclusion: Our study demonstrated that SLC has advantages compared with CLC, including requiring less time to retrieve specimens, a lower chance of the endobag rupturing or requiring an elongated wound, and less postoperative pain. Moreover, using SLC provides an ovarian reserve that is similar to using CLC.
514 OpQual Project: A Patient Centred Approach to Promote Safety and Improved Outcomes of Laparoscopic Hysterectomy through Collegial Audit Chittenden BG,1 Tan AL,2 Mcconnell D.3 1Obstetrics and Gynaecology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, Bay of Plenty, New Zealand; 2Ascot Hospital, Remeura, Auckland, New Zealand; 3 Southern Cross Hospital, Wellington, Wellington City, New Zealand Study Objective: We present a group practice model of surgical audit that emphasises the patient perspective when interpreting and reporting effectiveness and safety of laparoscopic hysterectomy. The results of postoperative anonymous patient questionnaires are used to construct a group profile. Key indicators are serious adverse events and patient satisfaction. Surgeons are the owners of their individual data and retain patient identifiers within their database. An independent group acts as the custodian and guardian of anonymous amalgamated data. Interpretation of the data allows for the fostering of collegiality amongst surgeons. The principle of encouraging regression to the mean for outliers is used in feedback loops with individual surgeons. Design: A questionnaire is posted to women six weeks after laparoscopic hysterectomy. The patient completes details of length of stay, recovery, complications, satisfaction rates and reasons for dissatisfaction. The questionnaire is returned to a neutral third party that interprets and amalgamates the data for the group.The sensitivity and specificity of serious adverse events is addressed by involving the surgeon in regular data stringency feedback loops. Outcomes and comparison to the group mean are then distributed periodically to individual participating surgeons. Setting: Four public and private hospitals in New Zealand. Patients: All women where the intention to treat was laparoscopic hysterectomy. Intervention: Patient questionnaire. Measurements and Main Results: The results of patient satisfaction, duration of hospital stay, and serious adverse event data will be presented. Analysis of the sensitivity and specificity of patient-based reporting of serious adverse event data will be presented. This data confirms that patient reporting of serious adverse events lack specificity, but is highly sensitive. Conclusion: Our patient centric model allows surgeons to measure their performance through their patients interpretation of their procedure. The design of the project fosters collegiality amongst surgeons and develops a network that is able to provide mentorship and support to surgeons performing laparoscopic hysterectomy.
515 Postoperative Analgesic Effects of Ultrasound-Guided Bilateral Rectus Sheath Block for Laparoscopic Gynecologic Surgery Cho S,1 Park SY,2 Kim YJ,1 Jeong K.2 1Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea; 2Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea Study Objective: To evaluate the postoperative analgesic efficacy of ultrasound-guided bilateral rectus sheath block (BRSB) for laparoscopic gynecologic surgery. Design: Prospective randomized clinical trial. Setting: Ewha Womans University Mokdong Hospital, Seoul, Korea. Patients: Forty six women aged 15 to 55 years undergoing laparoscopic gynecologic surgery were enrolled and randomly assigned to BRSB group (n=23) and control group (n=23). Intervention: After induction of general anesthesia, 30 ml of 0.25% ropivacaine administered as ultrasound-guided BRSB in the BRSB group. Same dose of intravenous patient controlled anesthesia (IV-PCA) was applied to all patients of both groups for 48 hours postoperatively. Measurements and Main Results: Total and bolus infusion volume of IVPCA and number of PCA attempt were assessed for pain at 1, 3, 6, 12, 24, 36 and 48 hours postoperatively. The both groups were similar in age. Although total and bolus infusion volume of IV-PCA and number of PCA attempt showed a downward tendency in BRSB group compared to control group, there were no significant differences in infusion volume of IV-PCA and number of PCA attempt for postoperative pain control. Conclusion: Ultrasound-guided BRSB with IV-PCA has no significant additional analgesic effect after the laparoscopic gynecologic surgery compared with IV-PCA only pain control. Further studies in large scale will be warranted to identify the postoperative analgesic efficacy of BRSB.
Fig. 1. Comparison of total and bolus infusion volume of IV-PCA and number of PCA attempt between BRSB group and control.