Chawla Mason

Bilateral Transversus Abdominis Plane Block Does Not Decrease Postoperative Pain After Laparoscopic Cholecystectomy When Compared With Local Anesthetic Infiltration of Trocar Insertion Sites

Background and Objectives Transversus abdominis plane (TAP) block has been shown to reduce pain and analgesic requirements after abdominal surgery. Our hypothesis was that bilateral TAP blocks decrease pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites. Methods Eighty patients undergoing laparoscopic cholecystectomy were randomized to receive either bilateral TAP blocks or local anesthetic infiltration of trocar insertion sites with ropivacaine 0.5%. Postoperative pain scores and analgesic use for the first 24 hrs were recorded. Results Eighty patients were enrolled in the study. After exclusions, data were analyzed on 39 patients in group T (bilateral TAP block) and 35 patients in group I (infiltration). There was no statistically significant difference in pain scores on the numeric analog scale (0–10) between the groups at 4 hrs after surgery (P = 0.18) or during the 24 hrs after surgery (P = 0.23). The time interval from anesthesia start to surgery start was greater in group T than group I (48 vs 35 mins, P < 0.001). There was no significant difference found in analgesic use during the first 24 hrs after surgery. Conclusions Bilateral ultrasound-guided TAP block is equivalent to local anesthetic infiltration of trocar insertion sites for overall postoperative pain in a heterogeneous group of patients undergoing laparoscopic cholecystectomy.

Quando um paciente cai (no sono) e não consegue acordar: transtorno conversivo – Paraplegia após anestesia geral ☆

BACKGROUND AND OBJECTIVES This case report describes the rare occurrence of paraplegia caused by conversion disorder in a woman who received general anesthesia for breast surgery. CASE REPORT A 46-year-old healthy woman received general anesthesia for excision of a left breast fibroepithelial lesion. In the post-anesthesia care unit, she reported bilateral loss of both sensation and motor function below the knees. Physical signs and symptoms did not correlate with any anatomical or neurological patterns; imaging revealed no abnormalities. Psychiatric consultation was performed wherein familial stressor circumstances were identified, leading to diagnosis and management of conversion disorder. CONCLUSION Conversion disorder is characterized by alteration of physical function due to expression of an underlying psychological ailment. Its diagnosis requires thorough evaluation including appropriate workup to exclude organic causes. The meshing together of anesthesiology and psychiatry - as demonstrated by this case report - offers an opportunity to highlight important information pertaining to the definition, diagnosis, and management of conversion disorder as it may be encountered in the postanesthesia recovery period.