Browsing by Author "Yeap, Yar Luan"

Now showing 1 - 7 of 7
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    Comparison of methods of providing analgesia after pancreas transplant: IV opioid analgesia versus transversus abdominis plane block with liposomal bupivacaine or continuous catheter infusion
    (Wiley, 2019) Yeap, Yar Luan; Fridell, Jonathan A.; Wu, Derrick; Mangus, Richard S.; Kroepf, Elizabeth; Wolfe, John; Powelson, John A.; Anesthesia, School of Medicine
    Background Current practices emphasize a multimodal approach to perioperative analgesia due to higher efficacy and decreased opioid usage. Analgesia for pancreas transplant (PT) has traditionally been managed with intravenous (IV) opioids, and reports of transversus abdominis plane (TAP) blocks are limited in this population. Methods Three interventions were compared in adult PT patients, including IV opioids, TAP catheter, and TAP block with liposomal bupivacaine. Time to return of intestinal function and oral diet, postoperative pain scores, opioid usage, and length of stay were recorded. Results Study included 197 PT patients: 62 (32%) standard care, 90 (45%) TAP catheters with continuous 0.2% ropivacaine, and 45 (23%) single liposomal bupivacaine TAP block. Pain scores were lowest for the IV opioid group (P < 0.001). The liposomal bupivacaine group had lower pain scores on postoperative days (POD) 1‐5 than the TAP catheter group. Opioid use during POD 1‐5 was lower for both TAP block groups (P = 0.03). Time to bowel function was faster for the TAP block groups (P < 0.05). Conclusions Compared with IV opioid analgesia, TAP block interventions were associated with lower overall use of opioids and a faster time to intestinal function following pancreas transplant.
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    Effect of Prior Formal Education on Successful Thoracic Epidural Placement By Anesthesia Residents
    (Elsevier, 2020-11) Yeap, Yar Luan; Randolph, Tim; Lemmon, Adam J.; Mann, Miles D.; Stewart, Jennifer; Wolfe, John W.; Anesthesia, School of Medicine
    Objective: Catheter placement for thoracic epidural analgesia (TEA) is technically challenging; however, methods for teaching this technique to anesthesia residents have not been well-studied. The present study aimed to determine optimal teaching methods for proficient TEA catheter placement by comparing video-based formal resident education with traditional bedside training by attending physicians. Design: Prospective, randomized study. Setting: Large academic hospital, single institution. Participants: The study comprised 76 postgraduate year 3 and 4 anesthesiology residents (38 intervention, 38 control). Interventions: Formal education included an instructional video on proper TEA technique. Measurements and Main Results: Measures of proficiency in TEA catheter placement included the time needed to complete the procedure successfully and the success of placement as indicated by patient confirmation. Residents who received formal video instruction had similar success in catheter placement and similar procedure times compared with the traditionally trained residents. The overall success rate was 99.2%, with faculty intervention required in only 17% of cases. More experienced residents (ie, having placed more epidural catheters) were faster at TEA catheter placement. Conclusions: Formal video education for TEA catheter placement provided no additional improvement of resident proficiency compared with traditional training at a high-volume academic center. The success rate was very high in this group of residents; however, experiences at other institutions may vary. Future studies are needed to determine optimum teaching strategies for TEA.
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    Erector spinae plane block versus transversus abdominis plane block in laparoscopic hysterectomy
    (Future Science Group, 2022-11) Warner, Matthew; Yeap, Yar Luan; Rigueiro , Gabriel; Zhang , Pengyue; Kasper , Kelly; Obstetrics and Gynecology, School of Medicine
    Background: The objective was to determine whether an erector spinae plane (ESP) block could provide additional postoperative analgesic benefits compared with a transversus abdominis plane block. Methods: 78 patients were separated into two groups (n = 39 per group). Both groups received bilateral injections of 266 mg Exparel® (20 ml) and 60 ml of 0.125% bupivacaine. Patients undergoing a transversus abdominis plane block received these injections intraoperatively, while patients undergoing an ESP block received these preoperatively. Outcomes were measured based on scores in opioid usage; pain (visual analog scale) at rest and with movement; nausea; sedation and patient satisfaction. Results: There were no significant intergroup differences in any category (all scores had p > 0.05). Conclusion: No additional analgesic benefits were found using the ESP block procedure.
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    Pain interventions for organ transplant patients undergoing incisional hernia repair: Is epidural or transversus abdominus plane block a better option?
    (Wiley, 2018) Yeap, Yar Luan; Wolfe, John; Fridell, Jonathan A.; Ezell, Jake; Powelson, John A.; Anesthesia, School of Medicine
    Background Postoperative pain management in transplant recipients undergoing incisional herniorraphy is challenging. Historically limited to intravenous or oral opioids, alternatives including transversus abdominus plane (TAP) block catheters and thoracic epidural catheters have been introduced. The aim of this study was to determine whether TAP catheters and thoracic epidural analgesia significantly impacted on postoperative pain and opioid usage in transplant recipients undergoing incisional hernia repair. Methods This single‐center retrospective study included 154 patients undergoing incisional hernia repair from January 2011 to June 2015. Of these, 56 received epidurals, 51 received TAP catheters, and 47 received no intervention. Results Demographic profiles were comparable among the three groups including type of previous transplant and type of hernia surgery. Thoracic epidural analgesia was associated with lower median, mean, and maximum pain scores (P < 0.001) and less opioid requirement (P < 0.001). There was no difference in pain scores and opioid usage among the TAP catheter and no intervention groups. There was no difference in time to first flatus or first bowel movement, length of hospital stay, individual opioid‐related side effects, and adverse reactions among the three groups. Conclusion This study supports the use of thoracic epidural analgesia in patients undergoing hernia repair after transplant surgery.
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    Prospective Comparison of Ultrasound-Guided Versus Palpation Techniques for Arterial Line Placement by Residents in a Teaching Institution
    (Accreditation Council for Graduate Medical Education, 2019-04) Yeap, Yar Luan; Wolfe, John W.; Stewart, Jennifer; Backfish, Kevin M.; Anesthesia, School of Medicine
    Background: Arterial line insertion is traditionally done by blind palpation. Residents may need multiple attempts for successful insertion, leading to longer procedure times and many failed attempts. Objective: We hypothesized that ultrasound guidance (USG) would be faster and more successful than traditional blind palpation (TBP) for radial artery line placement by residents. Methods: Patients undergoing elective surgery requiring a radial arterial line were randomized to either the USG or TBP groups. Exclusion criteria included a need for arterial line placement in an awake patient, emergent surgery, or American Society of Anesthesiologists (ASA) physical status class VI. After the induction of anesthesia, a postgraduate year 3 (PGY-3) or PGY-4 anesthesia resident placed an arterial line by either USG or TBP. Results: A total of 412 patients and 85 of 106 residents (80%) in the training program were included. The 2 groups were similar with respect to sex, weight, height, ASA class, baseline systolic blood pressure, and baseline heart rate. USG was faster than TBP (mean times 171.1 ± 16.7 seconds versus 243.6 ± 23.5 seconds, P = .012), required fewer attempts (mean 1.78 ± 0.11 versus 2.48 ± 0.15, P = .035), and had an improved success rate (96% versus 90%, P = .012). Conclusions: We found that residents using USG in an academic institution resulted in significantly faster placement of the arterial lines, fewer attempts, and fewer catheters used.
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    Randomized Prospective Study Evaluating Single-Injection Paravertebral Block, Paravertebral Catheter, and Thoracic Epidural Catheter for Postoperative Regional Analgesia After Video-Assisted Thoracoscopic Surgery
    (Elsevier, 2020-07) Yeap, Yar Luan; Wolfe, John W.; Backfish-White, Kevin M.; Young, Jerry V.; Stewart, Jennifer; Ceppa, DuyKhanh P.; Moser, Elizabeth A. S.; Birdas, Thomas J.; Anesthesia, School of Medicine
    Objective Video-assisted thoracoscopic surgery (VATS) has improved patient outcomes; however, postoperative pain remains potentially severe. The objective of this study was to compare adjunct analgesic modalities for VATS, including paravertebral nerve blockade (PVB) and thoracic epidural anesthesia (TEA). Design Prospective, randomized trial. Setting Large academic hospital, single institution. Participants Adult patients undergoing VATS. Interventions Ultrasound-guided PVB catheter, ultrasound-guided single-injection PVB, or TEA. Measurements and Main Results Postoperative visual analog scale pain scores (at rest and with knee flexion) and opioid usage were recorded. Pain scores (with movement) for the TEA group were lower than those for either PVB group at 24 hours (p ≤ 0.008) and for the PVB catheter group at 48 hours (p = 0.002). Opioid use in TEA group was lower than that for either PVB group at 24 and 48 hours (p < 0.001) and 72 hours (p < 0.05). Single-injection PVB was faster compared with PVB catheter placement (6 min v 12 min; p < 0.001) but similar to TEA (5 min). Patient satisfaction, nausea, sedation, and 6-month postsurgical pain did not differ between groups. Conclusions TEA led to lower pain scores and opioid requirement for VATS procedures compared with PVB techniques. Single-injection PVB was faster and equally as effective as PVB catheter, and it led to similar patient satisfaction as TEA; therefore, it should be considered in patients who are not ideal candidates for TEA.
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    Randomized Prospective Study Evaluating Single-Injection Paravertebral Block, Paravertebral Catheter, and Thoracic Epidural Catheter for Postoperative Regional Analgesia After Video-Assisted Thoracoscopic Surgery
    (Elsevier, 2020-07) Yeap, Yar Luan; Wolfe, John W.; Backfish-White, Kevin M.; Young, Jerry V.; Stewart, Jennifer; Ceppa, Duykhanh P.; Moser, Elizabeth A. S.; Birdas, Thomas J.; Surgery, School of Medicine
    Objective Video-assisted thoracoscopic surgery (VATS) has improved patient outcomes; however, postoperative pain remains potentially severe. The objective of this study was to compare adjunct analgesic modalities for VATS, including paravertebral nerve blockade (PVB) and thoracic epidural anesthesia (TEA). Design Prospective, randomized trial. Setting Large academic hospital, single institution. Participants Adult patients undergoing VATS. Interventions Ultrasound-guided PVB catheter, ultrasound-guided single-injection PVB, or TEA. Measurements and Main Results Postoperative visual analog scale pain scores (at rest and with knee flexion) and opioid usage were recorded. Pain scores (with movement) for the TEA group were lower than those for either PVB group at 24 hours (p ≤ 0.008) and for the PVB catheter group at 48 hours (p = 0.002). Opioid use in TEA group was lower than that for either PVB group at 24 and 48 hours (p < 0.001) and 72 hours (p < 0.05). Single-injection PVB was faster compared with PVB catheter placement (6 min v 12 min; p < 0.001) but similar to TEA (5 min). Patient satisfaction, nausea, sedation, and 6-month postsurgical pain did not differ between groups. Conclusions TEA led to lower pain scores and opioid requirement for VATS procedures compared with PVB techniques. Single-injection PVB was faster and equally as effective as PVB catheter, and it led to similar patient satisfaction as TEA; therefore, it should be considered in patients who are not ideal candidates for TEA.