Cholecystectomy is the most common abdominal surgical procedure in developed countriesLaparoscopic cholecystectomy is considered the gold standard surgical technique forgallstones.The analgesic effectiveness of TAP block has been demonstrated after laparoscopiccholecystectomy operations. m-TAPA block has been described as an alternative analgesictechnique in abdominal surgeries.The aim of this study is to compare these two analgesic methods in terms of effectivenessfor postoperative analgesia management after laparoscopic cholecystectomy operations.
Cholecystectomy is the most common abdominal surgical procedure in developed countries
Laparoscopic cholecystectomy is considered the gold standard surgical technique for
gallstones.
Several factors play a role in pain after laparoscopic cholecystectomy. This pain is
complex and generally considered to be visceral. These factors are include phrenic nerve
irritation caused by CO2 insufflation, abdominal distension, port incisions, the effect
of gallbladder removal and individual factors.
Regional analgesia has been widely accepted by both patients and treating physicians and
has become an important part of multimodal analgesia techniques. Transversus abdominis
plane (TAP) block has been shown to reduce postoperative pain like hysterectomy,
cholecystectomy, cesarean section and colorectal surgery.
Ultrasound (US)-guided Modified Thoracoabdominal Nerve Block Through Perichondrial
Approach (M-TAPA) is performed by applying local anesthetic only to the underside of the
perichondral surface. It provides effective analgesia in the anterior and lateral
thoracoabdominal area.
M-TAPA is a good alternative for analgesia of the upper dermatome levels and lateral
abdominal region and may be an opioid-sparing strategy that provides better quality
recovery in patients undergoing laporoscopic surgery. M-TAPA provides analgesia at the
T5-T11 level in the abdomen. Sonoanatomy is easy to visualize and the spread of local
anesthetic can be easily seen with US guidance. Cephalo caudal spread of local anesthetic
solution produces analgesia in several dermatomes. There are studies investigating the
efficacy of M-TAPA for postoperative pain management in bariatric surgery in the
literature.
Global recovery score (QoR) 15 is a sensitive, reliable and easy method to measure
postoperative recovery quality. This scale, which has become a promising tool for
assessing the quality of the recovery period, questions various aspects of recovery in 5
different areas: pain, physical comfort, physical independence, psychological support and
emotional state. It may be an important scale to evaluate the outcome of changes in
healthcare for quality assurance purposes in perioperative clinical studies. For these
reasons, the "Standardized Endpoints in Perioperative Medicine" initiative and the
European Society of Anesthesia have recommended the use of the QoR-15 scale in clinical
studies investigating patient comfort and pain levels after surgery.
The aim of this study was to compare the efficacy of US-guided M-TAPA block and TAP for
postoperative analgesia management after cholecystectomy. The primary outcome is to
compare global recovery scores, the secondary outcome is to compare postoperative pain
scores (NRS), to evaluate postoperative rescue analgesic (opioid) use and side effects
(allergic reaction, nausea, vomiting) associated with opioid use in this study.
Other: Modified Perichondral Approach Thoracoabdominal Nerve block
M-TAPA block will be performed to Group M-TAPA at the end of the surgery, using US (Vivid
Q) while the patient is in the supine position After providing aseptic conditions, the
high frequency linear US probe (11-12 MHz, Vivid Q) will be covered with a sterile
sheath, and an 80 mm block needle (Braun 360°) will be used. The US probe will be placed
in the sagittal plane where the midclavicular line intersects with the costal cartilage
corresponding to the costochondral angle. Using the In Plane technique, the probe is
gently pushed to visualize the lower part of the costochondral angle at the central
level, advancing the block needle in the caudal-cranio direction, 5 ml of saline will be
injected into the layer between the transverse abdominal muscle and the lower plane of
the costal cartilage, and the block location will be confirmed. After the block location
is confirmed, a total of 20 ml + 20 ml of 0.25% bupivacaine (total 40 ml for both sides)
will be injected bilaterally
Other Name: Postoperative analgesia management
Other: Transversus Abdominal Plane block
TAP block will be performed to Group TAP at the end of the surgery, using US (Vivid Q)
while the patient is in the supine position. After providing aseptic conditions, the high
frequency linear US probe (11-12 MHz, Vivid Q) will be covered with a sterile sheath, and
an 80 mm block needle (Braun 360°) will be used. USG will be placed transversely on the
mid-axillary line between the iliac crest and subcostal planes. Using the In Plane
technique, the block needle will be advanced into the fascial plane between the internal
oblique and transversus abdominis muscles and the location will be confirmed by
administering 5 ml of saline. The block needle will be advanced into the fascial plane
between the internal oblique and transversus abdominis muscles and the location will be
confirmed by administering 5 ml of saline.and than 20 ml of 0.25% bupivacaine (total 40
ml for both sides) will be injected bilaterally
Other Name: Postoperative analgesia management
Inclusion Criteria:
- American Society of Anesthesiologists (ASA) classification I-II
- Elective laparoscopic cholecystectomy
Exclusion Criteria:
- Bleeding diathesis
- Anticoagulant treatment
- Local anesthetics and opioid allergy
- Infection at the site of block
- Patients who do not accept the procedure
Mürsel Ekinci
Bursa, Turkey
Investigator: MÜRSEL EKİNCİ
Contact: +905067137596
drmurselekinci@gmail.com
Mursel Ekinci
+905067137596
drmurselekinci@gmail.com
Ahmet Kaciroglu
akaciroglu@gmail.com
Not Provided