Yıl: 2019 Cilt: 27 Sayı: 4 Sayfa Aralığı: 285 - 290 Metin Dili: İngilizce DOI: 10.5222/jarss.2019.83584 İndeks Tarihi: 03-01-2020

Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study

Öz:
Objective: Laparoscopic cholecystectomy is a minimally invasive surgical procedure but it is stillassociated with postoperative pain within the first 24 hours. Ultrasound-guided transversusabdominis plane block is a regional anesthetic technique which provides postoperative analgesiain abdominal surgery. We aimed to determine the effects of the TAP block on discharge time,non-opioid and opioid consumption, shoulder tip pain, incidence of postoperative nausea andvomiting, and severity of pain evaluated with visual analogue scale in patients who underwentlaparoscopic cholecystectomy.Methods: Seventy-two eligible patients who underwent laparoscopic cholecystectomy wereincluded in the study. In 38 patients ultrasound-guided TAP block was performed, and 34 patientswere treated with conventional methods such as non-steroid anti-inflamatory drugs. Data relatedto VAS pain scores, shoulder tip pain, intraoperative opioid consumption, postoperative non-opioid and opioid consumption, nausea vomiting and discharge time were collected retrospec-tively to determine statistically significant differences between TAP block and non-TAP blockgroups.Results: VAS pain scores were globally reduced at all time periods in two groups (significantgroup main effect, F(7.760)=94.47, P<0.001). VAS pain scores were significantly lower at all mea-surement intervals except 24h in the TAP group than in the non-TAP group. Shoulder pain wassignificantly higher in TAP block group than non-TAP block group (p<0.001). Any statistically sig-nificant difference was not found between the groups in terms of intraoperative, and postopera-tive opioid consumption, discharge time, nausea and vomiting.Conclusion: Ultrasound-guided TAP block is an effective regional analgesic technique to decreasepostoperative abdominal pain, however TAP block does not reduce shoulder tip pain. Multimodalpain management is required after laparoscopic cholecystectomy.
Anahtar Kelime:

Konular: Anestezi Yoğun Bakım, Tıp

Laparoskopik Kolesistektomi Sonrası Postoperatif Ağrıda Transversus Abdominis Alan Bloğu, Retrospektif Bir Çalışma

Öz:
Amaç: Laparoskopik kolesistektomi, minimal invazif cerrahi girişim olmasına rağmen, postopera- tif ilk 24 saat ağrı görülmektedir. Ultrasonografi eşliğinde transversus abdominis alan (TAP) bloğu, abdominal cerrahide postoperatif analjezi sağlayan rejyonal anestezi tekniğidir. Laparoskopik kolesistektomi nedeniyle opere edilen hastalarda, transversus abdominis alan blo- ğunun; taburculuk süresi, opioid ve opioid olmayan ilaçların tüketimi, bulantı, kusma, omuz ağrısı, vizüel analog ağrı skalasına (VAS) göre ağrı şiddetine etkilerini belirlemeyi amaçladık. Yöntem: Laparoskopik kolesistektomi olan 72 hasta çalışmaya dahil edildi. Otuz sekiz hastaya ultrasonografi eşliğinde TAP blok uygulanmış olup, 34 hastaya non steroid anti inflamatuvar ilaçlarla ağrı kontrolü sağlanmıştır. VAS skoru, omuz ağrısı, intraoperatif ve postoperatif opioid ve opioid olmayan ilaçların tüketimi, bulantı, kusma ve taburculuk süresi, TAP blok uygulanan ve uygulanmayan olmak üzere gruplar arası farklılıklar istatistiksel analiz ile araştırıldı. Bulgular: VAS skorları her 2 grupta da genel olarak tüm zaman periyodlarında azalmıştır (anlam- lı temel etki, F(7.760)=94.47, p<0.001). VAS ağrı skorları, TAP blok uygulanan grupta 24. saat hariç olmak üzere TAP uygulanmayan gruba göre anlamlı düşüktü. Omuz ağrısı, TAP blok uygula- nan grupta anlamlı yüksek bulundu (p<0.001). İntraoperatif ve postoperatif opioid tüketimi, bulantı, kusma, taburculuk süresi kıyaslandığında anlamlı fark bulunmadı. Sonuç: Ultrasonografi eşliğinde TAP blok, abdominal ağrıya bağlı postoperatif ağrının azaltılma- sında etkili bir rejyonal anestezi tekniğidir, ancak omuz ağrısını azaltmamaktadır. Laparoskopik kolesistektomi sonrası multimodal ağrı yönetimi gerekmektedir.
Anahtar Kelime:

Konular: Anestezi Yoğun Bakım, Tıp
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • Singla S, Mittal G, Raghav RK. Pain management after laparoscopic cholecystectomy-a randomized prospec- tive trial of low pressure and standard pressure pneu- moperitoneum. Journal of Clinical and Diagnostic Research: JCDR. 2014;8:92. https://doi.org/10.7860/JCDR/2014/7782.4017
  • Elamin G, Waters PS, Hamid H, et al. Efficacy of a lapa- roscopically delivered transversus abdominis plane block technique during elective laparoscopic cholecy- stectomy: a prospective, double-blind randomized trial. Journal of the American College of Surgeons. 2015;221:335-44. https://doi.org/10.1016/j.jamcollsurg.2015.03.030
  • Johns N, O’neill S, Ventham NT, Barron F, Brady RR, Daniel T. Clinical effectiveness of transversus abdomi- nis plane (TAP) block in abdominal surgery: a systema- tic review and meta‐analysis. Colorectal Disease. 2012;14:e635-42. https://doi.org/10.1111/j.1463-1318.2012.03104.x
  • Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56:1024-6. https://doi.org/10.1046/j.1365-2044.2001.02279-40.x
  • Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for lapa- rotomy. Journal of anaesthesiology. Clinical Pharmacology. 2013;29:550. https://doi.org/10.4103/0970-9185.119148
  • Saliminia A, Azimaraghi O, Babayipour S, Ardavan K, Movafegh A. Efficacy of transverse abdominis plane block in reduction of postoperation pain in laparosco- pic cholecystectomy. Acta Anaesthesiologica Taiwanica. 2015;53:119-22. https://doi.org/10.1016/j.aat.2015.07.003
  • Milas M, Deveđija S, Trkulja V. Single incision versus standard multiport laparoscopic cholecystectomy: up-dated systematic review and meta-analysis of ran- domized trials. the Surgeon. 2014;12:271-89. https://doi.org/10.1016/j.surge.2014.01.009
  • Sarvestani AS, Zamiri M. Residual pneumoperitoneum volume and postlaparoscopic cholecystectomy pain. Anesthesiology and Pain Medicine. 2014;4:e17366. https://doi.org/10.5812/aapm.17366
  • Reddy VS, Brown JD, Ku B, Gilchrist BF, Farkas DT. Effect of pain medication choice on emergency room visits for pain after ambulatory laparoscopic cholecystec- tomy. The American Surgeon. 2015;81:826-8.
  • Petersen PL, Stjernholm P, Kristiansen VB et al. The beneficial effect of transversus abdominis plane block after laparoscopic cholecystectomy in day-case sur- gery: a randomized clinical trial. Anesthesia & Analgesia. 2012;115:527-33. https://doi.org/10.1213/ANE.0b013e318261f16e
  • El-Dawlatly AA, Turkistani A, Kettner SC, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. British Journal of Anaesthesia. 2009;102:763-7. https://doi.org/10.1093/bja/aep067
  • Ra YS, Kim CH, Lee GY, Han JI. The analgesic effect of the ultrasound-guided transverse abdominis plane block after laparoscopic cholecystectomy. Korean Journal of Anesthesiology. 2010;58:362-8. https://doi.org/10.4097/kjae.2010.58.4.362
  • Ortiz J, Suliburk JW, Wu K, et al. Bilateral transversus abdominis plane block does not decrease postoperati- ve pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites. Regional anesthesia and pain medicine. 2012;37:188-92. https://doi.org/10.1097/AAP.0b013e318244851b
  • McCloy R, Randall D, Schug SA, et al. Is smaller neces- sarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparos- copic cholecystectomy on patient outcomes. Surgical Endoscopy. 2008;22:2541-53. https://doi.org/10.1007/s00464-008-0055-1
  • Khanna A, Sezen E, Barlow A, Rayt H, Finch JG. Randomized clinical trial of a simple pulmonary recru- itment manoeuvre to reduce pain after laparoscopy. British Journal of Surgery. 2013;100:1290-4. https://doi.org/10.1002/bjs.9202
  • Yasir M, Mehta KS, Banday VH, Aiman A, Masood I, Iqbal B. Evaluation of post operative shoulder tip pain in low pressure versus standard pressure pneumoperi- toneum during laparoscopic cholecystectomy. the Surgeon. 2012;10:71-4. https://doi.org/10.1016/j.surge.2011.02.003
  • Rashid A, Gorissen KJ, Ris F, et al. No benefit of ultrasound‐guided transversus abdominis plane blocks over wound infiltration with local anaesthetic in electi- ve laparoscopic colonic surgery: results of a double‐blind randomized controlled trial. Colorectal Disease. 2017;19:681-9. https://doi.org/10.1111/codi.13578
APA Yaman F, KARACA G, Çolak S, Ateş G, PEHLİVANLI F, GENÇAY I, Aydın G (2019). Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study. , 285 - 290. 10.5222/jarss.2019.83584
Chicago Yaman Ferda,KARACA GÖKHAN,Çolak Selim,Ateş Gökay,PEHLİVANLI Faruk,GENÇAY IŞIN,Aydın Gülçin Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study. (2019): 285 - 290. 10.5222/jarss.2019.83584
MLA Yaman Ferda,KARACA GÖKHAN,Çolak Selim,Ateş Gökay,PEHLİVANLI Faruk,GENÇAY IŞIN,Aydın Gülçin Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study. , 2019, ss.285 - 290. 10.5222/jarss.2019.83584
AMA Yaman F,KARACA G,Çolak S,Ateş G,PEHLİVANLI F,GENÇAY I,Aydın G Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study. . 2019; 285 - 290. 10.5222/jarss.2019.83584
Vancouver Yaman F,KARACA G,Çolak S,Ateş G,PEHLİVANLI F,GENÇAY I,Aydın G Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study. . 2019; 285 - 290. 10.5222/jarss.2019.83584
IEEE Yaman F,KARACA G,Çolak S,Ateş G,PEHLİVANLI F,GENÇAY I,Aydın G "Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study." , ss.285 - 290, 2019. 10.5222/jarss.2019.83584
ISNAD Yaman, Ferda vd. "Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study". (2019), 285-290. https://doi.org/10.5222/jarss.2019.83584
APA Yaman F, KARACA G, Çolak S, Ateş G, PEHLİVANLI F, GENÇAY I, Aydın G (2019). Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study. Anestezi Dergisi, 27(4), 285 - 290. 10.5222/jarss.2019.83584
Chicago Yaman Ferda,KARACA GÖKHAN,Çolak Selim,Ateş Gökay,PEHLİVANLI Faruk,GENÇAY IŞIN,Aydın Gülçin Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study. Anestezi Dergisi 27, no.4 (2019): 285 - 290. 10.5222/jarss.2019.83584
MLA Yaman Ferda,KARACA GÖKHAN,Çolak Selim,Ateş Gökay,PEHLİVANLI Faruk,GENÇAY IŞIN,Aydın Gülçin Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study. Anestezi Dergisi, vol.27, no.4, 2019, ss.285 - 290. 10.5222/jarss.2019.83584
AMA Yaman F,KARACA G,Çolak S,Ateş G,PEHLİVANLI F,GENÇAY I,Aydın G Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study. Anestezi Dergisi. 2019; 27(4): 285 - 290. 10.5222/jarss.2019.83584
Vancouver Yaman F,KARACA G,Çolak S,Ateş G,PEHLİVANLI F,GENÇAY I,Aydın G Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study. Anestezi Dergisi. 2019; 27(4): 285 - 290. 10.5222/jarss.2019.83584
IEEE Yaman F,KARACA G,Çolak S,Ateş G,PEHLİVANLI F,GENÇAY I,Aydın G "Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study." Anestezi Dergisi, 27, ss.285 - 290, 2019. 10.5222/jarss.2019.83584
ISNAD Yaman, Ferda vd. "Transversus Abdominis Plane (TAP) Block for Postoperative Analgesia After Laparoscopic Cholecystectomy, A Retrospective Study". Anestezi Dergisi 27/4 (2019), 285-290. https://doi.org/10.5222/jarss.2019.83584