Burhan DOST, Gülbin YALÇIN SEZEN, Abdulkadir İSKENDER, Onur ÖZLÜ

Laparoskopik kolesistektomi ameliyatlarında ultrasonografi eşliğinde uygulanan transversus abdominis plan bloğu ile lokal anestezik infiltrasyonu yöntemlerinin karşılaştırılması

Amaç: Çalışmamızda laparoskopik kolesistektomi ameliyatı geçiren hastalarda ultrason rehberliğinde yapılan Transversus Abdominis Plan (TAP) Bloğu ile trokar giriş yerlerine Lokal Anestezik İnfiltrasyonu (LAI) yöntemlerinin intraoperatif ve postoperatif analjezik etkinlikleri, intraoperatif opioid gereksinimleri ve yan etkileri bakımından karşılaştırmayı amaçladık. Gereç ve Yöntem: Randomize, kontrollü, prospektif yapılan çalışmaya katılan ASA I-II risk grubu 75 hasta üç gruba ayrıldı. Grup L’ye (n=25) cerrahi öncesi trokar giriş yerleri etrafına toplam 20 ml. %0.5 levobupivakain infiltrasyonu uygulandı. Grup T‘ye (n=25) cerrahi öncesi ultrason rehberliğinde bilateral TAP blok uygulanarak toplam 30 ml. %0.25 levobupivakain uygulandı. Kontrol grubuna (n=25) TAP blok veya LAI uygulanmadı. Postoperatif ilk 24 saat süresince hasta kontrollü analjezi cihazı (HKA) ile tramadol infüzyonu yapıldı. İntraoperatif fentanil kullanımı, postoperatif 1, 2, 4, 8, 12, 16 ve 24. saatlerde VASistirahat, VASöksürük, omuz ağrısı, ile 24 saatteki toplam analjezik tüketimi, kaydedildi. Bulgular: Gruplar arası karşılaştırmada ölçülen VASistirahat ve VASöksürük değerleri, intraoperatif dönemde yapılan fentanil dozu, 24. saat sonunda uygulanan toplam analjezik miktarı istatistiksel olarak anlamlı bir fark saptanmadı (p>0.05). Grup T’de postoperatif 1 ve 2. saatlerde kusma oranı (sırası ile %20, %12), Grup K’ya (sırası ile %64, %44) göre anlamlı düzeyde düşük gözlemlendi (p

A comparison of transversus abdominis plane block guided with ultrasonography and local anesthetic infiltration in laparoscopic cholecystectomy operations

Objectives: The aim of this study was to compare a transversus abdominis plane (TAP) block guided with ultrasound (USG) and local anesthetic infiltration (LAI) in terms of the intraoperative and postoperative analgesia efficiency, intraoperative opioid need, and side effects in cases of laparoscopic cholecystectomy. Methods: A total of 75 patients classified as American Society of Anesthesiologists class I or II were included in this randomized, controlled, prospective study and divided into 3 groups. 20 mL of levobupivacaine 0.5% was applied around the trocar entrance site before the operation to group L (n=25), and 30 mL 0.25% levobupivacaine was applied with a USG-guided TAP block to group T (n=25). No TAP block or LAI was applied to the control group (n=25), group K. In the first 24 hours after surgery, an infusion of tramadol was administered with a controlled analgesia device. The intraoperative fentanyl use was recorded, and a visual analogue scale was administered to assess pain while resting (VASrest) and upon coughing (VAScough) at 1, 2, 4, 8, 12, 16, and 24 hours postoperative. An evaluation of shoulder pain and the consumption of analgesia in 24 hours were also recorded. Results: The VASrest and VAScough values, the dose of fentanyl used intraoperatively, and the total analgesia dose administered in 24 hours were compared between groups and there was no statistically significant difference detected (p>0.05). In group T, the vomiting rate 1 and 2 hours postoperative (20% and 12%, respectively) was significantly lower than in group K (64% and 44%, respectively). Conclusion: The efficiency of the analgesia provided after a laparoscopic cholecystectomy with a bilateral TAP block guided with USG and LAI was determined to be similar

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