Ayşe Lafcı, Kevser Dilek Andıç, Aysu Hayriye Nadir, Nermin Göğüş

Laparoskopik Kolesistektomi Geçiren Hastalarda Ultrasonografi Eşliğinde Uygulanan Transversus Abdominis Plan Bloğun Perioperatif Analjezi ve Hasta Konforuna Katkısı

112 ÖZ Amaç: Laparoskopik kolesistektomi sonrası yetersiz ağrı tedavisi, çeşitli komplikasyonlara yol açabilen ve hastanın iyileşmesini olumsuz etkileyen önemli bir sorundur. Transversus abdominis plan bloğu abdominal bölge ameliyatlarında postoperatif analjeziye katkı sağlayabilir. Çalışmamızın amacı, preoperatif dönemde unilateral ya da bilateral uygulanan transversus abdominis plan bloğun, laparoskopik kolesistektomi yapı- lan hastalarda perioperatif analjezik etkilerini ve hasta konforuna katkısını araştırmaktır. Yöntem: Elektif laparoskopik kolesistektomi yapılan toplam 75 hasta blok yapılmayan Grup-1 (n=25), uni- lateral blok yapılan Grup-2 (n=25) ve bilateral blok yapılan Grup-3 (n=25) olarak 3 gruba ayrıldı. Grup 2’ye ve Grup 3’e cerrahi öncesi genel anestezi altında USG ile transversus abdominis plan blok uygulandı. Hastaların demografik özellikleri, intraoperatif opioid tüketim miktarları, postoperatif 30. dk., 2, 4, 8, 12 ve 24. saatlerde VAS istirahat - VAS öksürük skorları, hasta kontrollü analjezi cihazındaki analjezik tüketim miktarları, postoperatif ek analjezik gereksinimi, yan etkiler, hastaların mobilizasyon zamanları ve hasta memnuniyetleri kaydedildi. Bulgular: İntraoperatif tüketilen remifentanil dozu Grup 3’te anlamlı olarak daha düşüktü. Postoperatif 12. saate kadar 3 grup arasında tüm VAS değerleri anlamlı olarak farklı idi. Bilateral blok yapılan grupta VAS istirahat ve VAS öksürük değerleri daha düşüktü. Hasta kontrollü analjezi cihazlarında bolus doz talep/ verilen miktarları ile istenilen/tüketilen toplam ilaç miktarları karşılaştırıldığında, gruplar arasında istatis- tiksel olarak anlamlı fark vardı. Toplam ilaç tüketim miktarı en yüksek Grup 1’de ve en düşük Grup 3’te belirlendi. Grup 3’teki hastaların memnuniyet skorları diğer gruplara göre daha yüksek saptandı. Sonuç: Çalışmamız, laparoskopik kolesistektomi ameliyatlarında transversus abdominis plan blok uygula- masının, perioperatif analjezik tüketiminin azalmasına, 12. saate kadarki VAS skorlarının daha düşük olmasına katkı sağladığını göstermiştir. Laparoskopik kolesistektomi yapılan hastalara preoperatif dönem- de uygulanan transversus abdominis plan bloğun, etkin bir analjezik yöntem olduğu gösterilmiştir.

Evaluation of the Effects of Ultrasound-Guided Transversus Abdominis Plane Block on Perioperative Analgesia and Patient Comfort in Patients Undergoing Laparoscopic Cholecystectomy

Objective: Inadequate pain management after laparoscopic cholecystectomy is an important problem that can lead to complications and negatively affect the patient’s recovery. Transversus abdominis plane block can contribute to postoperative analgesia in abdominal surgeries. The aim of this study is to investigate the effects of preoperative unilateral or bilateral transversus abdominis plane block on perioperative analgesia in patients underwent laparoscopic cholecystectomy and its contribution to patient comfort. Methods: A total of 75 patients were randomized into 3 groups as Group-1 (n=25) without unblocking, Group-2 (n=25) with unilateral block and Group-3 (n=25) with bilateral block. Block was applied to Group 2 and Group 3 under general anesthesia before surgery. Demographic characteristics of patients, intraoperative opioid consumption, postoperative 30 min, 2, 4, 8, 12 and 24 hours VAS rest-VAS cough scores, analgesic consumption in patient controlled analgesia, postoperative additional analgesic requirement, side effects, mobilization times and patient satisfaction were recorded. Results: The dose of remifentanil consumed intraoperatively was significantly lower in Group-3. VAS values were significantly different among the groups until the 12th hour postoperatively. The VAS rest and VAS cough values were lower in the Group 3. There was a significant difference among the groups in the patient-controlled analgesia devices when the bolus dose demand/given amounts and the total amount of drugs requested/consumed were compared. Total drug consumption was determined in the highest Group-1 and the lowest in Group-3. The satisfaction scores of the patients in group-3 were higher than the other groups. Conclusion: Our study showed that transversus abdominis plane block application in laparoscopic cholecystectomy surgeries contributed to decreased perioperative analgesic consumption and lower VAS scores up to 12 hours. Transversus abdominis plane block, which was performed with laparoscopic cholecystectomy in the preoperative period, has been shown to be an effective analgesic method.

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