Suat ALTIN, Selcan YEREBAKAN AKESEN, Belgin YAVAŞCAOĞLU

Laparaskopik Nefrektomide Ağrı Kontrolünde Transvers Abdominis Plane (TAP) Blok Etkinliğinin Retrospektif Olarak İncelenmesi

Laparoskopik cerrahilerde, postoperatif ağrı yönetiminde uygulanan multimodal yaklaşımda rejyonal tekniklerin önemli bir yeri vardır. Bu çalışmada, laparoskopik nefrektomilerde Transvers Abdominis Plane (TAP) bloğun postoperatif ağrı yönetiminde etkinliğini retrospektif olarak değerlendirmeyi amaçladık. Laparoskopik nefrektomi cerrahisi geçirmiş, postoperatif analjezi için hasta kontrollü analjezi (HKA) ile iv morfin verilen 50 olgunun anestezi kayıtları incelendi. Operasyon odasında anestezi indüksiyonu öncesi TAP blok uygulanan (Grup TAP, n=25) ve uygulanmayan (Grup Kontrol, n=25) hastalar iki gruba ayrıldı. İntraoperatif desfluran MAK (minimum alveolar konsantrasyon) değerlerinin ve fentanil tüketiminin Grup TAP’de anlamlı olarak düşük olduğu bulundu (p<0,001). Postoperatif ağrı skorlarının (VAS 0-10) (0. dk, 30. dk, 2.sa, 4.sa, 8.sa ve 12. sa) ve postoperatif HKA yöntemi ile morfin tüketiminin Grup TAP’de anlamlı olarak düşük olduğu saptandı (p<0,001). HKA ile ilk morfin kullanma zamanının Grup kontrol’de daha kısa olduğu bulundu. (p<0,001). Bulantı-kusma ve hipertansiyon gibi opioidlerle ilişkili yan etkilere kontrol grubunda, TAP grubuna göre daha sık rastlandığı saptandı (p<0,001). Grup TAP’de hasta memnuniyetinin daha yüksek olduğu saptandı (p<0,001). Sonuç olarak, laparoskopik nefrektomi cerrahisi geçirecek olgularda preoperatif dönemde genel anesteziye ilave TAP bloğun uygulanması, intraoperatif anestezik ve analjezik tüketimini azaltarak daha kaliteli bir postoperatif ağrı yönetimi sağlamaktadır.

Anahtar Kelimeler:

AĞRI, TRANVERSUS ABDOMİNİS PLAN BLOĞU, LAPAROSKOPİK NEFREKTOMİ

Retrospective Evaluation of Transvers Abominis Plane (TAP) Block Efficiency in Pain Control of Laparascopic Nephrectomy

Regional block techniques have important role in postoperative pain management of laparoscopic surgeries in multimodal strategy. We planned to evaluate the efficiency of TAP block in postoperative pain management in laparoscopic nephrectomy retrospectively. Data records of 50 patients which had laparoscopic nephrectomy surgery and used intravenous (IV) morphine by Patient Controlled Analgesia (PCA) device for postoperative pain management was analysed. We divided patients in two groups; TAP and control. TAP group (n=25) include the patients which had applied TAP block before anesthesia induction in operating room and control group (n=25) include the patients which had not applied TAP block before induction. Intraoperative value of desflurane minimum alveolar concentration (MAC) and Fentanyl consumption were found significantly lower in TAP group (p<0,001). Postoperative pain scores (VAS 0-10) (0 minute, 30 minute, 2 hour, 4 hour, 8 hour and 12 hour) and IV morphine consumption with PCA device were found significantly low in TAP group (p<0,001). First time to use morphine with PCA in control group is also found to be less (p<0,001). Adverse effects such as vomiting, nausea and hypertension related with opioids were reported more frequently in control group (p<0,001). The satisfaction of patients and surgeons was higher in TAP group (p<0,001). As a result, applying TAP block on the patients that will have laparoscopic nephrectomy surgery, additional to general anesthesia, provides higher quality of postoperative pain management by reducing intraoperative anesthetic and analgesic drugs consumption.

Keywords:

Pain, Transvers Abominis Plane Block, Laparoscopic nephrectomy,

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