Postoperatif Analjezi İçin Ultrason Kılavuzluğunda Transversus Abdominal Plan Bloğunun Laparoskopik Kolesistektomide Derlenme ve Postoperatif Hemodinamik Parametreler Üzerine Etkilerinin Değerlendirilmesi

Year 2022, Volume: 5 Issue: 2, 213 - 221, 31.08.2022

Öztürk Taşkın , Ayşe Yılmaz , Ufuk Demir

https://doi.org/10.36516/jocass.1113668

Abstract

Amaç: Laparoskopik kolesistektomi tüm dünyada oldukça yaygın hale gelmiştir. Laparoskopik işlemlerden sonra da şiddetli ağrı gelişebilir. Ameliyat sonrası ağrı birçok sistemde değişikliğe neden olabilir ve komplikasyon riskini artırabilir. Bu çalışmada, laparoskopik kolesistektomide ultrason eşliğinde yapılan Transversus Abdominis plan bloğunun derlenme ve postoperatif hemodinamik parametrelere etkisini değerlendirmeyi amaçladık.
Yöntemler: Hastalar postoperatif analjezi için parasetamol alanlar ve parasetamol ve TAP blok alanlar olarak 2 gruba ayrıldı. Hastaların postoperatif hemodinamik parametreleri, periferik oksijen satürasyonları, VAS skorları ve Aldrete Skorları hasta dosyalarından kaydedilerek karşılaştırıldı.
Bulgular: TAP bloklu hastalarda VAS skorları ve sistolik-diyastolik arter basınçları istatistiksel olarak anlamlı derecede düşüktü ve Modifiye Aldrete skorları ve oksijen satürasyonları istatistiksel olarak anlamlı derecede yüksekti.
Sonuç: Laparoskopik kolesistektomi yapılan hastalarda konvansiyonel analjezi yöntemlerine ek olarak USG ile uygulanan TAP bloğun postoperatif ağrı kontrolünü kolaylaştırdığını, daha stabil bir hemodinami sağladığını ve hem daha iyi hem de daha erken derlenme sağladığını gösterdik. Özellikle kardiyovasküler sistem bozukluğu olan hastalarda hem iyileşme hem de komplikasyon riski açısından avantaj sağlayacaktır.

Keywords

tap blok, rejyonel anestezi, transversus abdominis plan bloğu, laparoskopik kolesistektomi, postoperatif analjezi

Evaluation of the Effects of Ultrasound-Guided Transversus Abdominal Plane Block for Postoperative Analgesia on Recovery and Postoperative Hemodynamic Parameters in Laparoscopic Cholecystectomy

Abstract

Objectives: Laparoscopic cholecystectomy has become quite common all over the world. Severe pain may also develop after laparoscopic procedures. Postoperative pain can cause changes in many systems and increase the risk of complications. In this study, we aimed to evaluate the effect of ultrasound-guided Transversus Abdominis plane block on recovery and postoperative hemodynamic parameters in laparoscopic cholecystectomy.
Methods: The patients were divided into 2 groups as those who received paracetamol for postoperative analgesia and those who received paracetamol and TAP block. Postoperative hemodynamic parameters, peripheral oxygen saturations, VAS scores and Aldrete Scores of the patients were recorded from the patient files and compared.
Results: VAS scores and systolic-diastolic arterial pressures were statistically significantly lower and Modified Aldrete scores and oxygen saturations were statistically significantly higher in patients with TAP block.
Conclusion: We showed that in addition to conventional analgesia methods in patients who underwent laparoscopic cholecystectomy, TAP block applied with USG facilitates postoperative pain control, provides a more stable hemodynamics and both better and earlier recovery. It will provide an advantage in terms of both recovery and complication risk, especially in patients with cardiovascular system disorders.

Keywords

TAP Block, Regional anesthesia, Transversus Abdominis Plan Block, Laparoscopic cholecystectomy, Postoperative analgesia

References

• 1. Kaloo P, Armstrong S, Kaloo C, et al. Interventions to reduce shoulder pain following gynaecological laparoscopic procedures. Cochrane Database Syst Rev. 2019;1(1):CD011101.
• 2. Reisli R, Akkaya ÖT, Arıcan Ş, et al. Akut postoperatif ağrının farmakolojik tedavisi: Türk Algoloji-Ağrı Derneği klinik uygulama kılavuzu [Pharmachologic treatment of acute postoperative pain: A clinical practice guideline of The Turkish Society of Algology]. Agri. 2021;33(Suppl 1):1-51. 3. Ferguson MK. Preoperative assessment of pulmonary risk. Chest. 1999;115(5 Suppl):58S-63S.
• 4. Hall JC, Tarala R, Harris J, et al. Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery. Lancet. 1991;337(8747):953-956.
• 5. Kehlet H, Rung GW, Callesen T. Postoperative opioid analgesia: time for a reconsideration?. J Clin Anesth. 1996;8(6):441-445.
• 6. Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg. 2001;93(4):853-858.
• 7. Barczyński M, Herman RM. A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc. 2003;17(4):533-538.
• 8. Mouton WG, Bessell JR, Millard SH, et al. A randomized controlled trial assessing the benefit of humidified insufflation gas during laparoscopic surgery. Surg Endosc. 1999;13(2):106-108.
• 9. Akyol Beyoğlu Ç, Özdilek A, Erbabacan E, et al. Evaluation of the effects of subcostal transversus abdominis plane block on acute and subacute pain development following inguinal herniography: Randomized clinical study. Agri. 2018;30(3):123-129.
• 10. Netter FH. Abdomen Posterolateral Abdominal Wall. In: Netter FH, Editor. Atlas Of Human Anatomy Summit. New Jersey: The Ciba-Geigy Corporation; 1989. Pp. 231–240.
• 11. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89-91. 12. Foster MA, Taylor AE, Hill NE, et al. Mapping the Steroid Response to Major Trauma From Injury to Recovery: A Prospective Cohort Study. J Clin Endocrinol Metab. 2020;105(3):925-937.
• 13. Kim HY, Choi JB, Min SK, et al. A randomized clinical trial on the effect of a lidocaine patch on shoulder pain relief in laparoscopic cholecystectomy. Sci Rep. 2021;11(1):1052.
• 14. Chung JW, Kang KS, Park SH, et al. İntraperitonal CO etkisi 2 laparoskopik kolesistektomide ameliyat sonrası ağrı ile ilgili konsantrasyon. Ann Surg Tedavi Arş . 2017;93(4):181-185.
• 15. Altıparmak B, Korkmaz Toker M, Uysal AI, et al. Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: Randomized, controlled trial. J Clin Anesth. 2019;57:31-36.
• 16. Barazanchi AWH, MacFater WS, Rahiri JL, et al. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth. 2018;121(4):787-803.
• 17. Faiz SHR, Alebouyeh MR, Derakhshan P, et al. Comparison of ultrasound-guided posterior transversus abdominis plane block and lateral transversus abdominis plane block for postoperative pain management in patients undergoing cesarean section: a randomized double-blind clinical trial study. J Pain Res. 2017;11:5-9. Published 2017 Dec 19.
• 18. Khan KK, Khan RI. Analgesic Effect Of Bilateral Subcostal Tap Block After Laparoscopic Cholecystectomy. J Ayub Med Coll Abbottabad. 2018;30(1):12-15.
• 19. Shahait M, Lee DI. Application of TAP Block in Laparoscopic Urological Surgery: Current Status and Future Directions. Curr Urol Rep. 2019;20(5):20.
• 20. Alsadek W. M., Al-Gohari M. M., Elsonbaty M. I., et al. Ultrasound guided TAP block versus ultrasound guided caudal block for pain relief in children undergoing lower abdominal surgeries. Egyptian Journal of Anaesthesia, 2015, 31.2: 155-160.
• 21. Jain S, Kalra S, Sharma B, et al. Evaluation of Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Intraperitoneal Onlay Mesh Repair. Anesth Essays Res. 2019;13(1):126-131.
• 22. Conacher ID. Pain relief after thoracotomy. Br J Anaesth. 1990;65(6):806-812.
• 23. Kara H, Sahin N, Ulusan V, et al. Magnesium infusion reduces perioperative pain. Eur J Anaesthesiol. 2002;19(1):52-56.
• 24. Güven Aytac B., Aytaç İ., Lafçı A., et al. The effect of pain management in laparoscopic cholecystectomy on recovery parameters. TJCL. 2018; 9(3): 216-220.