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J Clin Anesth. 2016 Nov;34:72-8. doi: 10.1016/j.jclinane.2016.03.033. Epub 2016 May 2.

Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy.

Author information

1
Department of Anesthesiology and Reanimation, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey. Electronic address: menekseoksar@gmail.com.
2
Department of Anesthesiology and Reanimation, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey. Electronic address: onurko@yahoo.com.
3
Department of Anesthesiology and Reanimation, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey. Electronic address: adat63@gmail.com.
4
Department of General Surgery, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey. Electronic address: mhytemiz@yahoo.com.
5
Department of Anesthesiology and Reanimation, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey. Electronic address: cemiloran@gmail.com.

Abstract

OBJECTIVE:

To evaluate and compare intercostal-iliac transversus abdominis plane (TAP) and oblique subcostal TAP (OSTAP) blocks for multimodal analgesia in patients receiving laparoscopic cholecystectomy.

DESIGN:

A prospective, randomized, double-blinded clinical study.

SETTING:

Operating room, postoperative recovery area, and ward.

PATIENTS:

In total, 60 laparoscopic cholecystectomy patients (43 women, 17 men, American Society of Anesthesiologists grades I-II) were enrolled from the general surgery department of our tertiary care center.

INTERVENTION:

The patients were assigned to 1 of the 3 groups. Group 1 received TAP blocks (n=20), group 2 received OSTAP blocks (n=20), and group 3 patients were used as controls and received patient-controlled analgesia (PCA) only (n=20). After the induction of anesthesia, blocks were performed bilaterally in study groups 1 and 2, using 20mL of lidocaine (5mg/mL). PCA with intravenous tramadol was routinely provided for all patients during the first 24hours.

MEASUREMENTS:

The intraoperative use of remifentanil, postoperative visual analog scale (VAS) scores, demand for PCA, and total analgesic consumption were recorded.

MAIN RESULTS:

The patients in the control group had greater analgesic demands and analgesic consumption than did those in groups 1 and 2. However, patients in the OSTAP group had lower VAS scores than did those in groups 1 and 3.

RESULTS:

The demand for analgesia was greater in the control group than in groups 1 and 2. Moreover, lower VAS scores were recorded in the OSTAP group than in groups 1 and 3 and were positively correlated with total PCA consumption among all patients. However, postoperative VAS scores were negatively correlated with the total intraoperative consumption of remifentanil at 24hours.

CONCLUSIONS:

TAP and OSTAP blocks improved postoperative analgesia in patients receiving laparoscopic cholecystectomy, which resulted in lower VAS scores and reduction in total analgesic consumption.

KEYWORDS:

Laparoscopic cholecystectomy; Oblique subcostal transversus abdominis plane block; Transversus abdominis plane block

PMID:
27687350
DOI:
10.1016/j.jclinane.2016.03.033
[Indexed for MEDLINE]

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