title: Analgesia and respiratory function after laparoscopic cholecystectomy in patients receiving ultrasound-guided bilateral oblique subcostal transversus abdominis plane block: a randomized double-blind study.
abstract: BACKGROUND
  Transversus abdominis plane (TAP) block has been shown to ameliorate postoperative pain after abdominal surgery. Postoperative pain-associated respiratory compromise has been the subject of several studies. Herein, we evaluate the effect of oblique subcostal TAP (OSTAP) block on postoperative pain and respiratory functions during the first 24 postoperative hours.
  
  
  METHODS
  In this double-blind, randomized study, 76 patients undergoing laparoscopic cholecystectomy were assigned to either the OSTAP group (n=38) or control group (n=38). Bilateral ultrasound-guided OSTAP blocks were performed with 20 ml 0.25% bupivacaine after induction of general anesthesia. Both the OSTAP and control groups were treated with paracetamol, tenoxicam, and tramadol as required for postoperative analgesia. Visual Analog Scale (VAS) pain scores (while moving and at rest), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), arterial blood gas variables, and opioid consumption were assessed during first 24 h.
  
  
  RESULTS
  VAS pain scores at rest and while moving were significantly lower in the OSTAP group on arrival to PACU and at 2 h postoperatively. The total postoperative tramadol requirement was significantly reduced at 0-2 h and 2-24 h in the OSTAP group. Postoperative deterioration in FEV1 and FVC was significantly less in the OSTAP group when compared to the control group (P<0.01 and P<0.05, respectively). There were no between-group differences in arterial blood gas variables.
  
  
  CONCLUSIONS
  After laparoscopic cholecystectomy, OSTAP block can provide significant improvement in respiratory function and better pain relief with lower opioid requirement.
authors.affiliation: Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Betul
authors.initials: B
authors.lastname: Basaran
authors.affiliation: Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Basaran
authors.affiliation: Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Betul
authors.initials: B
authors.lastname: Kozanhan
authors.affiliation: Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Ela
authors.initials: E
authors.lastname: Kasdogan
authors.affiliation: Department of General Surgery, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Eryilmaz
authors.affiliation: Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Sadik
authors.initials: S
authors.lastname: Ozmen
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000768:Anesthesia, General; D000779:Anesthetics, Local; D002045:Bupivacaine; D002245:Carbon Dioxide / Q000097:blood; D017081:Cholecystectomy, Laparoscopic; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D006801:Humans; D008787:Metoclopramide / Q000627:therapeutic use; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D010100:Oxygen / Q000097:blood; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000517:prevention & control; D012120:Respiration Disorders / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D012129:Respiratory Function Tests; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use; D018084:Ultrasonography, Interventional
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009294:Narcotics; D002245:Carbon Dioxide; D014147:Tramadol; D008787:Metoclopramide; D010100:Oxygen; D002045:Bupivacaine