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


METHODS
A prospective, randomized, double-blinded clinical study.


METHODS
Operating room, postoperative recovery area, and ward.


METHODS
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.


METHODS
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.


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


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.
Department of Anesthesiology and Reanimation, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey. Electronic address: menekseoksar@gmail.com.
Menekse
M
Oksar
Department of Anesthesiology and Reanimation, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey. Electronic address: onurko@yahoo.com.
Onur
O
Koyuncu
Department of Anesthesiology and Reanimation, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey. Electronic address: adat63@gmail.com.
Selim
S
Turhanoglu
Department of General Surgery, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey. Electronic address: mhytemiz@yahoo.com.
Muhyittin
M
Temiz
Department of Anesthesiology and Reanimation, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey. Electronic address: cemiloran@gmail.com.
Mustafa Cemil
MC
Oran
D000009:Abdominal Muscles / Q000294:innervation; D000293:Adolescent; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010880:Piperidines / Q000008:administration & dosage; D011446:Prospective Studies; D000077208:Remifentanil; D014147:Tramadol / Q000008:administration & dosage; D018084:Ultrasonography, Interventional; D055815:Young Adult
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010880:Piperidines; D014147:Tramadol; D008012:Lidocaine; D000077208:Remifentanil
Laparoscopic cholecystectomy; Oblique subcostal transversus abdominis plane block; Transversus abdominis plane block