Abstract
Purpose
To compare the analgesic efficacy of unilateral subcostal transversus abdominis plane (TAP) block with local anesthetic infiltration, applied to the port site in patients undergoing laparoscopic cholecystectomy (LC).
Methods
Group T received a unilateral subcostal TAP block, group I received a local anesthetic infiltration at port sites, and group C was the control group. Groups T and I received 20 mL 0.25% bupivacaine. Intravenous patient-controlled analgesia with tramadol was similarly applied to all groups. Postoperative pain levels during rest and cough were evaluated using a numeric rating scale (NRS). Nausea and vomiting were evaluated using postoperative nausea vomiting scores (PONV) at 1, 3, 6, 12 and 24 h and tramadol consumption was also determined. Patient satisfaction was evaluated using a Likert-type scale.
Results
Postoperative resting NRS scores were lower in group T than the other groups at 1 h and 12 h (p = 0.007 and p = 0.016), while NRS values during cough were statistically significant at 1 h (p = 0.004). The 24‑h tramadol consumption was different: group T 229 ± 33 mg, group I 335 ± 95 mg, and group C 358 ± 66 mg (p < 0.001). The percentages of patients reporting that they would prefer the applied postoperative pain control method again were 83.3%, 62.5% and 70.8% in groups T, I and C, respectively (p = 0.118).
Conclusion
Unilateral subcostal TAP block was superior to local anesthetic infiltration at port sites after LC, in terms of low opioid consumption. Unilateral subcostal TAP block is recommended as part of a multimodal analgesic protocol.
Zusammenfassung
Ziel
Die analgetische Wirksamkeit der unilateralen subkostalen Transversus-abdominis-plane(TAP)-Blockade wurde mit der lokalen Port-site-Infiltrationsanästhesie bei laparoskopisch behandelten Patienten verglichen.
Methoden
Gruppe T erhielt eine einseitige subkostale TAP-Blockade, Gruppe I erhielt eine lokale Port-site-Infiltrationsanästhesie. Gruppe C war die Kontrollgruppe. Gruppe T und I erhielt 20 ml Bupivacain 0,25 %. Eine intravenöse patientengesteuerte Analgesie mit Tramadol wurde bei allen Gruppen angewendet. Das postoperative Schmerzniveau während Ruhe und Husten wurde mit dem numerischen Schmerzskala (NRS) bewertet: Übelkeit und Erbrechen wurden mit dem Postoperative Nausea and Vomiting Score (PONV) nach 1, 3, 6, 12 und 24 h bewertet und der kumulative Tramadolverbrauch wurde bestimmt. Die Patientenzufriedenheit wurde anhand der Likert-Skala bewertet.
Ergebnis
Die postoperativen NRS-Werte im Ruhezustand waren in Gruppe T nach der 1. und 12. Stunde niedriger als in den anderen Gruppen (p = 0,007, p = 0,016). Der NRS-Wert während des Hustens war nach der 1. Stunde statistisch signifikant (p = 0,004). Der 24-Stunden-Tramadolverbrauch der Gruppen war unterschiedlich, Gruppe T: 229 + 33 mg; Gruppe I: 335 + 95 mg und Gruppe C: 358 + 66 mg (p < 0,001). Der prozentuale Anteil der Patienten, die angaben, dass sie die angewandte postoperative Schmerzkontrollmethode wieder bevorzugen würden, betrug 83,3 %, 62,5 % und 70,8 % in den Gruppen T, I und C (p = 0,118).
Schlussfolgerung
Die unilaterale subkostale TAP-Blockade war der lokalen Port-site-Infiltrationsanästhesie an den Portstellen nach laparoskopischer Cholezystektomie in Bezug auf einen geringen Opioidverbrauch überlegen. Die Verwendung einer unilateralen subkostalen TAP-Blockade als Teil multimodaler Analgetikaprotokolle ist zu empfehlen.
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E. Arik, T. Akkaya, S. Ozciftci, A. Alptekin and Ş. Balas declare no financial or other conflicts of interest.
All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Arık, E., Akkaya, T., Ozciftci, S. et al. Unilateral transversus abdominis plane block and port-site infiltration. Anaesthesist 69, 270–276 (2020). https://doi.org/10.1007/s00101-020-00746-1
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DOI: https://doi.org/10.1007/s00101-020-00746-1
Keywords
- Laparoscopic cholecystectomy
- Unilateral transversus abdominis plane block
- Port-site infiltration
- Post-operative analgesia
- Opioid consumption