Akademik Veri Yönetim Sistemi
Journal of Clinical Anesthesia, cilt.34, ss.72-78, 2016 (SCI-Expanded)
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 20 mL of lidocaine (5 mg/mL). PCA with intravenous tramadol was routinely provided for all patients during the first 24 hours. 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 24 hours. 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.