Laparoskopik kolesistektomi cerrahisinde perikondrial yaklaşımla modifiye torakoabdominal sinir bloğu: prospektif, randomize, kontrollü, çift kör bir çalışma

Abstract

Amaç: Laparoskopik kolesistektomi (LC) minimal invaziv olarak kabul edilmesine rağmen, postoperatif dönemde orta ila şiddetli ağrıya neden olabilir. Bu çalışma, LC sonrası postoperatif analjezi üzerine modifiye torakoabdominal sinir bloğu ile perikondriyal yaklaşımın (M-TAPA) etkilerini araştırmaktadır. Gereç ve Yöntemler: Hastalar iki gruba ayrıldı: Grup M (M-TAPA bloğu uygulanan hastalar) ve Grup C (blok uygulanmayan kontrol grubu hastalar). Birincil sonuç ölçütleri, postoperatif 0, 2, 4, 8, 12 ve 24 saatlerdeki ağrı skorlarıydı. İkincil sonuç ölçütleri, toplam kurtarıcı analjezik tüketimi, ilk kurtarıcı analjezik ihtiyacına kadar geçen süre, komplikasyonların (bulantı ve kusma) görülmesi ve hasta memnuniyetini içeriyordu. Bulgular: 24 saatlik postoperatif dönemde hem istirahat hem de hareket halindeki numerik derecelendirme ölçeği (NRS) skorlarının zamana bağlı değişimi değerlendirildiğinde, zaman*grup etkileşimi hem istirahat hem de hareket halindeki NRS skorları için istatistiksel olarak anlamlıydı (p<0.001 ve p<0.001, sırasıyla). Ameliyattan sonraki ilk 24 saatte tüketilen toplam tramadol miktarı Grup C'de daha yüksekti (220 (170-260) vs 70 (0-80); P<0.001). Grup C'deki tüm hastalara kurtarıcı analjezi uygulanırken, Grup M'deki 8 hastaya kurtarıcı analjezik uygulanmadı (p<0.005). Sonuçlar: Multimodal analjezi yaklaşımının bir bileşeni olarak M-TAPA kullanımı, opioid tüketimini azaltarak opioid kaynaklı yan etkilerin önlenmesine ve postoperatif hasta konforunun artmasına yardımcı olmaktadır.

Keywords

• laparoskopik kolesistektomi
• m-tapa
• multimodal analjezi
• numerik derecelendirme ölçeği

Modified thoracoabdominal nerve block with perichondrial approach in laparoscopic cholecystectomy surgery: a prospective, randomized, controlled, double-blind study

Abstract

Aim: Although laparoscopic cholecystectomy (LC) is considered minimally invasive, it can cause moderate to severe pain in the postoperative period. This study investigates the effects of modified thoracoabdominal nerve block with perichondrial approach (M-TAPA) on postoperative analgesia after LC. Material and Methods: The patients were divided into two groups: Group M (patients who received the M-TAPA block) and Group C (control group patients who did not receive the block). The primary outcome measures were the pain scores at 0, 2, 4, 8, 12, and 24 hours postoperatively. The secondary outcome measures included the total amount of rescue analgesic consumed, the time to first rescue analgesia, the occurrence of complications (nausea, and vomiting), and patient satisfaction. Results: When the change over time of the numerical rating scale (NRS) scores at 24 hours postoperative was evaluated for both rest and movement, the time*group interaction was statistically significant for NRS scores during both rest and movement (p<0.001 and p<0.001, respectively). The total amount of tramadol consumed within the first 24 hours after surgery was higher in Group C (220 (170-260) vs 70 (0-80); P<0.001). Rescue analgesia was administered to all patien ts in Group C; in Group M, 8 patients did not receive rescue analgesic (p<0.005). Conclusion: The use of M-TAPA as a component of a multimodal analgesia approach helps to reduce opioid consumption, thereby preventing opioid-related side effects and enhancing postoperative patient comfort.

Keywords

• laparoscopic cholecystectomy
• m-tapa
• multimodal analgesia
• numerical rating scale

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