HOW TO MANAGE POST-OPERATIVE PAIN AFTER LAPAROSCOPIC CHOLESYSTECTOMY? COMPARISON OF THREE DISTINCT APPROACHES: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY

Öz

Aim: Laparoscopic Cholecystectomy (LC) is one of the most performed surgeries in daily general surgery practice and inadequate pain relief following surgery is associated with prolonged hospital stay. Transverse abdominis plane block (TAPB), port site local anesthetic injection (PSLAI) and gallbladder bed local anesthetic spraying (GBLAS) account for a part of numerous pain management strategies. In this study, we aimed to compare post-operative pain after laparoscopic cholecystectomy in transverse abdominis plane block (TAPB), port site local anesthetic injection (PSLAI) and gallbladder bed local anesthetic spraying (GBLAS) approaches. Materials and Methods: 99 patients were randomized into 3 groups. Patient-Controlled Analgesia (PCA) was utilized, and total analgesic demand and dosage were recorded along with Numerical Rating Scale (NRS) values at post-operative (p.o) 2, 6, 12 and 24 hours. Results: At p.o 24 hours, there was no statistically significant difference between groups in terms of PCA readings. However, NRS values were significantly higher in PSLAI group compared to TAPB and GBLAS groups. Conclusion: This study is unique as it compares the three methods in a single trial. While GBLAS gains slightly more attention as it is associated with a shorter procedure, all three methods are viable and might even be combined. We believe this study will pave way for future randomized controlled trials (RCT) in this regard.

Anahtar Kelimeler

• Laparoscopic cholecystectomy
• Transverse abdominis plane block
• Port site local anesthetic injection
• Gallbladder bed local anesthetic spraying
• Pain management

LAPAROSKOPİK KOLESİSTEKTOMİ SONRASI POSTOPERATİF AĞRI NASIL YÖNETİLİR? ÜÇ FARKLI YAKLAŞIMIN KARŞILAŞTIRILMASI: PROSPEKTİF RANDOMİZE KONTROLLÜ BİR ÇALIŞMA

Öz

Amaç: Laparoskopik Kolesisektomi (LC), günlük genel cerrahi pratiğinde en çok yapılan ameliyatlardan biridir ve ameliyat sonrası ağrının giderilmesinin yetersiz olması, hastanede kalış süresinin uzamasıyla ilişkilidir. Transvers abdominis düzlem bloğu (TAPB), port bölgesi lokal anestezik enjeksiyonu (PSLAI) ve safra kesesi yatağı lokal anestezik püskürtme (GBLAS), çok sayıda ağrı yönetimi stratejisinin bir parçasını oluşturur. Bu çalışmada, transvers abdominis düzlem bloğu (TAPB), port bölgesi lokal anestezik enjeksiyonu (PSLAI) ve safra kesesi yatağı lokal anestezik püskürtme (GBLAS) yaklaşımlarında laparoskopik kolesisektomi sonrası postoperatif ağrıyı karşılaştırmayı amaçladık. Gereç ve Yöntem: 99 hasta 3 gruba randomize edildi. Hasta Kontrollü Analjezi (PCA) kullanıldı ve toplam analjezik talebi ve dozu, postoperatif (p.o) 2, 6, 12 ve 24 saatlerde Sayısal Derecelendirme Ölçeği (NRS) değerleri ile birlikte kaydedildi. Bulgular: Postoperatif 24. saatte gruplar arasında PCA açısından istatistiksel olarak anlamlı bir fark yoktu. Bununla birlikte, NRS değerleri PSLAI grubunda TAPB ve GBLAS gruplarına kıyasla anlamlı olarak daha yüksekti. Sonuç: Bu çalışma, tek bir denemedeki üç yöntemi karşılaştırdığı için benzersizdir. GBLAS, daha kısa bir prosedürle ilişkili olduğu için biraz daha fazla dikkat çekerken, her üç yöntem de uygulanabilir ve hatta birleştirilebilir. Bu çalışmanın, bu konuda gelecekteki randomize kontrollü çalışmaların (RCT) önünü açacağına inanıyoruz.

Anahtar Kelimeler

• Laparoskopik kolesistektomi
• Transvers abdominis düzlem bloğu
• Port bölgesi lokal anestezik enjeksiyonu
• Safra kesesi yatağı lokal anestezik püskürtme
• Ağrı yönetimi

Kaynakça

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