Retrospective Evaluation of Transvers Abominis Plane (TAP) Block Efficiency in Pain Control of Laparascopic Nephrectomy

Öz

Regional block techniques have important role in postoperative pain management of laparoscopic surgeries in multimodal strategy. We planned to evaluate the efficiency of TAP block in postoperative pain management in laparoscopic nephrectomy retrospectively. Data records of 50 patients which had laparoscopic nephrectomy surgery and used intravenous (IV) morphine by Patient Controlled Analgesia (PCA) device for postoperative pain management was analysed. We divided patients in two groups; TAP and control. TAP group (n=25) include the patients which had applied TAP block before anesthesia induction in operating room and control group (n=25) include the patients which had not applied TAP block before induction. Intraoperative value of desflurane minimum alveolar concentration (MAC) and Fentanyl consumption were found significantly lower in TAP group (p<0,001). Postoperative pain scores (VAS 0-10) (0 minute, 30 minute, 2 hour, 4 hour, 8 hour and 12 hour) and IV morphine consumption with PCA device were found significantly low in TAP group (p<0,001). First time to use morphine with PCA in control group is also found to be less (p<0,001). Adverse effects such as vomiting, nausea and hypertension related with opioids were reported more frequently in control group (p<0,001). The satisfaction of patients and surgeons was higher in TAP group (p<0,001). As a result, applying TAP block on the patients that will have laparoscopic nephrectomy surgery, additional to general anesthesia, provides higher quality of postoperative pain management by reducing intraoperative anesthetic and analgesic drugs consumption.

Anahtar Kelimeler

• Pain,Transvers Abominis Plane Block,Laparoscopic nephrectomy

Laparaskopik Nefrektomide Ağrı Kontrolünde Transvers Abdominis Plane (TAP) Blok Etkinliğinin Retrospektif Olarak İncelenmesi

Öz

Laparoskopik cerrahilerde, postoperatif ağrı yönetiminde uygulanan multimodal yaklaşımda rejyonal tekniklerin önemli bir yeri vardır. Bu çalışmada, laparoskopik nefrektomilerde Transvers Abdominis Plane (TAP) bloğun postoperatif ağrı yönetiminde etkinliğini retrospektif olarak değerlendirmeyi amaçladık. Laparoskopik nefrektomi cerrahisi geçirmiş, postoperatif analjezi için hasta kontrollü analjezi (HKA) ile iv morfin verilen 50 olgunun anestezi kayıtları incelendi. Operasyon odasında anestezi indüksiyonu öncesi TAP blok uygulanan (Grup TAP, n=25) ve uygulanmayan (Grup Kontrol, n=25) hastalar iki gruba ayrıldı. İntraoperatif desfluran MAK (minimum alveolar konsantrasyon) değerlerinin ve fentanil tüketiminin Grup TAP’de anlamlı olarak düşük olduğu bulundu (p<0,001). Postoperatif ağrı skorlarının (VAS 0-10) (0. dk, 30. dk, 2.sa, 4.sa, 8.sa ve 12. sa) ve postoperatif HKA yöntemi ile morfin tüketiminin Grup TAP’de anlamlı olarak düşük olduğu saptandı (p<0,001). HKA ile ilk morfin kullanma zamanının Grup kontrol’de daha kısa olduğu bulundu. (p<0,001). Bulantı-kusma ve hipertansiyon gibi opioidlerle ilişkili yan etkilere kontrol grubunda, TAP grubuna göre daha sık rastlandığı saptandı (p<0,001). Grup TAP’de hasta memnuniyetinin daha yüksek olduğu saptandı (p<0,001). Sonuç olarak, laparoskopik nefrektomi cerrahisi geçirecek olgularda preoperatif dönemde genel anesteziye ilave TAP bloğun uygulanması, intraoperatif anestezik ve analjezik tüketimini azaltarak daha kaliteli bir postoperatif ağrı yönetimi sağlamaktadır.

Anahtar Kelimeler

• AĞRI,TRANVERSUS ABDOMİNİS PLAN BLOĞU,LAPAROSKOPİK NEFREKTOMİ

Kaynakça

1. 1. White PF: The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg, 2005; 101: 15–22
2. 2. Loeser ID_ Agn Tedavisinin Gelecegi_ Erdine S. Agn_ Birinci basla Nobel tip kitapevleri, istanbul 2000; 1: L
3. 3. Ashburn MA, Caplan RA, Carr DB, et al. Practice guidelines for acute pain management in the perioperative setting_ An updated report by the American Society of Anesthesiologists task force on acute pain management Anesthesiology 2004;100: 1573-81.
4. 4. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged_ Anesth Analg 2003; 97: 534-40
5. 5. Sharma P, Chand T, Saxena A, Bansal R, Mittal A, Sbrivastava U_ Evaluation of postoperative analgesic efficacy of transversus abdominis plane block after abdominal surgery: A comparative study_ JNat Sci Bioi Med 2013; 4: 177-80.
6. 6. F.W. Abdallah, V.W. Chan, R. BrullTransversus abdominis plane block: a systematic review Reg Anesth Pain Med, 37 (2012), pp. 193-209
7. 7. Cansız KH, Yedekçi AE, Şen H, Özkan S, Dağlı G. The Effect of Ultrasound Guided Transversus Abdominis Plane Block for Cesarean Delivery on Postoperative Analgesic Consumption. Gulhane Medical Journal 2015; 57.2:121-4
8. 8. Erbabacan E, Kendigelen P, Koksal GM, et aL Comparison of Transversus Abdominis Plane Block and IV Patient-Controlled Analgesia after Lower Abdominal Surgery. Turk Anestezi ve Reanimasyon Dernegi 2015,43:24

9. 9. Kucur Tülübaş Evrim, Duman Erkan, Çetingök Halil, Demir Güray, Altun Dilek, Hergünsel Oya ve ark. Post-Op Analgesic Efficacy of Transabdominal Rectus Plexus Block with the aid of USG in Cesarean Section, istanbul Med J 2013; 14:271-5.
10. 10. Salman AE, Yetişir F, Yürekli B, Aksoy M, Yıldrım M, Kılıç M. The efficacy of the semi-blind approach of transversus abdominis plane block on postoperative analgesia in patients undergoing inguinal hernia repair: a prospective randomized double-blind study. Local and regional anesthesia 2013;6 :1
11. 11. Nomaqhawe M, Farai D. Madzimbamuto, and Samson Shurnbairerwa. Adding a transversus abdominis plane block to parenteral opioid for postoperative analgesia following trans-abdominal hysterectomy in a low resource setting: a prospective, randomised, double blind, controlled study. BMC research notes 2016; 9: 50.
12. 12. Kıtlık A, Erdogan MA, Ozgul U et al. Ultrasound guided transversus abdominis plane block for postoperative analgesia in live liver donors: a prospective, randomized, double-blinded clinical trial J Clin Anesth.2017 Feb;37:103-107
13. 13. Parikh BK, Waghmare VT, Shah VR, et al. The analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic donor nephrectomy: A randomized controlled study. Saudi J Anaesth. 2013 Jan;7(1):43-7
14. 14. Araújo AM, Guimarães J, Nunes CS, Couto PS, Amadeu E. Postoperative pain after trocar placement infiltration against laparoscopic nephrectomy versus ultrasound transversus abdominis plane block: prospective study. Rev Bras Anestesiol. 2017 Sep - Oct;67(5):487-492
15. 15. Shaker TM, Carroll JT, Chung MH, Koehler TJ, Lane BR, Wolf AM, Wright GP. The efficacy and safety of transversus abdominis planar blocks versus thoracic epidural anesthesia in patients undergoing major abdominal oncologic resection: a prospective, randomized controlled trial. Am J Surg. 2018 Mar;215(3):498-501
16. 16. Kendall MC, Castro-Alves LJ. Transversus abdominis block (TAP) was compared with thoracic epidural analgesia: Are there any wins? Am J Surg. 2018 Jan 31
17. 17. Sahin L, Soydinc MH, Sen E, Cavus O, Sahin M. Comparison of three different regional block techniques in pediatric patients. Prospective randomized single-blind study. Saudi Med J. 2017 Sep;38(9):952-959.
18. 18. Park SY, Park JS, Choi GS, Kim HJ, Moon S, Yeo J. Comparison of analgesic efficacy of transversus abdominis plane block in laparoscopically assisted and ultrasound guidance after laparoscopic colorectal surgery: Randomize, Single Blind, Non-Inferiority Study. JAmCollSurg. 2017 Sep;225(3):403-410
19. 19. Petersen PL, Mathiesen O, Stjernholm P et aL The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair: a randomised clinical triaL Eur J Anaesthesiol2013;30: 415-21
20. 20. Freir NM, Murphy C, Mugawar M., Linnane A, Cunningham AJ. Transversus abdominis plane block for analgesia in renal transplantation: a randomized controlled trial. Anesth& Analg 2012;115.4:953-7.