Ultrason rehberliğinde transversus abdominis plane(us-tap) bloğu ve laparoskopi rehberliğinde transversus abdominis plane(ls-tap) bloğunun laparoskopik üst batın cerrahisi uygulanan hastalarda post-op analjezi üzerine etkinliklerinin araştırılması
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
T.C. Maltepe Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Laparoskopik üst batın cerrahisi uygulanan hastalarda genel anestezi altında, ultrasonografi rehberliğinde TAP blok ve laparoskopi rehberliğinde TAP blok uygulamasının operasyon sonrası ilk 24 saatte hastanın analjezi yönetimine katkısını değerlendirmeyi ve her iki yöntemin etkinliklerini kıyaslamayı amaçladık. Materyal ve Metot: Çalışma; etik kurul onayı alındıktan sonra, hastalardan yazılı onam alınarak, genel cerrahi kliniği tarafından laparoskopik üst batın cerrahisi planlanan, American Society of Anesthesiology (ASA) preoperatif fizyolojik değerlendirme skoru I-III olan, 18-70 yaş aralığında 60 hasta dahil edilerek yürütüldü. Çalışma; çift kör, prospektif, randomize olarak planlandı. Hastalar iki gruba ayrıldı. Tüm hastalara anestezi indüksiyonu aynı şekilde uygulandı. İki gruba da ekstübasyon öncesi; 30 ml %0,5 bupivakain ve 10 ml %2 lidokain ile TAP blok uygulandı. Operasyon bitiminde hastalar ekstübe edilip, derlenme odasına alındıkları andan itibaren ilk 1 saat boyunca 20 dakika ara ile, takiben ise 1.-3.-6.-12.-18.-24. saatlerde ağrı düzeyleri Numeric Rating Scale (NRS) sistemi ile belirlenerek kayıt altına alındı. Komplikasyon gelişip gelişmediği, hastanede kalış süresi, ek analjezik ihtiyacı ve ne zaman uygulandığı, opioid tüketimi, tüketilen parasetamol miktarı, bulantı ve kusma durumu, ayağa kalkma süresi ve gaz/gaita çıkış süresi kaydedildi. Bulgular: Çalışmaya dahil edilen 60 hastanın (%66,7 kadın) yaş ortalaması 48,45±14,96 yıldır. Her iki grup karşılaştırıldığında; postoperatif NRS skorlarında, 20.dakika, 40.dakika, 3.saat, 12.saat, 18.saat ve 24.saat ağrı düzeyleri istatistiksel olarak anlamlı farklılık göstermemektedir. Gruplar arasında; 1.saat ağrı düzeyleri ve 6.saat ağrı düzeyleri incelendiğinde istatistiksel olarak anlamlı farklılık saptanmış olup; L-TAP grubunun ağrı skorları U-TAP grubundan yüksek bulunmuştur. Hastanede kalış süresi, komplikasyon gelişimi, ayağa kalkma süresi, gaz/gaita çıkış süresi, tüketilen parasetamol miktarı, ek analjezik ihtiyacı ve ne zaman uygulandığı, ek opioid ihtiyacı ve postoperatif bulantı ve kusma parametrelerinin benzer olduğunu saptadık. Sonuç: Laparoskopik üst batın cerrahilerinde, laparoskopi veya ultrasonografi eşliğinde TAP blok uygulamaları, postoperatif analjezi yönetiminde multimodal analjezinin parçası olarak kullanılabilirler.
Objective: We aimed to investigate and compare the contribution and effectiveness of ultrasonography-guided TAP block and laparoscopy-guided TAP block in the postoperative analgesia management of patients undergoing laparoscopic upper abdominal surgery under general anesthesia. The study focused on evaluating the impact of the two different imaging methods on postoperative pain management during the initial 24 hours following the operation. Materials and Methods: Following ethical committee approval and obtaining written consent from patients, a total of 60 patients aged between 18-70 years, scheduled for laparoscopic upper abdominal surgery with American Society of Anesthesiology (ASA) preoperative physiological assessment scores I-III, were included in this prospective, randomized, double-blind study. The patients were divided into two groups. Anesthesia induction was provided in the same way for all patients. Prior to extubation, TAP block was performed with 30 ml of 0.5% bupivacaine and 10 ml of 2% lidocaine for both groups. After the operation, pain levels were recorded using the Numeric Rating Scale (NRS) system at 20-minute intervals during the first hour and subsequently at 1, 3, 6, 12, 18, and 24 hours. Additional parameters recorded included complications, length of hospital stay, time to first analgesic request, opioid consumption, paracetamol consumption, nausea and vomiting status, time to ambulation, and time to gas/stool passage. Results: The study included 60 patients (66.7% female) with a mean age of 48.45 ± 14.96 years. Comparison of NRS scores between the two groups at 20 minutes, 40 minutes, 3 hours, 12 hours, 18 hours, and 24 hours postoperatively showed no statistically significant differences. Statistically significant differences were observed in NRS scores at 1 hour and 6 hours between the groups; scores were higher in the LS-TAP group compared to the US-TAP group. We found that the length of hospital stay, complication rates, time to ambulation, time to first flatus/stool, the amount of consumed paracetamol, time to the first analgesic requirement, the need for additional analgesia, additional opioid requirements, and postoperative nausea/vomiting were similar. Conclusion: In laparoscopic upper abdominal surgeries, laparoscopic and ultrasound-guided TAP block applications can be used as part of multimodal analgesia to provide postoperative analgesia.
Objective: We aimed to investigate and compare the contribution and effectiveness of ultrasonography-guided TAP block and laparoscopy-guided TAP block in the postoperative analgesia management of patients undergoing laparoscopic upper abdominal surgery under general anesthesia. The study focused on evaluating the impact of the two different imaging methods on postoperative pain management during the initial 24 hours following the operation. Materials and Methods: Following ethical committee approval and obtaining written consent from patients, a total of 60 patients aged between 18-70 years, scheduled for laparoscopic upper abdominal surgery with American Society of Anesthesiology (ASA) preoperative physiological assessment scores I-III, were included in this prospective, randomized, double-blind study. The patients were divided into two groups. Anesthesia induction was provided in the same way for all patients. Prior to extubation, TAP block was performed with 30 ml of 0.5% bupivacaine and 10 ml of 2% lidocaine for both groups. After the operation, pain levels were recorded using the Numeric Rating Scale (NRS) system at 20-minute intervals during the first hour and subsequently at 1, 3, 6, 12, 18, and 24 hours. Additional parameters recorded included complications, length of hospital stay, time to first analgesic request, opioid consumption, paracetamol consumption, nausea and vomiting status, time to ambulation, and time to gas/stool passage. Results: The study included 60 patients (66.7% female) with a mean age of 48.45 ± 14.96 years. Comparison of NRS scores between the two groups at 20 minutes, 40 minutes, 3 hours, 12 hours, 18 hours, and 24 hours postoperatively showed no statistically significant differences. Statistically significant differences were observed in NRS scores at 1 hour and 6 hours between the groups; scores were higher in the LS-TAP group compared to the US-TAP group. We found that the length of hospital stay, complication rates, time to ambulation, time to first flatus/stool, the amount of consumed paracetamol, time to the first analgesic requirement, the need for additional analgesia, additional opioid requirements, and postoperative nausea/vomiting were similar. Conclusion: In laparoscopic upper abdominal surgeries, laparoscopic and ultrasound-guided TAP block applications can be used as part of multimodal analgesia to provide postoperative analgesia.
Açıklama
Anahtar Kelimeler
Analjezi, Transversus abdominis plan blok, Ultrasonografi, Laparoskopi, Kolesistektomi, Analgesia, Transversus abdominis plane block, Ultrasonography, Laparoscopic, Cholecystectomy
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Özelsel, B. G. (2023). Ultrason rehberliğinde transversus abdominis plane(us-tap) bloğu ve laparoskopi rehberliğinde transversus abdominis plane(ls-tap) bloğunun laparoskopik üst batın cerrahisi uygulanan hastalarda post-op analjezi üzerine etkinliklerinin araştırılması / Investigation of the efficacy of ultrasound-guided transversus abdominis plane (us-tap) block and laparoscopy-guided transversus abdominis plane(ls-tap) block on post-op analgesia in patients undergoing laparoscopic upper abdominal surgery. (Yayımlanmamış Tıpta Uzmanlık Tezi). Maltepe Üniversitesi, Lisansüstü Eğitim Enstitüsü, İstanbul.
