Postoperative Pain Management, Postoperative Pain, Analgesia, Nerve Blocks, Cholecystectomy
Conditions
Keywords
postoperative pain, laparoscopic cholecystectomy, quadratus lumborum block, m-tapa block, abdominal wall blocks, postoperative analgesia
Brief summary
Comparison of Postoperative Analgesic Effects of M-TAPA and Anterior Quadratus Lumborum Blocks in Laparoscopic Cholecystectomies.
Detailed description
In trunk blocks, the interfascial area between the anterior abdominal wall or back muscles is targeted. Local anesthetics are used for this purpose. Since there is no blood circulation and vascularization in the interfascial areas, the absorption of local anesthetics is slow, providing long-lasting analgesia. Therefore, they are used as a part of multimodal analgesia. The effectiveness of trunk blocks can vary depending on the patient's anatomical differences and previous surgeries, but on average, analgesic effectiveness lasts for 8-12 hours. Sometimes analgesic effectiveness extending up to 24 hours has been reported. In laparoscopic cholecystectomy operations, pain plays a role in postoperative atelectasis, pneumonia due to atelectasis, prolonged hospital stay, and discharge. To reduce the use of opioids due to their side effects such as nausea, vomiting, itching, constipation, and addiction, opioid-free analgesia is applied, and regional techniques are used. Quadratus lumborum blocks and M-TAPA blocks have been safely and easily applied in abdominal surgery in recent years thanks to developments in trunk blocks and ultrasound technology, and they are frequently preferred.
Interventions
PROCEDUREanterior Quadratus lumborum block
Patients are placed in the lateral decubitus position. The area where the block will be applied is disinfected with povidine iodine. A convex ultrasound probe is placed on the midaxillary line above the iliac crest. By visualizing the transverse process adjacent to the psoas major and quadratus lumborum muscles, using the in-plane technique, using a 22 gauge 80 mm peripheral block needle after negative aspiration into the anterior layer of the thoracolumbar fascia anterior to the quadratus lumborum muscle muscle, 0.5-1 ml of serum After observing hydrodissection with physiological, 20 ml of 0.25% bupivacaine is injected. The same is done to the opposite side.
PROCEDUREM-TAPA BLOCK
In the M-TAPA block group, with the patient in the supine position, a linear high-frequency linear ultrasound (USG) probe is angled to visualize the inferior surface of the costochondral junction at the level of the 10th costochondral cartilage. Under sterile conditions, using the in-plane technique with a 22G 80 mm peripheral block needle, the needle is advanced posterior to the 10th costal cartilage by taking the lower edge of the cartilage in the sagittal plane as the midline. After hydrodissection with 2-3 ml isotonic saline to confirm the site, 20 ml of 0.25% Bupivacaine is administered under USG guidance. The same procedure is performed on the contralateral side as well.
Sponsors
Gaziosmanpasa Research and Education Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Inclusion Criteria: * scheduled for elective Laparoscopic chplecystectomy * Patients aged ≥18 years * American Society of Anesthesiologists physical status (ASA) Ⅰ-II
Exclusion criteria
ASA III-IV patient * local anesthetic allergy * Infection at the procedure site Body Mass Index \>35 kg/m2 Anticoagulant use with bleeding disorder Chronic analgesia and opioid use with mental and psychiatric disorders Contraindications to regional anesthesia several lung and heart disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total amount of opioid requirements | within 24 hours after the surgery | The total tramadol use of the patients in 24 hours will be recorded. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| rescue analgesia | within 24 hours after the surgery | The rescue analgesia requirement and time of the need of the rescue analgesia requirement |
Other
| Measure | Time frame | Description |
|---|---|---|
| intraoperative remifentanil consumption | during operation procedure] | The total remifentanil use to be used in the maintenance of 0.05-0.2 mcg/kg remifentanil will be recorded by titration according to the hemodynamic data of the intraoperative patients. |
| Visual Analogue Scale values | at 1st, 4th,8th 12th and 24th hours after the surgery] | Visual Analogue Scale is a scale of 0-10 cm in length, expressed by non-standard verbal descriptors (no pain-unbearable pain..) indicating the limits of pain intensity on both sides, horizontally or vertically. |
| side effects such as nausea, vomiting and shoulder pain | within 24 hours after the surgery | The incidence of postoperative side effects such as nausea, vomiting and shoulder pain will be evaluated.a |
Countries
Turkey (Türkiye)
Outcome results
None listed