Pain,Postoperative
Conditions
Keywords
M-TAPA, post-operative pain,, Total laparoscopyc histerectomy
Brief summary
The aim of the study is comparing the postoperative effects of ultrasound-guided Modified Perichondrial Approach to Thoracoabdominal Nerves (M-TAPA) block for postoperative pain control after total laparoscopic hysterectomy.
Detailed description
Pain is one of the most common problems seen in the postoperative period in patients who underwent total laparoscopic hysterectomy. Multimodal analgesia methods are used in postoperative pain management. Nerve blocks, which are an important component of multimodal analgesia, have an important place in postoperative analgesia management today. Local Anesthetic Infiltration at the Trocar Site is the most classical nerve block method that has been used for a long time as a part of multimodal analgesia in laparoscopic surgeries. Modified TAPA block applied with ultrasound guidance; It is a regional block affecting both the anterior and lateral branches of the thoracoabdominal nerves with a perichondrial approach. It is used in total laparoscopic hysterectomies.
Interventions
OTHERM-TAPA Block
M-TAPA block will administer ultrasound guided (Sonosite, Inc., Bothell, WA, USA) bilaterally by same anesthesiologist (E.E.) who had more than 10 years experience of regional anesthesia, before weaking from general anesthesia after the surgical procedure. A high-frequency (6-13 MHz) linear probe (HFL38) will be used to identify the transversus abdominis, internal oblique, and external oblique muscles on the costochondral angle in the sagittal plane at the 10th costal margin. In the midclavicular line, between the upper fascia of the transversus abdominis muscle and the lower fascia of the costochondral tissue, at the level of the 10th rib, 20 mL of 0.25 percent bupivacaine will be injected (arcus costarum). The same procedure will be followed on the other side.
OTHERTrocar site local anesthetic infiltration
At the end of surgery, infiltration analgesia will be applied to all trocar entry sites (4 port entries) by the surgeon with 10 ml of 0.25% bupivacaine (40 mL in total) without waking the patient.
Sponsors
Gulhane Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Ages 18-65 * Elective cases * ASA I-III functional status * Body mass index (BMI)\<35 * Total laparoscopic hysterectomy planned with general anesthesia * No contraindications for M-TAPA block to be applied * Cases that give written and verbal consent for participation in the study will be included.
Exclusion criteria
* Conversion to open surgery * Development of perioperative complications (due to surgery and/or anesthesia) * Coagulation disorder * Infection at the injection site * Allergy to local anesthesia * Those who used any painkillers in the preoperative 24 hours * Those who did not agree to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative total tramadol consumption for first 24 hours | Postoperative 24 hours | The intravenous PCA pump will be programmed to deliver a bolus of 20 mg tramadol with a lockout interval of 30 min and no baseline infusion (tramadol 500 mg in 100 mL SF |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain scores | at postoperative 0 (PACU), 1, 2, 4, 8, 12 and 24 hours | Pain will be assessed with visual analog score (VAS) in 2 different ways, at rest and with movement (VAS: 0, no pain; 10, worst pain imaginable). VAS scores will be recorded at postoperative 0 (PACU), 1, 2, 4, 8, 12 and 24 hours |
Countries
Turkey (Türkiye)
Outcome results
None listed