Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy

• Published in: Journal of clinical anesthesia 2016-11, Vol.34, p.72-78
• Main Authors: Oksar, Menekse, MD, Koyuncu, Onur, MD, Turhanoglu, Selim, MD, Temiz, Muhyittin, MD, Oran, Mustafa Cemil, MD
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Muscles - innervation; Adolescent; Adult; Aged; Analgesia, Patient-Controlled; Analgesics; Analgesics, Opioid - administration & dosage; Anesthesia; Anesthesia & Perioperative Care; Anesthetics, Local - administration & dosage; Cholecystectomy; Cholecystectomy, Laparoscopic - adverse effects; Double-Blind Method; Female; Humans; Laparoscopic cholecystectomy; Laparoscopy; Lidocaine - administration & dosage; Male; Medical personnel; Middle Aged; Nerve Block - methods; Oblique subcostal transversus abdominis plane block; Pain; Pain Management - methods; Pain Measurement; Pain Medicine; Pain, Postoperative - prevention & control; Patients; Piperidines - administration & dosage; Prospective Studies; Surgery; Tramadol - administration & dosage; Transversus abdominis plane block; Ultrasonic imaging; Ultrasonography, Interventional; Young Adult
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.03.033

Abstract Objective To evaluate and compare intercostal-iliac transversus abdominis plane (TAP) and oblique subcostal TAP (OSTAP) blocks for multimodal analgesia in patients receiving laparoscopic cholecystectomy. Design A prospective, randomized, double-blinded clinical study. Setting Operating room, postoperative recovery area, and ward. Patients In total, 60 laparoscopic cholecystectomy patients (43 women, 17 men, American Society of Anesthesiologists grades I-II) were enrolled from the general surgery department of our tertiary care center. Intervention The patients were assigned to 1 of the 3 groups. Group 1 received TAP blocks (n = 20), group 2 received OSTAP blocks (n = 20), and group 3 patients were used as controls and received patient-controlled analgesia (PCA) only (n = 20). After the induction of anesthesia, blocks were performed bilaterally in study groups 1 and 2, using 20 mL of lidocaine (5 mg/mL). PCA with intravenous tramadol was routinely provided for all patients during the first 24 hours. Measurements The intraoperative use of remifentanil, postoperative visual analog scale (VAS) scores, demand for PCA, and total analgesic consumption were recorded. Main Results The patients in the control group had greater analgesic demands and analgesic consumption than did those in groups 1 and 2. However, patients in the OSTAP group had lower VAS scores than did those in groups 1 and 3. Results The demand for analgesia was greater in the control group than in groups 1 and 2. Moreover, lower VAS scores were recorded in the OSTAP group than in groups 1 and 3 and were positively correlated with total PCA consumption among all patients. However, postoperative VAS scores were negatively correlated with the total intraoperative consumption of remifentanil at 24 hours. Conclusions TAP and OSTAP blocks improved postoperative analgesia in patients receiving laparoscopic cholecystectomy, which resulted in lower VAS scores and reduction in total analgesic consumption.