Özet:

Background: In this study, we aimed to contribute to the literature on increasing laparoscopic surgery rates and perioperative pain management of such patients by comparing bilateral tap block application performed with the help of usg in patients undergoing laparoscopic cholecystectomy, local anesthetic infiltration instead of port entry, and postoperative effects of preemptive dexketoprofen application. Materials and Methods: Our study was planned prospectively, after the approval of the local ethics committee of Gazi Yaşargil Training and Research Hospital, numbered 228, dated 08.01.2019. Pain severity was determined with the Visual Analogue Scale (VAS) and Numerik Pain Scale(NRS) used to evaluate the pain. The patients included in the study were randomly divided into 3 groups. General anesthesia was applied to all patients. Patients in Group1 received 50 mg dexketoprofen as a preemptive 30 minutes before surgical insertion. Local anesthetics were applied to the laparoscopic port entry sites determined before the surgical incision in Group2 patients and no additional analgesics were performed. Bilateral subcostal transversus abdominis plan block (TAP) was applied to the patients in Group3. Patients with a 20% increase in the mean arterial pressure in the maintenance of anesthesia compared to the baseline value were administered 1 mcg/kg iv fentanyl and recorded. Results: 94 patients were included in the study. 2 patients were excluded from the study due to morbid obesity (BMI>35) and 2 patients due to coagulopathy. 90 patients were divided into 3 groups and analyzed. Postoperative analgesia duration was 15.83±10.94 hours in Group1, 14.95±10.39 hours in Group2, 23.21±4.29 hours in Group3. The difference between the groups was found statistically significant. The number of patients with additional analgesic needs was 36.9%(n=11) Group 1, 46.9%(n=14) Group 2, and 3%(n=1) in Group3. The difference between the groups was found statistically significant. When the average amount of tramadol consumption per patient was compared in the first 24 hours postoperatively, it was found 55±90.11mg in Group1 92.5±145.5mg in Group2 13.33±73.0 mg in Group3. The difference between the groups was found statistically significant. When VAS scores were examined in the first 24 hours postoperatively, it was found statistically lower in Group3 at 30 min, 1,2,4,8 and 16 hours. Similar results were detected in all groups at 12 and 24 hours. Conclusions: As a result, the data we obtained in this study is that bilateral tap block application is a successful method in postoperative pain management in laparoscopic cholecystectomy surgeries.

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