Analgesia and Respiratory Function after Laparoscopic Cholecystectomy in Patients receiving Ultrasound-Guided Bilateral Oblique Subcostal Transversus Abdominis Plane Block: A Randomized Double-Blind Study
Betul Basaran, Ahmet Basaran, Betul Kozanhan, Ela Kasdogan, Mehmet Ali Eryilmaz, Sadik Ozmen
Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey
Med Sci Monit 2015; 21:1304-1312
Transversus abdominis plane (TAP) block has been shown to ameliorate postoperative pain after abdominal surgery. Postoperative pain-associated respiratory compromise has been the subject of several studies. Herein, we evaluate the effect of oblique subcostal TAP (OSTAP) block on postoperative pain and respiratory functions during the first 24 postoperative hours.
MATERIAL AND METHODS: In this double-blind, randomized study, 76 patients undergoing laparoscopic cholecystectomy were assigned to either the OSTAP group (n=38) or control group (n=38). Bilateral ultrasound-guided OSTAP blocks were performed with 20 ml 0.25% bupivacaine after induction of general anesthesia. Both the OSTAP and control groups were treated with paracetamol, tenoxicam, and tramadol as required for postoperative analgesia. Visual Analog Scale (VAS) pain scores (while moving and at rest), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), arterial blood gas variables, and opioid consumption were assessed during first 24 h.
RESULTS: VAS pain scores at rest and while moving were significantly lower in the OSTAP group on arrival to PACU and at 2 h postoperatively. The total postoperative tramadol requirement was significantly reduced at 0–2 h and 2–24 h in the OSTAP group. Postoperative deterioration in FEV1 and FVC was significantly less in the OSTAP group when compared to the control group (P<0.01 and P<0.05, respectively). There were no between-group differences in arterial blood gas variables.
CONCLUSIONS: After laparoscopic cholecystectomy, OSTAP block can provide significant improvement in respiratory function and better pain relief with lower opioid requirement.
Keywords: Analgesics - therapeutic use, Adult, Analgesics, Opioid - therapeutic use, Anesthesia, General, Anesthetics, Local, Bupivacaine, Carbon Dioxide - blood, Cholecystectomy, Laparoscopic, Combined Modality Therapy, Double-Blind Method, Metoclopramide - therapeutic use, Narcotics - therapeutic use, Nerve Block - methods, Oxygen - blood, pain management, Pain Measurement, Pain, Postoperative - prevention & control, Postoperative Nausea and Vomiting - prevention & control, Respiration Disorders - prevention & control, Respiratory Function Tests, Tramadol - therapeutic use, Ultrasonography, Interventional