Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial

Ergin A., Aydin M. T., Ciyiltepe H., Karip A. B., Fersahoglu M. M., Ozcabi Y., ...Daha Fazla

INTERNATIONAL JOURNAL OF SURGERY, cilt.95, 2021 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 95
  • Basım Tarihi: 2021
  • Doi Numarası: 10.1016/j.ijsu.2021.106134
  • Dergi Adı: INTERNATIONAL JOURNAL OF SURGERY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
  • Anahtar Kelimeler: Laparoscopic cholecystectomy, Postoperative pain, Local anesthesia, Transversus abdominis plane block, Intraperitoneal anesthesia, ABDOMINIS PLANE BLOCK, DOUBLE-BLIND, INTRAPERITONEAL ROPIVACAINE, PRESSURE PNEUMOPERITONEUM, TAP BLOCK, RELIEF, APPENDECTOMY, ANALGESIA, EFFICACY, SURGERY
  • İstanbul Üniversitesi Adresli: Evet

Özet

Background: Laparoscopic cholecystectomy is a minimally invasive procedure that causes pain originating from parietal and visceral peritoneum. Many studies have been conducted to improve postoperative pain management and comfort of patients. Various methods such as local anesthetic injection (LAI) at trocar access points, intraperitoneal local anesthetic injection (IPLA), pneumoperitoneum pressure reduction, transversus abdominis plane block (TAPB), and reducing the number of trocars used during the operation were attempted to reduce postoperative pain. Methods: In this study, we compared LAI, TAPB and IPLA methods with the control group in which no local anesthetic was applied to reduce postoperative pain after laparoscopic cholecystectomy. We also demonstrated the effect of these methods on postoperative pain, need for additional analgesics, length of hospitalization, and patient satisfaction. Results: Overall, 160 patients aged 18-74 years who underwent laparoscopic cholecystectomy for cholelithiasis between October 2018 and August 2019 were included in the study and divided into four groups as follows: LAI group, TAPB group, IPLA group, and the control group without any intervention. Visual Analog Scale (VAS) values at 1, 2, 4, 6, 12, and 24 h in the control group were significantly higher than in the LAI, TAPB, and IPLA groups. Further, VAS values at 1, 2, 4, 6, 12, and 24 h in the IPLA group were significantly higher than in the LAI and TAPB groups. No significant difference was observed between the LAI and TAPB groups in terms of VAS values at 1, 2, 4, 6, and 24 h. VAS values at 12 h in the LAI group were significantly higher than in the TAPB group. Conclusions: Peroperative local anesthetic administration methods were more effective in preventing pain after laparoscopic cholecystectomy compared to the control group. In addition to reducing postoperative pain, these methods reduced the need for postoperative analgesics and increased patient satisfaction.