Laparosc Endosc Surg Sci . 2018; 25(4): 133-139 | DOI: 10.14744/less.2018.27928

Effectiveness of transversus abdominis plane block for laparoscopic appendectomy in non-perforated acute appendicitis

Mehmet Aziret¹, Onur Palabýyýk², Kerem Karaman¹, Ali Muhtaroðlu¹, Enes Baþ¹, Volkan Öter¹, Metin Ercan¹, Fehmi Çelebi¹, Erdal Bostancý^3
1Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
²Department of Anesthesiology, Sakarya University Training and Research Hospital, Sakarya, Turkey
³Department of Gastroenterology Surgery, Health Sciences University, Ankara Yüksek Ýhtisas Hospital, Ankara, Turkey

INTRODUCTION: One of the most important goals in abdominal surgery is to reduce as much as possible the postoperative pain and increasing patients comfort. We aimed to assess the analgesic efficacy of the transversus abdominis plane block (TAP) in patients with non-perforated acute appendicitis undergoing laparoscopic appendectomy (LA).
METHODS: Seventy patients who underwent LA were divided retrospectively into two groups; the LA group (control group: n=39) and the LA group with TAP-block (treatment group; n=31). The present study was planned retrospectively but the data was collected prospectively. Groups were compared regarding age, gender, perioperative symptoms and signs, such as physical operation time, postoperative pain score (visual analogue scale = VAS), hospitalization period stay time, postoperative complications, and return to normal daily activity.
RESULTS: The mean VAS score in LA+TAP-block group was 3.1±2.1; 3.3±2.1; 3.9±2.3; 4.2±2.6 and 4.3±3 on the 0th; 2th; 6th; 16th and 24th hours and 4±1.5; 4.7±2.2; 6±2; 6.2±2 and 5.9±2 on the 0th; 2th; 6th; 16th and 24th hours in only LA group, respectively. Postoperative abdominal pain was significantly less in LA+TAP-block group than the LA group at 2th (p=0.01), 6th (p<0.01), 16th (p<0.001) and 24th (p=0.01) hours. Although, statistically not significant, TAP-block was associated with more quickly to return to normal daily activities.
DISCUSSION AND CONCLUSION: USG-guided TAP block can improve significantly postoperative abdominal pain during the first 24 hours in laparoscopic appendectomy performed patients.

Keywords: Appendectomy, laparoscopic; postoperative abdominal pain; transversus abdominis plane (TAP) block.

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Perfore olmayan akut apandisit nedeniyle laparoskopik appendektomi yapýlan hastalarda transversus abdominis plan bloðun etkinliði

Mehmet Aziret¹, Onur Palabýyýk², Kerem Karaman¹, Ali Muhtaroðlu¹, Enes Baþ¹, Volkan Öter¹, Metin Ercan¹, Fehmi Çelebi¹, Erdal Bostancý^3
1Sakarya Üniversitesi Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði, Sakarya Türkiye
²Sakarya Üniversitesi Eðitim ve Araþtýrma Hastanesi Anesteziyoloji Kliniði, Sakarya, Türkiye
³Saðlýk Bilimleri Üniversitesi Ankara Yüksek Ihtisas Gastroenteroloji Cerrahisi Kliniði Sakarya, Türkiye

GÝRÝÞ ve AMAÇ: Abdominal operasyonlarýn en önemli amaçlarýndan biri ameliyat sonrasý aðrýyý azaltarak hastanýn konforunu arttýrmaktýr. Bu çalýþmada amacýmýz, perfore olmayan akut apandisit nedeniyle laparoskopik appendektomi (LA) yapýlan hastalarda transversus abdominis plan bloðun (TAP-blok) analjezik etkinliðini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Çalýþmada, LA yapýlan yetmiþ hasta iki gruba ayrýldý; sadece LA grubu (kontrol grup: n= 39) ve LA ile birlikte TAP-blok yapýlan grup (tedavi grubu, n= 31). Çalýþma retrospektif planlandý ancak hasta verileri prospektif olarak tutuldu. Gruplar yaþ, cinsiyet, perioperatif ameliyat süresi, postoperatif aðrý skoru (visual analogue scale = VAS), hastanede kalýþ süresi, postoperative komplikasyonlar ve normal aktiviteye ve iþe dönüþ süreleri açýsýndan karþýlaþtýrýldý.
BULGULAR: Çalýþmamýzda, ortalama VAS skoru LA + TAP-blok yapýlan grupta 0., 2., 6., 16., ve 24. saatlerde sýrasýyla; 3.1±2.1, 3.3±2.1, 3.9±2.3, 4.2±2.6, 4.3±3 ve yalnýzca LA yapýlan grupta ayný saatlerde 4±1.5, 4.7±2.2, 6±2, 6.2±2 ve 5.9±2 birim olarak bulundu. Postoperatif aðrý deðerlendirmesinde TAP-blok yapýlan grupta hastalarýn aðrýlarý azdý ve bu istatiksel olarak anlamlýydý (2. Saat (P = 0.01), 6. saat (P < 0.01), 16. saat (P < 0.001) ve 24. saat (P = 0.01)). Çalýþmada TAP-blok yapýlan grupta normal aktiviteye dönüþ ve iþe baþlama süresi daha kýsaydý (P > 0.05).
TARTIÞMA ve SONUÇ: Laparoskopik appendektomi yapýlan hastalarda, USG eþliðinde yapýlan TAP-blok postoperative aðrýyý ilk 24 saatte azaltabilmektedir.

Anahtar Kelimeler: Laparoskopik appendektomi, postoperatif karýn aðrýsý, transversus abdominis plan (TAP) blok.

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