Antiinflamatory effect of bupivacaine transversus abdominis plan block in live liver donors

Aim: The liver transplantation is the only treatment for end-stage liver failure. Lack of sufficient organs from the cadaver to meet the organ needs has increased the interest in a live organ donor transplantation. Live organ donors; who are without any health problems are low-tolerance individuals for postoperative pain, expecting rapid recovery after anesthesia and surgery. A peripheral nerve block, tarnsversus abdominus plane block (TAP block); When combined with general anesthesia in live liver donors, it has been shown to significantly reduce perioperative and postoperative opioid consumption, provide shorter recovery time and shorten hospital stay. Immunological, metabolic and endocrine reactions occur due to tissue damage, pain and anesthesia caused by surgery. It has been shown that regional block techniques using local anesthetics and analgesic adjuvants modulate both local and systemic inflammatory reactions caused by surgical injury. Cytokines are important mediators of local and systemic inflammatory response including hyperalgesia after surgery. Cytokines are indispensable for wound healing and restoration of homeostasis, but usually the overactivity of either proinflammatory or anti-inflammatory cytokines damages the host. With Preemptive epidural analgesia, peripheral nerve block and thoracic epidural analgesia; postoperative pain and proinflammatory cytokines have been reduced. In literature, the effect of TAP block on anti-inflammatory cytokines in live liver donors was not shown. The aim of this study was to investigate the effect of bupivakine TAP block on antiflamatory response in live liver donors. Materials and Methods: This prospective clinical study was performed in 72 liver transplant donors aged 18-65 years, ASA score I-II, scheduled for right hepatectomy surgery. For Patients without premedication, after being taken to operating room bispectral index (BIS) and standard anesthesia monitoring were performed. Peripheral vascular access was opened and blood samples were taken for preopertive cytokine and bupivacaine measurements. Anesthesia was induced with 2-3 mg / kg propofol and 1mg / kg fentanyl. Muscle relaxation was achieved with 0,6 mg / kg rocuronium. Arterial cannula was inserted and blood samples were taken during the study and invasive arterial blood pressure was performed. The patients who underwent standard general anesthesia were determined as Group 1, and those who underwent TAP block after standard general anesthesia were determined as Group 2. All TAP blocks were performed immediately after induction and just before the surgical incision. The block was applied in-plane with a 22 G 80 mm needle and 1,5 mg / kg 0,5% bupivacaine + saline was injected into the abdominal wall bilaterally with 2 mL of 20 mL injectors. For cytokine measurement; preoperatively, 30 minutes after TAP block (30 minutes), 2nd hour (2nd hour), 6th hour (6th hour) and 24th hour postoperatively (24 hours) blood samples were taken. The primary aim of this study was to investigate the effect of TAP block on the inflammatory response by cytokine level. The secondary aim of this study was to determine the plasma bupivakin concentrations in patients undergoing TAP block and to investigate the relationship between plasma bupivakan level and cytokine levels. Serum IL-1β, IL-6 and TNF-α levels were determined by enzyme-linked immunosorbent assay (ELISA). Bupivacaine concentrations in plasma were measured using HPLC method in IU Faculty of Pharmacy Department of Analytical Chemistry. Results: Demographic data of the groups were similar. There was no difference between Group 1 cytokine levels and Group 2 cytokine levels. When the cytokine levels of Group 1 were evaluated within the group; There was a difference between IL-1 preop value, 30th minute, 2nd hour, 6th hour and 24 hours. When IL-6 preoperative cytokine level was compared with the cytokine values of other measurement periods, a significant difference was observed except the cytokine value at 30 min. Preoperative TNF-α values were found to be different when compared with other measurement periods. In the comparison of cytokine levels of Group 2; There was a significant difference between preoperative IL-1 levels and other measurement periods (except the 2nd hour measurement). The preoperative IL-6 value was different compared to all other measurement periods (except 30 min IL-6). When preoperative TNF-α levels were compared with the other measurement periods, there was a difference between all periods. The correlations of cytokine levels studied simultaneously with plasma bupivacaine were as follows. There was no correlation between bupivacaine at 30 minutes and cytokine levels at 30 minutes. There was a moderate positive correlation between bupivacaine levels measured at 2 hours and IL-1 and IL-6 levels at 2 hours. However, there was no correlation between TNF-α. There was a slight positive correlation between bupivacaine measured at 6 h and IL-1, IL-6 and TNF-α measured at 6 h. There was a positive moderate correlation between bupivakine measured at 24 h and IL-1, IL-6 and TNF-α levels at 24 h. Concentrations of bupivacaine in all measures were found to be below the toxic dose level of local anesthesia. Conclusion: It was observed that bupivacaine-administered TAP block had no effect on inflammatory endocrine response (cytokine level) in live liver donors undergoing right hepatectomy. In addition, plasma bupivacaine levels were demonstrated for the first time after TAP block in live liver donors. Keywords: Live liver donors, Bupivacaine, Transversus abdominis plan block, Inflammatıon, IL-1, IL-6, TNF-α