Evaluati̇on of the effi̇cacy of usg gui̇ded transversus abdomi̇ni̇s plan (TAP) block after laparoscopi̇c sleeve gastrectomy

BACKGROUND AND AIM: Transversus abdominis Plan (TAP) block is become a common block that is used to reduce postoperative pain on anterior wall of the abdomen at abdominal surgery. The aim of our study is to invastigate Ultrasound-guided TAP block applications analgesic efficacy in patients with laparoscopic sleeve gastrectomy. Our hypothesis is, TAP block is part of postoperative multimodel analgesia and reduces postoperative analgesic consumption and VAS scores. MATERIALS AND METHODS: After obtaining ethical approval, between 18-65 years of age, ASA I-II, morbidly obese (BMI> 35), 48 patients, scheduled for laparoscopic sleeve gastrectomy enrolled to study. All patients underwent general anesthesia with propofol and ultiva ( remifentanyl) induction and maintenance of anesthesia was provided with TIVA. Immediately after the end of the operation before weaning , 24 patients randomized by sealed envelope, were applied USG guided TAP block with 1.5mg kg-1 dose of bupivacaine completed 20 ml with serum physilogic. All patient received trocar site local anesthetic infiltration with 0.5 mg kg-1 dose of bupivakain completed 20 ml with serum physilogic. All patients received 1 mg kg-1 tramadol after then taken to PACU followed for at least 30 minutes with iv PCA with tramadol (5 cc mg-1 tramadol, 4 cc bolus). Tramadol consumption and 30. min 2., 6., 12., 24. hour VAS scores and additional analgesic consumption were recorded. RESULTS: Sixteen (33.3%) men and 32 (66.7%) women ages range from 19 to 64, total 48 patient enrolled to study. The mean age of cases 37.54 ± 11.30 years. Cases were divided into two groups TAP and nonTap including 24 patients. According to the group of cases, there is no statistically significant difference between age , weight, height, BMI, corrected average weight and sex distribution, duration of anesthesia and surgery, total propofol and remifentanyl amount average during maintance of anesthesia. In nonTap group, total tramadol consumption at 30 minutes, 2 hours, 6 hours, 12 hours and 24 hours the bolus demands, bolus delivery, VAS-motion levels, VAS-resting levels, were statistically higher from the TAP group. There was no complications in either two groups. CONCLUSION: . In our study, both postoperative analgesic consumption and VAS scores were significantly lower in patients who underwent TAP-block. Ultrasound-guided TAP block is an effective and safe method of application in laparoscopic sleeve gastrectomy patients under general anesthesia and is part of the postoperative multimodal analgesia