Evaluation of postoperative pain and complications in patients with and without transversus abdominis plane block in laparoscopic upper uri̇nary tract surgeries

AİM: Regional methods have an important place in the multimodal approach applied in postoperative pain management in minimally invasive surgeries. Transversus abdominis plane (TAP) block, which is one of these methods, has become very popular in recent years. We aimed to prospectively compare the postoperative pain status, drug use and side effects, and postoperative patient comfort in the ultrasound (USG) guided preoperative TAP block group and the control group without TAP block, in patients scheduled for laparoscopic upper urinary tract surgery. MATERIAL AND METHODS: Between November 2022 and June 2023 in our urology clinic, oriented and cooperative patients between the ages of 18-85 who are planned to have laparoscopic upper urinary system surgery due to kidney, ureter tumor or stone, kidney cyst, kidney atrophy, ureteropelvic stenosis, who agree to participate in the study, who do not have active infection. Patients with normal bleeding diathesis, non-pregnant, without severe comorbid diseases, obesity and previous abdominal surgeries were included in the study. The patients were randomly divided into two groups as the first 21 patients in the control group and the second 21 patients in the study group. Intravenous analgesic medication was administered to the control group instead of TAP block, depending on the postoperative pain status. After the induction of general anesthesia in the study group, unilateral TAP block was performed by the anesthesiologist under ultrasound guidance. Visual Analogue Scale (VAS) scores (1st, 2nd, 6th, 12th and 24th hours) were used for postoperative pain assessment. Patients with a VAS score of 4 and above were administered intravenously first tramadol and then paracetamol, respectively. The amount and types of analgesics used, side effects, fever, atelectasis, postoperative mobility, gas discharge, drain, discharge, hemogram, glomerular filtration rate (GFR) follow-up and possible complications were investigated prospectively. RESULTS: A total of 42 cases were included in the study. Of these patients, 16 were female and 26 were male. Age, gender, BMI, smoking rate, comorbid disease, type of diagnosis and treatment, side distribution, operation time did not differ significantly between the groups (p>0,05). We found that the 1st hour, 2nd hour, 6th hour, and 12th hour VAS scores were significantly lower (p<0,05) in the TAP group than in the non- TAP group. There was no significant difference (p>0,05) in the 24th hour VAS score. We found that the rate of Tramadol and Paracetamol use in the first 24 hours postoperatively in the TAP group was significantly (p<0,05) lower than the group without TAP. The rate of hypotension and the day of flatulence (intestinal activation) in the TAP group were significantly lower (p<0,05) than the group without TAP. CONCLUSION: In patients who will undergo laparoscopic upper urinary system surgery, the application of USG-TAP block in addition to general anesthesia in the preoperative period provides better patient comfort by reducing postoperative pain, analgesic consumption and preventing possible side effects. KEYWORDS: Minimally Invasive Surgery, Laparoscopic Urologic Surgery, TAP Block