Investigation of the efficacy of ultrasound-guided transversus abdominis plane (US-TAP) block and laparoscopy-guided transversus abdominis plane(LS-TAP) block on post-op analgesia in patients undergoing laparoscopic upper abdominal surgery

Objective: We aimed to investigate and compare the contribution and effectiveness of ultrasonography-guided TAP block and laparoscopy-guided TAP block in the postoperative analgesia management of patients undergoing laparoscopic upper abdominal surgery under general anesthesia. The study focused on evaluating the impact of the two different imaging methods on postoperative pain management during the initial 24 hours following the operation. Materials and Methods: Following ethical committee approval and obtaining written consent from patients, a total of 60 patients aged between 18-70 years, scheduled for laparoscopic upper abdominal surgery with American Society of Anesthesiology (ASA) preoperative physiological assessment scores I-III, were included in this prospective, randomized, double-blind study. The patients were divided into two groups. Anesthesia induction was provided in the same way for all patients. Prior to extubation, TAP block was performed with 30 ml of 0.5% bupivacaine and 10 ml of 2% lidocaine for both groups. After the operation, pain levels were recorded using the Numeric Rating Scale (NRS) system at 20-minute intervals during the first hour and subsequently at 1, 3, 6, 12, 18, and 24 hours. Additional parameters recorded included complications, length of hospital stay, time to first analgesic request, opioid consumption, paracetamol consumption, nausea and vomiting status, time to ambulation, and time to gas/stool passage. Results: The study included 60 patients (66.7% female) with a mean age of 48.45 ± 14.96 years. Comparison of NRS scores between the two groups at 20 minutes, 40 minutes, 3 hours, 12 hours, 18 hours, and 24 hours postoperatively showed no statistically significant differences. Statistically significant differences were observed in NRS scores at 1 hour and 6 hours between the groups; scores were higher in the LS-TAP group compared to the US-TAP group. We found that the length of hospital stay, complication rates, time to ambulation, time to first flatus/stool, the amount of consumed paracetamol, time to the first analgesic requirement, the need for additional analgesia, additional opioid requirements, and postoperative nausea/vomiting were similar. Conclusion: In laparoscopic upper abdominal surgeries, laparoscopic and ultrasound-guided TAP block applications can be used as part of multimodal analgesia to provide postoperative analgesia. Keywords: Analgesia; Transversus Abdominis Plane Block; Ultrasonography; Laparoscopic; Cholecystectomy.