Ultrasound Guided Subcostal Transversus Abdominis Plane Versus Paravertebral Block in the Laparoscopic Cholecystectomy
Condition: Cholecystitis
MeSH terms: Cholecystitis
Study type: Interventional

Summary: 
      The investigators aimed to compare the effects of perioperative anesthesia consumption of
      ultrasound guided subcostal transversus abdominis plane and paravertebral block in
      laparoscopic cholecystectomy.
    

Detailed description: 
      Fifty patients aged 18 - 65 years, American Society of Anesthesiologists (ASA) I-II-III,
      scheduled for laparoscopic cholecystectomy were enrolled into the study. Patients were
      allocated into two groups to receive ultrasound guided subcostal transversus abdominis plane
      block (group T, n=25) or ultrasound guided paravertebral block (group P, n=25). In all
      patients; anesthesia was induced with iv propofol (2 mg.kg-1) and maintained with total
      intravenous anesthesia (TIVA) in a mixture of 50 % nitrous oxide and 50 % oxygen with a total
      gas flow rate of 4 L min-1. Neuromuscular relaxation was induced with iv rocuronium (0.5
      mg.kg-1). Propofol (2 mg / cc, 2-4 mg / kg / h) and remifentanil (13.3 mcg / cc, 1-3 mcg / kg
      / h) combination was used in TIVA. Propofol and remifentanil rates increased or reduced
      according to the patient's hemodynamic response. Prior to start surgery, ultrasound guided
      subcostal transversus abdominis plane or paravertebral block was performed in patients .

      Blood pressure, heart rate and peripheral oxygen saturation,TIVA consumption of 0, 5, 10, 15,
      30, 60 min were recorded for all patients.Before the end of surgery, tramadol was
      administered (2 mg / kg) for all patients.

      All patients were evaluated at postoperative 2th, 4th, 8th, 12th, 24th hours with; operation
      time, heart rate, blood pressure, peripheral oxygen saturation, visual pain scores (VAS),
      analgesic consumption, complications (hypotension, anaphylaxis, hematoma, IV injection,
      intra-abdominal organ injury, pneumothorax ) and patient satisfaction status were recorded.
      In the postoperative period if there is additional analgesic requirements (VAS≥4) tramadol 2
      mg.kg-1 was administered as IV. The first hour is needed analgesia were recorded.
    

Intervention name(s): USG guided Subcostal TAP block; USG guided Paravertebral Block
Intervention type(s): Procedure; Procedure
Intervention description(s): Ultrasonography Assisted Subcostal TAP blockage: In plane technique was applied and 22 G needle (BRAUN Stimuplex D Plus 0,71*50 mm 22G*2) was used. Intravascular injection was eliminated after the passage of rectus sheath by negative aspiration. 0,5-1 ml local anesthetic was applied directly to confirm the right place. 10 cc bupivacain ( 0,5 % Marcain flacon, Astra Zeneca, Sweeden) and 5 cc lidocaine was injected to the site. The same procedure was applied to the opposite site.
we investigated amount of TIVA during the operation, postoperative Visual Analog Scores and the time that the pain free time.; Ultrasonoraphy assisted Thoracic Paravertebral blockage application: In-plane or out-of-plane technique was used with stimuplex needle (BRAUN Stimuplec D Plus 0,71*50 mm 22 G* 2'', 15°). Popping sensation that was felt by the penetration of the internal intercostal membrane, guided to paravertebral space. Intravascular injection was eliminated by negative aspiration. 0,5 - 1 ml local anesthetic injection was administered to show the displacement of pleura downward that confirmed the place of the needle in the right place. Then 10 cc bupivacain (% 0.5 Marcaine® flacon, Astra Zeneca, Sweeden) and 5 cc lidocaine was injected to the site.
we investigated amount of TIVA during the operation, postoperative Visual Analog Scores and the time that the pain free time.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment