COMPARISON OF INTRAOPERATIVE LOCAL ANESTHETIC APPLICATIONS IN POSTOPERATIVE PAIN MANAGEMENT IN LAPAROSCOPIC CHOLECYSTECTOMY PATIENTS
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 4

Summary: 
      Since 1987, laparoscopic cholecystectomy has become the standard procedure for gallbladder
      stones and lesions. Complications due to improvements in laparoscopy and increased surgical
      experience have decreased day by day, but there is still a problem in terms of postoperative
      pain management. Several pain management procedures have been tried to combat pain after
      laparoscopic cholecystectomy. The aim of this study is to decrease the length of hospital
      stay, to increase the comfort of the patient and to reduce the cost of treatment. Local
      anesthetic injection to port locations, intraperitoneal periportal local anesthetic injection
      ,Transversus Abdominis Plane Blok and without any local anesthetic application to the control
      group compared to the group's analgesic efficiency and to reduce the amount of analgesics
      needed, shorten the length of hospital stay and improve patient comfort.
    

Detailed description: 
      Laparoscopic cholecystectomy procedure will be performed in patients older than 18 years of
      age for the diagnosis of cholelithiasis. Laparoscopic cholecystectomy procedure will be
      performed.4 patients group will be formed Power: 0.80 and alpha: :0.05 The minimum number of
      samples determined for each group is n: 34 for each group. It will be determined. In our
      clinic, local anesthetic injections are performed routinely to the trocar areas in
      laparoscopic cholecystectomy operations. After endotracheal intubation at the beginning of
      the operation, after appropriate skin staining and sterile dressing, Transversus abdominis
      plane block (10 cc / 10 cc, 0.5% bupivacaine to the right and left transversus abdominis
      muscle regions) will be applied. to the second group local anesthetic injection (6 cc to
      subxiphoid and infraumbilical trocar sites, 4 cc instead of 2 cc, 0.5% bupivacaine solution)
      to be applied, in the third group intraperitoneal direct vision of the gallbladder
      area-periportal area under the direct injection of local anesthetic spraying process
      (percutaneous method injected into the periportal area 1: 1 diluted with 20 cc saline, 20 cc
      0.5% bupivacaine solution total 40 cc spraying will be applied. The fourth group will be the
      control group and any of these methods will not be applied, the operation time and
      peroperative complications (pouch perforation etc.) will be recorded. Paracetamol 1 g + 1 mg
      / kg tramadol IV will be applied to all four groups as standard before extubation. Visual
      analogue scale (VAS) will be applied to all patients in the postoperative period. If VAS> 3
      is still present, a dose of 1 mg / kg tramadol will be administered. Tenoxicam 1x1 IV will be
      applied to the patients on the 12th hour. All patients were postoperative; 1,2,4,6,12,24. VAS
      scores , patient satisfaction (0: never satisfied, 5: very satisfied) will be recorded. The
      group of patients will be determined according to the order of surgery. Pain scores of the
      patients will be performed by a physician who is not in the operation who does not know which
      group is taken. The patients included in the group will not be known to the patient by the
      pain scoring system and the study will be done as double blind. Patients will be randomized
      with this method.
    

Intervention name(s): Bupivacaine
Intervention type(s): Drug
Intervention description(s): In our study this local anesthetic agent will be applied for postoperative pain relief
Other intervention name(s): marcaine
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: 3 types of local anesthetic applying method will be compared
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: laparoscopic cholecystectomy; postoperative pain relief; local anesthetic