Effect of TAP Block for Postoperative Pain Control After Varicocele Operations.
Condition: Varicocele
MeSH terms: Varicocele; Pain, Postoperative
Study type: Interventional

Summary: 
      TAP block is the administration of local anesthetic agents into the anatomic neurofascial
      cavity between the internal oblique and transversus abdominis muscle in the antero-lateral
      region of the abdomen to block the anterior branches of the thoracic intercostal (T7-T12) and
      first lumbar (L1) nerves. TAP block may be a good method for postoperative pain control. We
      aim to show the effect of TAP block administration on analgesic consumption after
      varicocelectomy operations, side effects linked to analgesic use and analgesic quality.
    

Detailed description: 
      The study will include 50 patients aged from 18-45 years in ASA I-II risk group undergoing
      varicocelectomy operations under elective conditions, randomized with a lottery method.
      Patients will be informed of the study and included in the study after giving permission with
      a patient consent form. Patients will be divided into two groups; TAP group (Group T, n=25)
      and P (Group P, n=25). Both groups will be taken for operation under spinal anesthesia. Those
      with contraindications for spinal anesthesia, with coagulopathy, with known allergy to the
      medications used, with infection in the operated area, and those who do not volunteer will be
      excluded from the study. At the end of the operation, patients in Group T in the supine
      position will have a USI probe placed at the middle point between the costal edge and iliac
      crest (within the Petit triangle) after necessary antiseptic conditions are ensured. Then
      after the abdominal muscle layers are observed, the needle tip will be advanced through the
      muscle layers and pass the fascia, feeling the fascial click, monitored by USI in controlled
      fashion. After feeling the second click (passing the internal oblique muscle fascia), a test
      dose of 0.5-1 ml saline will be administered to determine the localization of the needle tip.
      Then noting the location, with frequent aspiration local anesthetic agent will be
      administered to the neurofascial plane for TAP block. Patients in Group P will have adjuvant
      added to spinal anesthesia. Patients in both groups will have pain scores assessed at 2, 4,
      6, 12 and 24 hours postoperative at rest and coughing with VAS (visual analog scale) (pain
      severity: 0 no pain to 10 most severe pain experienced to date) and values will be recorded.
      When patients are in pain, analgesic agent will be administered according to patient
      controlled analgesia protocol. The time of first requirement for analgesic agent and the
      amount of analgesic agent used in 24 hours will be recorded for patients. Side effects like
      postoperative nausea, vomiting, or itching will be noted. Additionally, patient satisfaction
      will be assessed by asking if the surgical method they experienced was bad, moderate, good or
      very good and recorded.
    

Intervention name(s): TAP block group (Group T); spinal anesthesia
Intervention type(s): Procedure; Procedure
Intervention description(s): At the end of the operation, patients in Group T in the supine position will have a USI probe placed at the middle point between the costal edge and iliac crest (within the Petit triangle) after necessary antiseptic conditions are ensured. Then after the abdominal muscle layers are observed, the needle (Stimuplex Ultra 22G, 100mm, B.Braun, Germany) tip will be advanced through the muscle layers and pass the fascia, feeling the fascial click, monitored by USI in controlled fashion. After feeling the second click (passing the internal oblique muscle fascia), a test dose of 0.5-1 ml saline will be administered to determine the localization of the needle tip. Then noting the location, with frequent aspiration local anesthetic agent will be administered to the neurofascial plane for TAP block.; Patients in Group P will have adjuvant added to spinal anesthesia (25 G, Quincke spinal anesthesia needle, Egemen,Turkey).
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Varicocele; TAP block; spinal anesthesia