COMPARISON OF TRANSVERSUS ABDOMINIS PLANE BLOCK, LOCAL ANESTHETIC INJECTION TO THE PORT SITES AND INTRAPERITONEAL LOCAL ANESTHESIA APPLICATIONS IN POSTOPERATIVE PAIN MANAGEMENT IN PATIENTS WITH LAPAROSCOPIC APPENDECTOMY
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 4

Summary: 
      The most important determinant of the recovery in abdominal surgery is postoperative pain.
      Postoperative pain can be explained by 2 pathways connected to the peritoneum; The first is
      the parietal peritoneum, whose innervation is very rich and the other is the visceral
      peritoneum which is stimulated at the vagus level. Since 1950, they have been injecting local
      anesthetic for post-surgery pain. inflammation and peritoneal irritation are the most
      important factors of pain when acute appendicitis is diagnosed. . This increases the length
      of hospital stay and increases the cost of pain relief, and reduces patient satisfaction. The
      aim of this study is to evaluate the application of Transversus Abdominis Plane Block . local
      anesthetic injection to the port sites, intraperitoneal periappendiceal local anesthetic
      injection is compared with the control group without any local anesthetic application to
      investigate which group has more analgesic effectiveness and thus reduce the amount of
      analgesics needed postoperatively, hospitalization Shortening the duration of the patient and
      taking the patient comfort to the next level.
    

Detailed description: 
      Laparoscopic Appendectomy procedure will be performed in patients over 18 years of age who
      are hospitalized from the emergency department for acute appendicitis. 4 patient group will
      be established. The number of samples determined for Power: 0.80 and alpha: 0.05 was
      determined as minimum n: 28 for each group. Therefore, the groups will be determined to
      include 28 patients. In our clinic, local anesthetic injection to the trocar areas is
      routinely performed in laparoscopic appendectomy 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. local anesthetic injection to the
      pre-incision trocar sites (8 cc instead of infraumbilical trocar, 6 cc instead of the other 2
      trocar 20 cc 0.5% bupivacaine solution will be applied), following intraperitoneal direct
      visualization of the appendiceal region - local anesthetic spraying into the periappendiceal
      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, operation time and peroperative complications (appendiceal 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: acute appendicitis; postoperative pain relief; local anesthetic; laparoscopic appendectomy