Effects of Subcostal TAP Block and Local Anesthetic Infiltration After Laparoscopic Cholecystectomy
Condition: Postoperative Pain; Subcostal Transversus Abdominis Plane Block; Gall Bladder Disease
MeSH terms: Gallbladder Diseases; Urinary Bladder Diseases
Study type: Interventional

Summary: 
      Laparoscopic cholecystectomy surgery is an intra-abdominal surgery that is frequently used in
      the treatment of gallbladder-related pathologies. Compared to open surgery, the cost, the
      risk of bleeding, the risk of surgical site infection are lower, the need for hospitalization
      is shorter, and the recovery is rapid. Adequate pain relief is very important after
      laparoscopic cholecystectomy. Inadequate analgesia in post-operative period has been
      associated with pain-related cognitive dysfunction, atelectasis, thromboembolic events,
      increased surgery-related stress response, prolonged hospital stay, and chronic pain in
      patients. Acetaminophen, non-steroidal anti-inflammatory drugs, opioid analgesics,
      intraperitoneal washing, local anesthesia infiltration and various regional anesthesia
      techniques can be used for appropriate analgesia. Studies have shown that subcostal
      transversus abdominis block has good analgesic efficacy in laparoscopic cholecystectomy
      surgeries. In the perioperative and postoperative period, afferent nerve signals in the
      surgical incision area stimulate the hypothalamus, causing the release of CRH, arginine
      vasopressin, and cortisol depending on the size of the surgical procedure. Providing patients
      with appropriate postoperative analgesia reduces the release of the stress hormones cortisol
      and prolactin.

      In this study, the investigators are aiming to compare the post-operative analgesic affects
      and stress hormone responses of subcostal transversus abdominis plane block and local
      anesthetic infiltration in patients undergoing laparoscopic surgery. The study is planned to
      be prospective, randomized and single-blind.
    

Detailed description: 
      Laparoscopic cholecystectomy surgery is an intra-abdominal surgery that is frequently used in
      the treatment of gallbladder-related pathologies. With the widespread use of laparoscopic
      procedures, open surgery has been replaced by laparoscopic cholecystectomy. Compared to open
      surgery, the cost, the risk of bleeding, the risk of surgical site infection are lower, the
      need for hospitalization is shorter, and the recovery is rapid.

      Post-abdominal pain is carried by T6-L1 thoracolumbar nerves. Pain after laparoscopic
      cholecystectomy has both visceral and parietal components, and patients are generally more
      bothered by visceral pain after surgery. Visceral pain arises from intraperitoneal
      inflammation and increases with coughing, respiratory effort, and mobilization in the
      post-operative period, and inadequate analgesia in this period has been associated with
      pain-related cognitive dysfunction, atelectasis, thromboembolic events, increased
      surgery-related stress response, prolonged hospital stay, and chronic pain in patients.
      Acetaminophen, non-steroidal anti-inflammatory drugs, opioid analgesics, intraperitoneal
      washing, local anesthesia infiltration and various regional anesthesia techniques can be used
      for appropriate analgesia. Studies have shown that subcostal transversus abdominis block has
      good analgesic efficacy in laparoscopic cholecystectomy surgeries.

      In the perioperative and postoperative period, afferent nerve signals in the surgical
      incision area stimulate the hypothalamus, causing the release of CRH, arginine vasopressin,
      and cortisol depending on the size of the surgical procedure. Providing appropriate
      postoperative analgesia in patients decreased the release of stress hormones cortisol and
      prolactin.

      In this study, the investigators are aiming to compare the effects of subcostal transversus
      abdominis block and local anesthetic infiltration on postoperative analgesia and stress
      hormone response in patients who underwent laparoscopic cholecystectomy surgery. The study is
      planned to be prospective, randomized and single-blind.
    

Intervention name(s): Ultrasound guided subcostal transversus abdominis plane block; Wound site local anesthetic infiltration
Intervention type(s): Procedure; Procedure
Intervention description(s): After the induction of anesthesia, before the beginning of the operation, the subcostal transversus abdominis region is going to be detected under ultrasound guidance and 25-30 ml of 0.25% bupivacaine will be administered; After induction of anesthesia, before the beginning of the operation, a total of 20 ml of 0.25% bupivacaine is going to be infiltrated in equal doses to the four regions that will have trocar access
Intervention MeSH terms: Anesthetics; Anesthetics, Local
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Cholecystectomy, Laparoscopic; Subcostal Transversus Abdominis Plane Block; Analgesia; Cortisol; Prolactin