As the number of obese patients increases, the number of surgeries performed for morbid-obese
is also increasing. Pain following bariatric surgery is highly troubling and can lead to
increased complication rate, decreased patient satisfaction rate, and prolonging the healing
process, increasing the risk of pulmonary complications and the incidence of deep vein
thrombosis. Since postoperative recovery is directly related to the severity and duration of
pain, it is imperative to reduce postoperative pain as early as possible. Many post-operative
methods have been suggested for patients undergoing laparoscopic surgery. Transversus
abdominis plane (TAP) block is a regional anesthesia technique routinely used to reduce
postoperative pain.
Quadratus lumborum block (QLB) and Transversus abdominis plane (TAP) blocks are regional
anesthesia techniques that are frequently used to reduce postoperative pain and are an
important part of the current analgesic regimen for many abdominal surgeries. Researchers are
doing these two blocks in our clinic to provide postoperative analgesia. The aim of our study
is to compare the effectiveness of TAP block and QLB block in postoperative pain control in
laparoscopic sleeve gastrectomy. Secondary outcomes evaluated in this study were to assess
postoperative nausea and vomiting (PONV), time to discharge, and patient satisfaction.
Many methods have been suggested to reduce postoperative abdominal wall pain, such as
instillation of local anesthetics at the site of entry, patient-controlled analgesia (PCA),
epidural catheterization, and the use of non-steroidal anti-inflammatory drugs (NSAIDS). It
is known that opioid analgesics against acute postoperative pain cause postoperative nausea
and vomiting (PONV) [3]. The mean incidence of PONV reported in the early postoperative
period in patients undergoing bariatric surgery ranges from 30% to 50% [4].
Transversus abdominis plane (TAP) block is a routinely used regional anesthesia technique to
reduce postoperative pain and is an important part of the current analgesic regimen for many
abdominal surgeries [5]. A multimodal approach to pain management, with various combinations
such as TAP blocks, local anesthetic infiltration and patient-controlled analgesia (PCA) has
been suggested as the optimal combination for laparoscopic bariatric surgery [6]. Quadratus
lumborum block (QLB) is one of the effective and routinely applied blocks in The primary aim
of our study is to compare the effectiveness of TAP block and QLB block in postoperative pain
control in laparoscopic sleeve gastrectomy. Secondary outcomes evaluated in this study were
to assess postoperative nausea and vomiting (PONV), time to discharge, and patient
satisfaction.
Method
Researchers planned to perform this study in a randomized controlled design in patients who
will undergo laparoscopic sleeve gastrectomy in the operating room of Biruni University
Hospital. After ethics committee approval, patients with BMI> 35 kg/m2, laparoscopic sleeve
gastrectomy, ASA I-III, general anesthesia will be applied and patients who agree to
participate in the study will be included. Patients younger than 18 years of age with
bleeding disorders (INR: 1.2, antithrombotic, antiaggregant drug use, hematological
disorders, etc.) that are contraindications for regional anesthesia, and those with infection
at the planned skin site, psychiatric or neurological disorders, and substance addictions,
will be excluded from the study.
Randomization of patients will be provided through a computer program (software). After
randomization, all patients will be brought to the operating room and then put to sleep with
the general anesthesia method researchers apply daily. After the patients are routinely
anesthesia administration TAP block will be applied to the 1st group, QLB block will be
applied to the 2nd group, and no intervention will be performed to the 3rd group as it is the
control group. Blocks will be performed with 0.25% bupivacaine under USG. PCA (patient
controlled analgesia) will be administered to all patients in the postoperative period to
provide analgesia. For rescue analgesia; If the VAS score of the patients reaches a level of
>4 and above in the postoperative period, an additional 2mg IV bolus of morphine will be
administered. In cases where it is not sufficient or it is needed again, it will be
intervened again with 2 mg morphine until 4 <VAS VAS score (Preop -Post op 1., 6., 12 and 24
hours) and Patient Satisfaction (Preoperative and 48 hours) (World Health Organization)
WHOQOL-BREF Quality of Life Assessment and analgesic consumption amount (Morphine
consumption) as evaluation parameters of the patients : Post op 1st, 6th, 12th and 24th
hours). It is planned to measure the effectiveness of the blocks by measuring the pain score
and patient satisfaction in the preoperative and postoperative periods, and by measuring the
amount of morphine consumed (in mg). In addition, it will be checked whether there is a
change in discharge times between the groups in all patients. If complications such as
postoperative nausea, vomiting, allergies, nerve damage and bleeding develop, they will be
recorded.
The required number of patients was determined by power analysis. In the calculation using
the data of Emile et al., if 15% change is expected according to the 1st Hour VAS value of
the TAP block [7]. Researchers plan a continuous study of response variables from matching
study subject groups. Previous data show that the difference of matched pairs is normally
distributed with a standard deviation of 1.3. If the true difference in the mean response of
the matched pairs is 0.72, Researchers would need to study 28 subjects per group to reject
the null hypothesis that this difference in response is zero with probability (power) 0.8.
The probability of Type I error associated with this test of the 'null hypothesis' is 0.05.
At least 84 patients for the three groups should be analyzed. Researchers plan to include 94
patients with a 10% probable dropout rate.
