الفهرس 
Laparoscopic abdominal surgery
Analgesic treatment after laparoscopic abdominalOnly 14 pages are availabe for public view
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Abstract
Laparoscopic surgery has better outcomes compared to those of open procedures in terms of short recovery time, less postoperative pain, better cosmetically, in some cases, less morbidity, decreased hospital stay and decreased overall cost of health care. Despite the brief recovery time and the generally good results, the effect of peritoneal irritation by the gas used for pneumoperitoneum leads to abdominal and referred postoperative pain. Perioperative pain management is very important as it has major role in reduction of stress response, reduction in postoperative morbidity, improving surgical outcome, facilitation of early rehabilitation and surgical recovery. Peripheral regional anesthetic techniques such as transversus abdominis plane (TAP) block are considered an attractive alternative to central blocks and IV analgesics. The TAP block is easy to be performed with different approaches and with few complications. Accurate placement of the local anesthetic drug through the needle and the potential damage to adjacent structures are main concerns in any landmark-based regional anesthetic technique and thus the transversus abdominis plane (TAP) block. Ultrasound guided and Laparoscopic assisted TAP block are both used to improve safety and block effectiveness as well as reduction of the complications. Aim of the work: Our study was done to compare between Ultrasound guided and Laparoscopic assisted transversus abdominis plane block for postoperative analgesia in laparoscopic abdominal surgery. Patients and methods: This study was approved by the Ethics Committee and was carried on sixty patients ASA I &II. Admitted to Tanta University Hospital in general surgery department for laparoscopic cholecystectomy. An informed written consent was obtained from the patient. The inclusion criteria included patients undergo elective laparoscopic cholecystectomy under general anesthesia with ASA physical status I or II. Exclusion criteria were Patient refusal, History of allergy to local anesthetics, Local infection at the site of injection, Patients with coagulopathies and patients with difficulty using VAS score. Patients were divided into 3 equal groups: group I (Control Group): Patients received standard general anesthesia and postoperative analgesia in the form of IV paracetamol 1 gm every 6 hours and rescue analgesic in form of morphine 2 mg IV group II(US): Patients received general anesthesia with bilateral US guided TAP block with 15ml bupivacaine 0.25 % on each side and postoperative analgesia in the form of IV paracetamol 1 gm every 6 hours and rescue analgesic in form of morphine 2 mg IV. group III(Lap): Patients received general anesthesia with bilateral Laparoscopic assisted TAP block with 15ml bupivacaine 0.25 % on each side and postoperative analgesia in the form of IV paracetamol 1 gm every 6 hours and rescue analgesic in form of morphine 2 mg IV. Measurements: Intra and postoperative vital signs (heart rate and mean arterial blood pressure), postoperative pain (using 10 point visual analogue scale (VAS) where (0) no pain and (10) most intense pain), time for first postoperative required analgesia and 24-hour morphine consumption were measured in the 3 groups immediately after full recovery of anesthesia, 1h , 2h , 4h ,6h, 8h, 12hr&24hr postoperatively . Results: As regard to intraoperative hemodynamic changes, in this study the mean values of heart rate and mean arterial blood pressure were significantly lower in group (US) and group (Lap) than group C at 45, 60min and end of surgery. There was no significant difference between group (US) and group (Lap). As regard to postoperative hemodynamic changes, in this study the mean values of heart rate and mean arterial blood pressure were significantly lower in group (US) and group (Lap) compared to group (C) after recovery at 2, 4 and 12 hours. There was insignificant difference in changes of mean values of heart rate and mean arterial blood pressure between group (US) and group (Lap). As regard to postoperative Pain assessment in this study, it was evaluated by using VAS (primary outcome), VAS in group US was lower than that of group C significantly immediately after recovery, at 1, 2, 4 and 12 hours after recovery. Also VAS in of group (Lap) was lower than that of group (C) significantly immediately after recovery, at 1, 2, 4 and 12 hours after recovery. There was no significant deference between VAS in group (Lap) and group (US). The results showed nonsignificant increase in VAS in group (Lap) than group (US) at 4, 8 and 12 hours postoperatively despite of giving TAP block after trocar insertion and pneumoperitoneum in Lap group while, in US group TAP block was given before any surgical stimulation. As regard to postoperative analgesic requirements, the mean time to the first request of morphine (secondary outcome) was longer in groups (US) and (Lap) than in group (C). There was no significant deference between group (Lap) and group (US).The total amount of postoperative morphine consumption (secondary outcome) in group (US) and group (Lap) were lower than that in group (C). There was no significant deference between group (Lap) and group (US). As regard to postoperative nausea and vomiting, our results showed that its incidence was lower in group (US) and group (Lap) than group (C) but it didn’t reach significant values. The incidence of other complications like (bowel hematoma, liver laceration, abdominal organ injury and transient femoral nerve palsy) was nil in this study. This can be explained by under vision introduction of needle in both techniques.