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ULTRASOUND-GUIDED SUBCOSTAL AND POSTERIOR TAP BLOCK COMBINATION IN LAPAROSCOPIC BARIATRIC SURGERY
ESRA Academy. Tuncer Peker T. Sep 8, 2016; 138302; 0129 Topic: PROCEDURE BASED - EVIDENCE BASED RA AND PERIOPERATIVE ANALGESIA
Assoc. Prof. Tulay Tuncer Peker
Assoc. Prof. Tulay Tuncer Peker

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Abstract
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Background and Aims:

Despite its effectiveness below the level of T10 dermatome, posterior TAP block often fails to block areas above the umbilicus. Subcostal TAP block has been shown to provide adequate postoperative analgesia after upper abdominal procedures. We aimed to compare subcostal-posterior TAP block combination with subcostal TAP block regarding analgesic efficacy following laparoscopic bariatric surgery.

Methods:

Following ethical committee approval, forty morbidly obese patients of ASA physical status II-III undergoing laparoscopic bariatric surgery were allocated into two equal groups. Group I: subcostal TAP block; Group II: subcostal + posterior TAP block. They received 4 ml of 0.25 % bupivacaine to each trocar insertion site, 1 gr paracetamol, 100 mg tramadol and 0.1mg kg-1 morphine intravenously. In the recovery room, ultrasound guided TAP block was performed using 30 ml of 0.2 % bupivacaine for each injection point. Following TAP block, they received patient controlled analgesia with morphine. Pain intensity was assessed at rest and during coughing using VAS score before and just after TAP block, at 30 minutes and 2, 4, 6, 12 and 24 hours after TAP block. Morphine consumption and time to first morphine requirement, incidence of nausea and vomiting and patient satisfaction score were recorded.

Results:

In both groups, TAP block resulted in significant reduction in VAS scores. VAS scores, morphine consumption, time to first morphine requirement, the incidence of nausea and vomiting and patient’s satisfaction showed no difference between groups.  

Conclusions:

The combination of posterior and subcostal TAP blocks did not provide superior analgesia when compared to subcostal TAP block alone. 

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