Postoperative Pain Difference for 'IV Paracetamol' and TAP Block' in Acute Cholecystitis
Postoperative Pain Difference for 'IV Paracetamol' and TAP Block' in Acute Cholecystitis
Patients with acute cholecystitis or pancreatitis due to gallstones benefit from emergency
 laparoscopic cholecystectomy (LC). Patients with emergency LC show improvement in their
 quality of life within one month compared to those treated. Delayed LC (after the acute phase
 has passed and recovered) and less time to work. This strategy reduces the risk of repeated
 admissions with more pain or pancreatitis. There are many studies on the effectiveness of the
 Elective LC and Transversus Abdominis Plan (TAP) Block on pain. However, a prospective study
 on the reduction of postoperative pain with emergency LC and TAP Block has not been carried
 out until now. This study will be conducted to evaluate the effectiveness of the TAP Block in
 patients undergoing emergency LC.
Patients to be included in the study will be selected from the group between the ages of 18
 and 70 who apply to general surgery and emergency outpatient clinics, depending on patient
 approval. All patients will be informed about the surgery and procedures to be performed.
 Patients who agree to participate in the study will be included in the study. The study will
 be carried out by 2 surgeons with 5 years of laparoscopic cholecystectomy (LC) experience.
 Adult patients presenting with acute cholecystitis who underwent emergency LC by one of the
 two surgeons will be included in the study. These two surgeons will be responsible for
 participant registration. Patients with fever greater than 3.37.2 ℃, including 1) a diagnosis
 of acute cholecystitis confirmed by hepatobiliary ultrasound, 2) a high leukocyte count (> 7
 × 109 / L), will be included in the study. Patients undergoing elective laparoscopic
 cholecystectomy (E-LC) and patients who are converted to an open procedure will be excluded
 from the study. Patients will be divided into two groups. In Group A, patients with emergency
 LC will be administered intravenously 1 gr vial of paracetemol in 30 minutes during the
 awakening phase. In Group B, the lateral part of the latissumus dorsi muscle attaches to the
 external lip of the iliac crest, behind the middle axillary line and the end is directed
 towards the cranial, firstly the external oblique muscle and fascia, then the internal
 oblique muscle and fascia, and after hydrodissection with saline physiological. 15-20 ml of
 local anesthetic agent (Bupivacaine 0.5%) will be injected bilaterally.

 Standard laparoscopic cholecystectomy will be applied in two groups. Nasogastric tube will be
 inserted after intubation in both groups and will be removed at the end of the operation.
 Age, height, weight, ASA score, body mass index, duration of surgery, complications,
 comorbidities, fever, leukocyte, CRP levels, ALT, AST, GGT, total bilirubin, direct bilirubin
 values will be recorded. Pulse, heart rate, systolic and diastolic pressures, Oxygen
 saturation (with a palimeter) will be recorded during surgery in both groups. VAS and VRS
 pain scoring will be done after surgery. VAS (Visuale analogue score) 0-10 cm and VRS (no
 pain in cough (score = 0); pain in cough, not in deep breathing (score = 1); pain in deep
 breathing, but not at rest (score = 2); at rest pain will be evaluated as mild (score = 3);
 pain at rest, severe (score = 4)). Evaluations will be made statistically between the two
 groups.
Inclusion Criteria:

 -  Acute stony cholecystitis

 -  Acute acalculous cholecystitis

 -  18-70 years old

 Exclusion Criteria:

 -  Open cholecystectomy