"The Efficiency of Laparoscopic-assisted Transversus Abdominis Plane Block for Post-laparoscopic Cholecystectomy Pain
"The Efficiency of Laparoscopic-assisted Transversus Abdominis Plane Block for Post-laparoscopic Cholecystectomy Pain
Laparoscopic cholecystectomy (LC) is a minimally invasive surgical procedure that causes
 moderate pain in the early postoperative period. In this prospective randomized study, the
 efficacy of four-quadrant and two-quadrant laparoscopic-assisted transversus abdominis plane
 (LTAP) block on postoperative pain will be compared with that of only intravenous analgesia
 (SA) and port-site infiltration of local anesthetic (LA).

 Patients undergoing elective LC will be divided into four groups of 40 patients each using a
 randomization scale. The standard analgesia group will receive LTAP block with normal saline
 (NS) and port-site infiltration of NS, the LA group will receive LTAP block with NS and
 port-site infiltration of bupivacaine, while the four and two quadrant LTAP group will
 receive the block with bupivacaine and port-site infiltration of NS. Postoperative analgesia
 will be administered to all groups as a standard procedure. The patients' demographic data,
 postoperative 1, 3, 6, 12, and 24-hour visual analog pain (VAS) scores at rest and on cough,
 opioid requirement, presence of nausea and vomiting, and satisfaction scores will record in a
 standard form. The statistical analysis will be carried out using the SPSS software and the
 level of significance was set at p<0.05.
This prospective, randomized, controlled, observer and patient-blind study will be conducted
 by the General Surgery, Anesthesiology and Reanimation Departments of Private Medicabil
 Hospital in accordance with the Declaration of Helsinki and Good Clinical Practice
 Guidelines. Hospital ethics committee approval was obtained for the study and the study was
 conducted between january 2021 and april 2020. Informed consent for the study to be conducted
 will obtained from each patient.

 Study Inclusion and Exclusion Criteria The study will included American Society Anesthesia
 (ASA) 1 and 2 patients aged 18-70 years who underwent conventional four-quadrant LC.

 Exclusion criteria:

 1. Patients who did not agree to participate in the study,

 2. ASA 3 and above patients, those who will undergone emergency surgery, open
 cholecystectomy

 3. BMI of >40,

 4. İntraoperative major complications,

 5. History of severe allergy,

 6. Chronic analgesic use, Study Parameters

 1. gender, age, presence of comorbidity, weight, height, smoking status, operative time,
 length of hospital stay, intraoperative fluid volume, and developed complications 2. the
 primary data of the study: the postoperative 1, 3, 6, 12, and 24-hour VAS scores (0 lowest-10
 highest) at rest and on cough after surgery 3. the rate of rescue analgesic dose of tramadol
 4. as the secondary data: nausea-vomiting, shoulder pain, discharge duration exceeding 24
 hours, and pre-discharge patient satisfaction (strongly disagree 1-strongly agree 5 on a
 Likert-type scale).

 The mean postoperative 1-hour Visual Analog Scale (VAS) scores and the rates of rescue
 analgesic use of 20 patients operated before the study were determined. With these values, it
 was calculated that there should be 40 patients in each group, with a 33% decrease in pain
 scores and rescue analgesic use after LTAP at a statistical power of 80% and a significance
 level of 5%. The study was conducted with 30 patients in each group for a better analysis.

 Randomization Randomization will be performed immediately before the surgery using a
 computer-generated random number table and was reported to the surgeon who would perform the
 surgery. Anesthesia team, the patient, and the clinical nurses who carry out and record the
 postoperative evaluation will blinded to the group of patients.

 Procedure and Study Groups

 The study groups were planned as follows:

 Group 1 (Standard IV analgesia group (SA), n=40):

 Group 2 (Local analgesia group (LA), n=40):

 Group 4 (Four qudrant-Laparoscopic-assisted transversus abdominis plane block (LTAP) group,
 n=40) Postoperative analgesic administration will be carried out following a standard
 protocol in all groups. Acetaminophen 1 g was gradually will administered every 6 hours
 depending on the level of pain, and diclofenac sodium will intravenously administered every
 12 hours depending on the requirement. In the case of a pain score above 4, tramadol 100 mg
 will be given intravenously as a rescue analgesic.

 Statistical Analysis The SPSS (IBM SPSS, version20) software will be used for the statistical
 analysis. The t-test was will use for continuous variables, while the chi-square test for
 categorical values. The level of significance was set at p<0.05.
Inclusion Criteria:

 -  American Society Anesthesia (ASA) 1 and 2 patients aged 18-70 years

 Exclusion Criteria:

 -  1. Patients who did not agree to participate in the study, 2. ASA 3 and above
 patients, those who will undergone emergency surgery, open cholecystectomy 3. BMI of
 >40, 4. İntraoperative major complications, 5. History of severe allergy, 6. Chronic
 analgesic use,