MODERN CONCEPT OF POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING URGENT LAPAROSCOPIC CHOLECYSTECTOMY

According to randomized studies, after surgical interventions such as laparoscopic cholecystectomy, severe and very severe pain is observed in 30 % to 87 % of patients. Regional techniques such as subcostal transversus abdominal plane block (Subcostal TAP-block) significantly improve the quality of postoperative analgesia. The aim of our study was to compare the effectiveness of postoperative analgesia when using multimodal analgesia and when combining it with subcostal TAP-block in patients with acute cholecystitis who underwent laparoscopic surgery. Materials and methods. 60 patients with acute cholecystitis who underwent laparoscopic surgery were examined. We investigated the level of pain according to the visual analog scale (VAS), hemodynamic parameters, glycemia level, frequency of nausea/vomiting, time to intestinal peristalsis recovery, time to activization, need for additional anesthesia, subjective assessment of sleep quality, level of daytime sleepiness (Epworth sleepiness scale), level of anxiety (Beck anxiety scale). Results. Upon admission, patients with acute cholecystitis had moderate pain syndrome (5.7±0.7 – 6.2±0.7 points according to VAS), both at rest and during movement, which was accompanied by nausea or vomiting in 43.1 % – 48.3 % of patients. In the early postoperative period, the level of pain when using the TAP block was significantly lower than in the control group, with a maximum effect after 2-4 hours. This was accompanied by a decrease in tachycardia by 12.7 % – 13.1 % (p<0.05), a decrease in the frequency of postoperative nausea and vomiting by 15.8 % – 42.5 % (p<0.05). Restoration of gastrointestinal function in the TAP block group was observed 4.4 hours earlier (p=0.049), and activation of patients was observed 7.9 hours earlier (p=0.01). Sleep quality in the TAP block group was significantly higher in the first three days after surgery, which led to a decrease in daytime sleepiness. Conclusions. In patients with acute cholecystitis, operated laparoscopically, the expansion of multimodal analgesia with regional techniques (TAP block) allowed to reduce the pain level to 1.8±0.5 – 3.1±0.4 points on the VAS at rest and to 1.9±0.6 – 3.0 ±0.4 points during movement; avoid the use of narcotic analgesics, reduce the level of tachycardia, accelerate the activation of the patient and the motor function of the intestine, as well as improve the psycho-emotional state of patients by improving the quality of night sleep and reducing the level of daytime drowsiness.