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Laparoscopic cholecystectomy is a frequently performed surgery and the gold standard for the treatment of symptomatic gallstone disease. Although laparoscopic cholecystectomy is considered minimally invasive, it can cause moderate to severe pain in the postoperative period. Poorly controlled early postoperative pain impairs recovery quality and increases the risk of postoperative pulmonary complications, serving as a risk factor for chronic pain development.
Multimodal analgesia, including opioids, is used to manage pain following laparoscopic cholecystectomy. However, opioid treatment may lead to side effects such as postoperative nausea and vomiting (PONV), respiratory depression, and constipation.
The primary aim of this study is to evaluate the effect of recto-intercostal nerve block as part of multimodal analgesia on intraoperative opioid consumption and postoperative pain scores in patients undergoing laparoscopic cholecystectomy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| The group without rectointercostal nerve block | Active Comparator | Patients in this group will be administered dexketoprofen 50 mg and tramadol 100 mg intravenously in the intraoperative period. These patients will not receive the rectointercostal nerve block. |
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| Postoperative analgesic efficacy of rectointercostal nerve block | Active Comparator | The patient lies in the supine position. The skin is disinfected. A high-frequency linear probe (6-13 MHz) is placed lateral to the xiphoid to visualize the rectus abdominis muscle at the level of the 7th rib. Using an in-plane technique, a 22G, 80 mm block needle is inserted in a cranial direction into the interfascial plane immediately inferolateral to the xiphoid, between the rectus abdominis muscle and the 6th-7th costal cartilages. A total of 20 ml of local anesthetic solution is injected bilaterally (40 ml of 0.25% bupivacaine (marcaine)). The spread of the local anesthetic is confirmed by ultrasound guidance. Additionally, patients in this group will be administered dexketoprofen 50 mg and tramadol 100 mg intravenously in the intraoperative period. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| The group without the rectointercostal nerve block | Procedure | Patients in this group will be administered dexketoprofen 50 mg and tramadol 100 mg intravenously in the intraoperative period. These patients will not receive the rectointercostal nerve block. |
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative remifentanil consumption | The amount of remifentanil that patients need to maintain anesthesia during the intraoperative period will be recorded | During the intraoperative period |
| Measure | Description | Time Frame |
|---|---|---|
| Pain scores | Pain will be assessed at rest and while movement using the from 0 (no pain) to 10 (worst) | First 24 hours after surgery |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ankara Etlik City Hospital | Yenimahalle | Ankara | 06170 | Turkey (Türkiye) |
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| ID | Term |
|---|---|
| D059787 | Acute Pain |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| The rectointercostal plane block | Procedure | The rectointercostal plane block is performed under ultrasound guidance before the surgical procedure and anesthesia induction, with the patient in the supine position. Additionally, patients in this group will be administered dexketoprofen 50 mg and tramadol 100 mg intravenously in the intraoperative period. |
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