ASSESSMENT OF THE EFFICIENCY OF ANALGETIC ACTION OF LAPAROSCOPICALLY ASSISTED TAP BLOCK AS A COMPONENT OF PERIOPERATIVE MULTIMODAL ANALGESIA PLAN IN OBESE PATIENTS UNDERGOING METABOLIC SURGERY.

OBJECTIVE: The aim: To assess the effectiveness and feasibility of laparoscopically assisted TAP block utilization in the system of multimodal analgesia by comparing the severity of pain and associated postoperative recovery indicators in obese patients after laparoscopic sleeve gastrectomy. PATIENTS AND METHODS: Materials and methods: The retrospective study included 39 patients, who underwent metabolic surgery from 2013-2022. All patients were divided into 2 groups depending on the chosen perioperative analgesia protocol. Group 1 included 19 patients who prior to skin incision a local infiltration of the trocar puncture areas of the abdominal wall. Group 2 included 20 patients, whom in addition to the above-described anaesthesia procedure after completion of the main stage of surgery, a laparoscopically assisted bilateral subcostal TAP block was additionally performed. RESULTS: Results: The need to use opioid analgesics in the rescue analgesia mode arose in 17.6% (3/17) of patients of the first group, and 5% (1/20) of patients in the second group Average duration of postoperative hospitalization in group 1 was 7.2±1.1 days, and in group 2 it was 6.2±1.4 days (P <0.05). CONCLUSION: Conclusions: Subcostal TAP block in obese patients is a safe and effective method of regional anaesthesia. Further study of this option of regional anaesthesia is required in order to be able to form clearer recommendations for its routine use in clinical practice.

Comparison of 2D versus 3D in the Basic Single Incision Laparoscopy Training. A Randomized Controlled Trial.

Background: Single incision laparoscopic surgery is a technically challenging procedure. The use of 3D laparoscopy can potentially improve training results. The aim of the present study was to compare the short-term effects of the 2D vs 3D single incision laparoscopy training. Methods: Forty novices (25 males and 15 females) with no prior experience in single incision laparoscopic surgery participated in the study. The participants were randomized into 2D or 3D training mode. Results: Twenty participants were assigned to 2D and twenty to 3D training group. Time to finish the first task with the polypropylene ball transfer was significantly shorter in the 3D group with no difference in the total number of errors during the task (p=0.007). Overall number of attempts and number of successful attempts were similar between the groups while the number of errors was significantly higher in the 2D group during the needle grasping task (p=0.033). In the intracorporeal knot tying test the probability of completing the task was significantly higher in the 3D group (p=0.02). Conclusion: 3D training in basic single incision laparoscopy techniques seems to offer advantage over standard 2D training mode.