Does laparoscopic-guided transversus abdominis plane block have an effect on postoperative pain and recovery after sleeve gastrectomy?

OBJECTIVE: Postoperative pain management is thought to have an effect on patient comfort, morbidity, and mortality after bariatric surgery. Local anesthetic agents are frequently used for this purpose. Local anesthetics can be used in many different ways. In this study, we aimed to investigate the effect of transversus abdominis plane (TAP) block on postoperative pain by laparoscopic method. PATIENTS AND METHODS: A prospective randomized clinical trial was performed. While TAP block was applied to one group with bupivacaine, no action was taken for the other group. Postoperative analgesia was given to both patient groups with the "patient-controlled analgesia (PCA)" device. Demographic, operational, and postoperative clinical and pain data of the patients were recorded. RESULTS: TAP block and non-TAP block groups consisted of 30 patients each. Visual analog scale (VAS) scores of the patients at 6, 12, and 24 hours were lower in the TAP group compared to the non-TAP group (p=0.015, 0.018, 0.04, respectively). According to the PCA device data, the analgesic requirement was lower in the TAP group at 6, 12, and 24 hours (p <0.001). Rescue analgesia was required more in the non-TAP group (p=0.04). There was no statistically significant difference between the two groups in terms of gas discharge time (p=0.102), stool discharge occurred earlier in the TAP group (p=0.02). Oral intake times (p=0.554) and length of stay hospital (p=0.551) were similar. CONCLUSIONS: Laparoscopic TAP block using bupivacaine can be safely administered in morbidly obese patients and reduces postoperative analgesic requirements. Thus, side effects that may develop secondary to the use of analgesics are avoided.

Melatonin: a hepatoprotective agent against radioiodine toxicity in rats.

OBJECTIVES: The aim of the current study was to investigate the possible radioprotective effects of melatonin against hepatic radioiodine (RAI) toxicity. METHODS: Thirty-six rats were randomly divided into three groups: untreated control (Group 1); oral radioiodine (RAI, 111 MBq) administrated rats (Group 2), and melatonin group (oral RAI and daily intraperitoneal injection of 12 mg/kg melatonin-Group 3). In the third group, melatonin administration was started two days before and continued for five days after RAI administration. Twenty-four hours after the administration of the last dose of melatonin, liver samples were taken for biochemical and histopathological evaluation. RESULTS: Oxidative stress parameters demonstrated that melatonin treatment decreased the tissue malondialdehyde (MDA), advanced the oxidation protein products (AOPP) levels, and increased the total-SH (sulphydryl) levels when compared with RAI group. The differences were statistically significant between these groups for all parameters (p < 0.05). The histopathological damage in the melatonin-treated group was significantly less than the damage in RAI group (p < 0.05 for all pathological parameters). CONCLUSION: The results of this study demonstrated that melatonin reduced the harmful effects of RAI treatment on the liver. Anti-inflammatory and antioxidant activities are likely to be involved in the mechanism underlying the radio-protective effects of melatonin (Tab. 3, Fig. 1, Ref. 30).