Analyzing the Impact of Transvers Abdominis Plane Block, PLR, NLR on Platelet Functions, Postoperative Pain, Analgesic Consumption and Nausea-Vomiting in the Patients who Received Laparoscopic Cholecystectomy

Analyzing the Impact of Transvers Abdominis Plane Block, PLR, NLR on Platelet Functions, Postoperative Pain, Analgesic Consumption and Nausea-Vomiting in the Patients who Received Laparoscopic Cholecystectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analyzing the Impact of Transvers Abdominis Plane Block, PLR, NLR on Platelet Functions, Postoperative Pain, Analgesic Consumption and Nausea-Vomiting in the Patients who Received Laparoscopic Cholecystectomy HARUN OZMEN, Serkan Doğru, Sinan Aslan, Çiğdem Yalçın, Erdi Hüseyin Erdem, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6214832/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The transversus abdominis plane (TAP) block is widely utilized for postoperative analgesia following laparoscopic cholecystectomy. The posterior approach, in particular, has been shown to provide effective analgesia due to its superior distribution of local anesthetic within the plane. Aim: This study aimed to compare analgesic consumption, pain scores, nausea and vomiting scores, and hemogram parameters between laparoscopic cholecystectomy patients who received bilateral TAP block and those who did not receive the block and were managed with conventional analgesics. Methods: This retrospective study analyzed the medical records of 109 patients who underwent laparoscopic cholecystectomy. Patients were categorized into three groups based on whether they received a TAP block or not. Demographic data, pain scores (using the Visual Analog Scale, VAS), nausea and vomiting scores, analgesic consumption, and the administration of antiemetics were evaluated. Results: The study demonstrated that the 6th and 12th hour VAS scores were significantly lower in the TAP-2 group compared to the control group (p < 0.05). Additionally, the 24-hour VAS scores in the TAP-2 group were significantly lower than those in the TAP-1 group (p < 0.05). Nausea and vomiting scores at 8 and 12 hours were significantly higher in the Control group compared to the TAP-2 group (p = 0.002 and p = 0.045, respectively). Analgesic requirements at the 8th hour were significantly higher in the Control group, where no block was administered, compared to the TAP-2 group (p < 0.05). No significant correlation was observed between platelet (Plt), procalcitonin (PCT), mean platelet volume (MPV), platelet distribution width (PDW), platelet-to-lymphocyte ratio (Plt/Lymp), neutrophil-to-lymphocyte ratio (Neut/Lymp), and postoperative pain scores or analgesic requirements in the TAP-1, TAP-2, and Control groups (ρ 0.05). Conclusions: Patients who underwent bilateral TAP block exhibited significantly lower analgesic consumption and pain scores during the first 8 hours postoperatively compared to those who did not receive the block. Additionally, postoperative nausea and vomiting scores were significantly reduced in patients who received the TAP block. These findings suggest that the TAP block is an effective adjunct for enhancing postoperative pain management and reducing opioid-related side effects in laparoscopic cholecystectomy patients. transverse abdominus plane block analgesia analgesic consumption nausea vomiting Introduction Effective pain control is a critical component of postoperative care, particularly for facilitating early discharge and enhancing recovery following laparoscopic surgery. Traditional pain management strategies typically involve the use of paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids. However, there is a growing trend toward incorporating regional analgesic techniques, either as standalone interventions or in combination with conventional methods, to optimize pain relief while minimizing opioid reliance. This shift aims to reduce opioid-related adverse effects, such as nausea and vomiting, and improve patient outcomes [ 1 – 2 ]. The transversus abdominis plane (TAP) block, first described by Rafi in 2001 [ 3 , 4 ], has emerged as a widely utilized regional analgesic technique. In 2007, Hebbart et al. further advanced the procedure by demonstrating its enhanced efficacy and safety when performed under ultrasound guidance (USG) [ 4 ]. The TAP block involves the administration of local anesthetics into the neurofascial plane between the internal oblique and transversus abdominis muscles, targeting the anterior branches of the thoracic intercostal (T7-T12) and first lumbar (L1) nerves. This technique has gained recognition as an effective opioid-sparing method for postoperative pain management, particularly following laparoscopic cholecystectomy [ 6 , 7 ]. Recent studies have explored the relationship between platelet indices and inflammatory processes, leading to investigations into their potential role in pain physiology. Platelet indices, including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet-large cell ratio (P-LCR), serve as important markers of platelet activation and function, reflecting changes in platelet size and distribution [ 8 – 11 ]. Additionally, the neutrophil-to-lymphocyte ratio (NLR) has been associated with postoperative pain intensity [ 11 ]. Furthermore, clinical studies have demonstrated that platelet count and indices, which influence the blood serotonin pool, may predict postoperative nausea and vomiting [ 12 ]. These parameters are increasingly recognized as cost-effective and readily accessible biomarkers for predicting and managing surgical inflammation, pain, and opioid-related side effects [ 11 , 13 , 14 ]. The aim of this study was to evaluate the correlation between analgesic consumption, pain scores, nausea and vomiting scores, and their predictability using hemogram parameters and platelet indices in patients undergoing laparoscopic cholecystectomy (LC) under general anesthesia. Specifically, we compared outcomes between patients who received a TAP block for postoperative analgesia and those managed exclusively with conventional analgesic regimens. METHODS Ethics Statement The study protocol was reviewed and approved by the Mersin University Clinical Research Ethics Committee (Approval Number: 2024/7/2024 − 696). Study Design This retrospective study analyzed the medical records of patients who underwent laparoscopic cholecystectomy (LC) at Mersin City Training and Research Hospital between May 2024 and October 2024, accessed through the hospital information management system. Inclusion criteria comprised patients aged 18 to 80 years, classified as ASA (American Society of Anesthesiologists) physical status of I-III, who experienced no surgical or anesthetic complications and were directly admitted to the postoperative service. Exclusion criteria included patients younger than 18 or older than 80 years, those classified as ASA IV, individuals with surgical or anesthetic complications, patients transferred to the intensive care unit postoperatively, pregnant or nursing women, and those with incomplete medical records. Patients were categorized into two groups based on postoperative pain management: the TAP Group, which received a transversus abdominis plane (TAP) block, and the Control Group (Control-g), which did not receive a TAP block and was managed with conventional analgesics. The TAP Group was further subdivided into TAP-1 (patients who received perioperative and postoperative antiemetics) and TAP-2 (patients who did not receive antiemetics). From the records of 110 patients meeting the inclusion and exclusion criteria, data on operation duration, anesthesia type, perioperative analgesics and antiemetics, postoperative analgesic and antiemetic requirements, pain scores (at 20 minutes, 8 hours, 12 hours, and 24 hours postoperatively), and nausea-vomiting scores were extracted. The groups were compared statistically based on 24-hour analgesic and antiemetic requirements, pain scores (assessed using the Visual Analog Scale, VAS: 0–10), nausea-vomiting scores (assessed using the Postoperative Nausea and Vomiting Scale, PONVS: 0–3), and hemogram parameters, including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), platelet distribution width (PDW), plateletcrit (PCT), platelet count (PLT), and mean platelet volume (MPV). All patients received a standardized anesthetic regimen, including induction with 2–3 mg/kg propofol, 1–3 mcg/kg fentanyl, and 0.6 mg/kg rocuronium, followed by maintenance with sevoflurane or desflurane in a 50% oxygen and 50% air mixture. Laparoscopic cholecystectomy was performed by the same surgeon using a carbon dioxide (CO2) pneumoperitoneum pressure of 10–11 cmH2O, with patients positioned at 20–30° Fowler. For postoperative analgesia, all patients received intravenous (IV) paracetamol 1 g and IV tramadol 100 mg perioperatively. Antiemetic prophylaxis included IV metoclopramide 10 mg perioperatively and IV ondansetron 8 mg postoperatively. The TAP block was administered before extubation following cholecystectomy. Under ultrasound guidance, a bilateral posterior TAP block was performed by the same anesthesiologist using 20 mL of 0.25% bupivacaine on each side. Extubation was facilitated using 2–3 mg/kg sugammadex. Postoperative analgesia was managed with IV paracetamol 1 g or IV diclofenac sodium 75 mg, as per the prescribed orders. Pain intensity was assessed using the Visual Analog Scale (VAS: 0–10), while nausea and vomiting were evaluated using the Postoperative Nausea and Vomiting Scale (PONVS: 0–3). Statistical analysis Qualitative data were presented as numbers and percentage where quantitative values as mean and standart deviation. The distribution of the data were analysed using one-sample Kolmogorov-Smirnov test. Categorical data was analysed using Chi-square test. Comparisons between groups were performed by Kruskal-Wallis test where posthoc analyses were completed using Tukey’s HSD test. The correlation analysis was conducted by Spearman’s correlation (rho). All analyses were completed using Statistical Package for social Sciences program (SPSS Inc, Chi, IL) version 20. Statistical significance was accepted as p < 0.05. Results A total of 110 patients were enrolled in this study. The mean age of the patients were 42.45 ± 10.73 where 32 (29.1%) of them were female (Table 1 ). The operation time in TAP 1 is slightly higher than in Control-g (p = 0.020; Table 1 ). The VAS values of 8th and 12th h in Control-g is increased compared to TAP 2 (p = 0.025, p = 0.001; respectively). The 24th h VAS value of TAP 2 is lower than TAP 1 (p = 0.007). The AR of 8th h in Control-g was found higher compared to TAP 2 (p < 0.05; Table 3 ). The 12th h AR of TAP 2 was elevated than the others (p = 0.010; Table 3 ). The AR in 24th h of Control g was elevated than the other groups (p = 0.033; Table 3 ). The number of paracetamol administration in Control-g at 12th h was increased compared to other groups (p < 0.05). The Hb value of TAP 1 was found elevated compared to Control-g (p = 0.030; Table 4 ). The WBC value of TAP 2 was significantly higher than in Control-g (p = 0.048; Table 4 ). The RDW value of TAP 1 was found elevated compared to TAP 2 (p = 0.042; Table 4 ). The 8th and 12th h NV score were significantly increased in Control-g compared to TAP 2 (p = 0.002, p = 0.045; respectively; Table 5 ). There was no correlation found in TAP 2 and Control-g between Plt, PCT, MPV, PDW and NV scores in first, 8th, 12th, and 24th hours postoperatively (ρ 0.05). Additionally, there was no correlation detected in TAP 1, TAP 2 and Control-g between Plt, PCT, MPV, PDW, Plt/Lymp ratio, Neut/Lymp ratio and VAS in first, 8th, 12th, and 24th hours, AR in first, 8th, 12th, and 24th hours postoperatively (ρ 0.05). Table 1 Demographic characteristics TAP 1 (n = 36) TAP 2 (n = 28) Control-g (n = 46) P Age (years) 43.77 ± 10.75 42.75 ± 10.95 41.23 ± 10.68 0.615 Gender n (%) Female 10 (27.8) 10 (35.7) 12 (26.1) 0.661 Male 26 (72.2) 18 (64.3) 34 (73.9) Operation time 50.69 ± 9.26 48.78 ± 10.86 44.71 ± 9.57 0.030* *p < 0.05 Kruskal-Wallis test Tukey’s HSD test Intragroup comparison for age: TAP 1-TAP 2: p = 0.924; TAP 1-Control-g : p = 0.542; TAP 2-Control 2: p = 0.829 Intragroup comparisons for operation time: TAP 1-TAP 2: p = 0.721; TAP 1-Control-g: p = 0.020* ; TAP 2-Control 2: p = 0.199 Table 2 The VAS of the groups TAP 1 (n = 36) TAP 2 (n = 28) Control-g (n = 46) P VAS 20th min 3.63 ± 1.82 3.5 ± 2.04 3.5 ± 1.9 0.707 VAS 8th h 2.69 ± 1.68 2 ± 1.27 3.21 ± 2.09 0.049* VAS 12th h 2.02 ± 1.93 1.1 ± 0.91 2.6 ± 1.81 0.001* VAS 24th h 2.19 ± 2.05 0.82 ± 0.94 1.73 ± 1.85 0.008* *p 0.05 Intragroup comparison for VAS 8th h: TAP 1-TAP 2: p = 0.408; TAP 1-Control-g: p = 0.548; TAP 2-Control-g : p = 0.025* Intragroup comparison for VAS 12th h: TAP 1-TAP 2: p = 0.107; TAP 1-Control-g: p = 0.364; TAP 2-Control-g: p = 0.001* Intragroup comparison for VAS 24th h: TAP 1-TAP 2: p = 0.007* ; TAP 1-Control-g: p = 0.606; TAP 2-Control-g: p = 0.101 Table 3 Comparison of analgesic requirement and analgesic administration among groups TAP 1 (n = 36) TAP 2 (n = 28) Control-g (n = 46) NAR-0 1 (2.8) — — NA NAR-8th h — 5 (17.9) 30 (65.2) < 0.05* NAR-12th h 15 (41.7) 22 (78.6) 29 (63) 0.010* NAR-24th h 1 (2.8) 3 (10.7) 10 (21.7) 0.036* Paracet-0 — — — NA Paracet-8th h — — 9 (19.6) NA Paracet-12th h 3 (8.3) — 17 (37.8) < 0.05* Paracet-24th h — 2 (7.1) 5 (10.9) NA NSAID-0 — — — NA NSAID-8th h — 4 (14.3) 26 (56.5) < 0.05* NSAID-12th h 13 (36.1) 22 (78.6) 20 (43.5) 0.002* NSAID-24th h 1 (2.8) 2 (7.1) 4 (8.7) 0.542 NAR,non analgesic requirement; NA, not applicable. Table 4 Biochemical findings of the groups TAP 1 (n = 36) TAP 2 (n = 28) Control-g (n = 46) P Hb 13.86 ± 1.28 13.55 ± 1.97 13 ± 1.29 0.028* WBC 7782.5 ± 1901.29 14112.57 ± 23237.29 7355 ± 1715.81 0.275 Neutrophil 4691.8 ± 1621.24 4658.57 ± 1369.44 4361.08 ± 1279.21 0.604 Lymphocyte 2307.77 ± 760.6 2455.35 ± 694.71 2163.91 ± 694.76 0.228 Monocyte 439.3 ± 142.49 439.64 ± 115.51 426.95 ± 131.46 0.793 Eosinophile 210 ± 217.66 193.21 ± 115.72 197.82 ± 158.35 0.923 Platelet 263916.66 ± 70117.6 282928.57 ± 78842.04 281673.91 ± 70974.81 0.563 RDW 13.94 ± 0.96 14.89 ± 2.57 14.16 ± 0.99 0.198 MCV 85.27 ± 4.57 83.92 ± 6.98 84.12 ± 5.5 0.608 MPV 8.19 ± 0.96 8.2 ± 0.82 8.25 ± 0.59 0.373 PCT 0.23 ± 0.05 0.22 ± 0.05 0.23 ± 0.05 0.959 PDW 46.68 ± 7.4 48.36 ± 8.07 45.08 ± 6.67 0.175 Plt/Lymp 123.5 ± 43.39 122.3 ± 39.64 175.64 ± 263.38 0.335 Neut/Lymp 2.26 ± 1.15 1.97 ± 0.59 2.45 ± 2.34 0.874 *p < 0.05 Kruskal-Wallis test Tukey’s HSD test Intragroup comparison for Hb: TAP 1-TAP 2: p = 0.699; TAP 1-Control-g: p = 0.030* ; TAP 2-Control-g: p = 0.275 Intragroup comparison for WBC: TAP 1-TAP 2: p = 0.088; TAP 1-Control-g: p = 0.985; TAP 2-Control-g: p = 0.048* Intragroup comparison for Neutrophil: TAP 1-TAP 2: p = 0.995; TAP 1-Control-g: p = 0.550; TAP 2-Control-g: p = 0.658 Intragroup comparison for Lymphocyte: TAP 1-TAP 2: p = 0.693; TAP 1-Control-g: p = 0.640; TAP 2-Control-g: p = 0.211 Intragroup comparison for Monocyte: TAP 1-TAP 2: p > 0.05; TAP 1-Control-g : p = 0.907; TAP 2-Control-g: p = 0.915 Intragroup comparison for Eosinophil: TAP 1-TAP 2: p = 0.920; TAP 1-Control-g: p = 0.945; TAP 2-Control-g: p = 0.993 Intragroup comparison for Plt: TAP 1-TAP 2: p = 0.555; TAP 1-Control-g : p = 0.518; TAP 2-Control-g: p = 0.997 Intragroup comparison for RDW: TAP 1-TAP 2: p = 0.042* ; TAP 1-Control-g : p = 0.798; TAP 2-Control-g: p = 0.124 Intragroup comparison for MCV: TAP 1-TAP 2: p = 0.611; TAP 1-Control-g: p = 0.632; TAP 2-Control-g: p = 0.988 Intragroup comparison for MPV: TAP 1-TAP 2: p = 0.999; TAP 1-Control-g : p = 0.944; TAP 2-Control-g : p = 0.967 Intragroup comparison for PCT: TAP 1-TAP 2: p = 0.943; TAP 1-Control-g : p = 0.984; TAP 2-Control-g: p = 0.982 Intragroup comparison for PDW: TAP 1-TAP 2: p = 0.633; TAP 1-Control-g: p = 0.588; TAP 2-Control-g: p = 0.151 Intragroup comparison for Plt/Lymp: TAP 1-TAP 2: p > 0.05; TAP 1-Control-g: p = 0.372; TAP 2-Control-g: p = 0.409 Intragroup comparison for Neut/Lymp: TAP 1-TAP 2: p = 0.782; TAP 1-Control-g: p = 0.872; TAP 2-Control-g: p = 0.476 Table 5 Comparison of nausea-vomiting scores of the groups TAP 1 (n = 36) TAP 2 (n = 28) Control-g (n = 46) P NV-0 — 0.07 ± 0.26 0.26 ± 0.61 0.139 NV-8h — 0.1 ± 0.31 0.76 ± 1.03 0.002* NV-12h — 0.17 ± 0.61 0.65 ± 1.11 0.045* NV-24h — 0.03 ± 0.18 0.28 ± 0.77 0.113 *p < 0.05 Mann-Whitney U test There is no correlation presented in TAP 1, TAP 2 and Control-g between Plt, MPV, PCT, MPV, PDW, Plt/Lymp ratio, Neut/Lymp ratio and VAS in first, 8th, 12th, and 24th hours, NSAID in first, 8th, 12th, and 24th hours postoperatively (ρ 0.05). DISCUSSION The present study revealed that the 6th and 12th hour Visual Analog Scale (VAS) scores were significantly lower in the TAP-2 group (patients who received a transversus abdominis plane (TAP) block without antiemetics) compared to the Control-g (patients who did not receive a TAP block). Additionally, nausea and vomiting scores at the 8th and 12th hours were significantly higher in the Control-g group than in the TAP-2 group. The analgesic requirement at the 8th hour was also higher in the Control-g compared to the TAP-2 group. However, no significant correlation was found between platelet indices (PLT, PCT, MPV, PDW), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and postoperative pain scores or analgesic requirements in the TAP-1, TAP-2, or Control-g. Numerous studies have explored pain management strategies following laparoscopic cholecystectomy (LC). Recent trends emphasize opioid-sparing analgesic regimens to reduce side effects and shorten hospital stays. A meta-analysis by Bisgard et al., which included 64 randomized studies with 5,018 patients, highlighted the use of preoperative dexamethasone, intraoperative local anesthetics, and multimodal analgesia with NSAIDs as effective strategies, with opioids reserved for cases where these methods failed [ 7 – 15 ]. Yacobsson’s review discussed TAP blocks as an alternative to intrathecal and epidural morphine analgesia, particularly in obese patients undergoing LC or colon surgery. The review emphasized the need for further research integrating TAP blocks into multimodal analgesia protocols, alongside local infiltration and intrathecal opioid techniques [ 16 ]. Studies comparing unilateral and bilateral TAP blocks for post-LC analgesia have demonstrated reduced tramadol consumption in patients receiving TAP blocks, though no significant differences were observed in nausea-vomiting (NV) scores or ondansetron consumption [ 7 ]. Siddiqui et al.’s meta-analysis noted heterogeneous outcomes for TAP blocks in various surgeries, including LC, but consistently highlighted their role in reducing opioid use and delaying the need for rescue analgesics [ 17 ]. Research comparing posterior and lateral TAP block approaches has shown that both techniques provide effective analgesia in the early postoperative period (0–12 hours), though the posterior approach may offer longer-lasting analgesia. However, the efficacy of both techniques beyond 12 hours remains debated [ 18 , 19 ]. Sahap et al. found that TAP blocks, whether administered under ultrasound guidance or laparoscopically, significantly reduced VAS scores and tramadol consumption compared to controls, with no significant difference between the two TAP block methods [ 20 ]. The broader spread of local anesthetic in the posterior approach has been noted as a potential advantage [ 21 ]. In our study, bilateral TAP blocks were performed using a posterior approach, with 20 mL of 0.25% bupivacaine administered on each side. The TAP-2 group exhibited lower VAS scores at 6 and 12 hours and reduced analgesic consumption in the first 8 hours compared to the control group. No opioids were used postoperatively, and 24-hour diclofenac sodium requirements were significantly higher in the control group, consistent with literature supporting the efficacy of TAP blocks in providing high-quality analgesia. Studies investigating the relationship between platelet indices and inflammatory processes have explored their potential role in pain physiology. Rathe et al. demonstrated a significant correlation between preoperative and postoperative NLR and post-arthroplasty pain, suggesting that NLR values could guide analgesic decisions [ 11 ]. Elevated NLR and PLR have been associated with inflammation and pain, while platelet indices such as MPV, PDW, and PCT have been linked to platelet activation and function [ 22 ]. Research on nonspecific abdominal pain (NAP) and chest pain has identified MPV as a potential biomarker for pain and inflammation [ 10 , 23 ]. Yıldız et al. proposed MPV as a useful indicator in emergency abdominal pain cases [ 24 ]. Turgut et al. found that higher NLR correlated with increased postoperative analgesic consumption in orthognathic surgery, while Yaşlı et al. highlighted the role of PLT and PCT levels in predicting postoperative pain and edema [ 9 , 25 ]. With the results of these studies, the authors asserted that the use of analgesic medications which enhance platelet function could be more effective for postoperative pain management when compared to opioids. On the other hand, some studies show that there is a correlation between MPV and inflammatory conditions and postoperative nausea and vomiting. This correlation makes us think that the higher PLT count could be the most effective predictor for postoperative pain and it is also seen that there is a significant correlation between the higher PCT level and analgesic consumption in postoperative 24 hours [ 9 , 26 – 28 ]. In their study, Tüzüner et al. compared the use of postoperative nonselective siklooksijenaz-1 enzyme (COX-1) and (COX-2) inhibitor diclofenac sodium, tramadol and placebo in terms of analgesic consumption and it was found that the use of analgesics was higher in the placebo group. Although it is not statistically significant in this study, diclofenac group was the one with the less and the least analgesic consumption when compared to tramadol [ 29 ]. The retrospective study by Adıgüzel et al. on the predictive value of NLR, PLR, SII as biomarkers for inflammation in patients undergoing LC is similar to our study in LC patients undergoing TAP block, if we take our control group as an example. In this study, the authors found only a weak statistical association between PDW and the dose of tramadol used. However, they stated that these parameters were ineffective in predicting pain and tramadol consumption after LC. They recommended randomized clinical trials on this subject[ 30 ]. Despite these findings, our study found no significant correlation between platelet indices (PLT, PDW, MPV, PCT, PLR, NLR) and postoperative pain scores or analgesic requirements. This discrepancy may be attributed to the retrospective design of our study, which limited our ability to control for confounding variables. Postoperative Nausea and Vomiting, defined as nausea, retching, or vomiting within 48 hours post-surgery, affects 20–30% of surgical patients without prophylaxis. Laparoscopic procedures, including LC, are known risk factors for PONV, exacerbated by the use of inhalation anesthetics and opioids [ 15 ]. Özçiftçi et al. found no significant difference in NV scores or ondansetron consumption between patients receiving unilateral or bilateral TAP blocks and controls [ 7 ]. Platelet serotonin levels have been implicated in PONV pathogenesis, with some studies suggesting that MPV and PLT may predict PONV risk [ 12 , 31 ]. In our study, nausea and vomiting scores were significantly lower in the TAP-2 group at 8 and 12 hours, likely due to the block’s effect on peritoneal and abdominal wall innervation. This study has several limitations. First, the sample size was constrained by the use of a single surgeon to standardize surgical technique. Second, the retrospective design precluded postoperative hemogram analysis, limiting our ability to compare preoperative and postoperative platelet indices. Additionally, the lack of data on NSAID effects on platelet indices and the serotonin pool necessitates further prospective research with larger sample sizes. Conclusion Postoperative pain and PONV are critical factors affecting patient comfort and recovery. Our findings suggest that TAP blocks not only provide effective analgesia but also reduce PONV, likely due to their impact on peritoneal and abdominal wall innervation. While platelet indices have been implicated in inflammation and pain, our study did not find a significant correlation, highlighting the need for prospective, controlled studies to further elucidate these relationships. Abbreviations TAP transvers abdominis plane USG ultrasonography PVI platelet variable index PLT platelet PLR platelet -lymphocyte ratio MPW mean platelet volume PDW platelet distribution width PCT thrombocytocrit P-LCR platelet large cell ratio are the NLR neutrophile-lymphocyte ratio VAS visual analog skala PONVS postoperatif nausea-vomiting scores NSAI nonsteroid antiinflamatuar LC laparoscopic cholecystectomy PNV postoperatif nausea-vomiting Declarations Ethics approval and consent to participate This study was approved by the Mersin University Ethics Committee (Approval number: 2024/7/2024-696). The need for informed consent was waived because of the retrospective design of the study and the use of anonymized personal information. Consent to participate: Not applicable Consent for publication: Not applicable Competing interests: The authors declare no competing interests. Availability of data and materials The data is available from the corresponding author on reasonable request. Clinical trial number: Not applicable Funding :No funding Authors' contributions: All authors contributed to the study conception and design of this study. Material preparation and data collection were performed by HO, SA, ÇY, EHE, MK. Analysis was performed by SD and HO. The first draft of the manuscript was written by BA,SD and HO, and all the authors commented on the previous versions of the manuscript. All authors have reviewed and approved the final manuscript. Author’s Details Harun Özmen*, Serkan Doğru, Çiğdem Yalçın, Erdi Hüseyin Erdem, Bahar Aydınlı, Mehlika Kurtay( Mersin City Hospital, Department of Anesthesiology and Reanimation, Mersin, Turkey) Sinan Aslan (Mersin City Hospital, Department of General Surgery, Mersin, Turkey ) Acknowledgements: Not applicable Corresponding author: Harun Özmen Corresponding author e-mail: [email protected] Prior Presentations: Not applicable. Conflict of interest: No potential conflict of interest relevant to this article was reported. 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Rathee A, Chaurasia MK, Singh MK, Singh V, Kaushal D. Relationship Between Pre- and Post-Operative C-Reactive Protein (CRP), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) With Post-Operative Pain After Total Hip and Knee Arthroplasty: An Observational Study. Cureus. 2023 Aug 20;15(8):e43782. doi: 10.7759/cureus.43782. PMID: 37731439; PMCID: PMC10507425. Canpolat DG, Dogruel F, Gönen ZB, Yılmaz C, Zararsız G, Alkan A. The Role Of Platelet Count, Mean Platelet Volume, And The Mean Platelet Volume/Platelet Count Ratio In Predicting Postoperative Vomiting In Children After Deep Sedation. Saudi Med J. 2016 Oct;37(10):1082-8. doi: 10.15537/smj.2016.10.14903. PMID: 27652358; PMCID: PMC5075371. Chen H, Wu Q, Zhang Y, Li Q, Ma J, Kong F, Ma X. Nomograms Based On The Novel Platelet Index Score Predict Postoperative Prognosis In Endometrial Cancer. Gynecol Oncol. 2020 Sep;158(3):689-697. doi: 10.1016/j.ygyno.2020.05.040. Epub 2020 Jun 5. PMID: 32507649. Lembeck AL, Posch F, Klocker EV, Szkandera J, Schlick K, Stojakovic T, Kornprat P, Lackner C, Gerger A, Stoeger H, Stotz M, Pichler M. Large Platelet Size Is Associated With Poor Outcome In Patients With Metastatic Pancreatic Cancer. Clin Chem Lab Med. 2019 Apr 24;57(5):740-744. doi: 10.1515/cclm-2018-0016. PMID: 30307891. T. Bisgaard and D. C. Warltier, “Analgesic Treatment After Laparoscopic Cholecystectomy,” Anesthesiology, vol.104, no. 4, pp. 835–846, 2006. Bisgaard T. Analgesic Treatment After Laparoscopic Cholecystectomy: A Critical Assessment Of The Evidence. Anesthesiology. 2006 Apr;104(4):835-46. doi: 10.1097/00000542-200604000-00030. PMID: 16571981. Siddiqui MR, Sajid MS, Uncles DR, Cheek L, Baig MK. A meta-analysis on the clinical effectiveness of transversus abdominis plane block. J Clin Anesth. 2011 Feb;23(1):7-14. doi: 10.1016/j.jclinane.2010.05.008. PMID: 21296242. Tsai HC, Yoshida T, Chuang TY, Yang SF, Chang CC, Yao HY, Tai YT, Lin JA, Chen KY. Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques. Biomed Res Int. 2017;2017:8284363. doi: 10.1155/2017/8284363. Epub 2017 Oct 31. PMID: 29226150; PMCID: PMC5684553.16- Rawish E, Langer HF. Platelets and the Role of P2X Receptors in Nociception, Pain, Neuronal Toxicity and Thromboinflammation. Int J Mol Sci. 2022 Jun 13;23(12):6585. doi: 10.3390/ijms23126585. PMID: 35743029; PMCID: PMC9224425. Mehmet Sahap1, Merve Sevim Artykov2, Handan Gulec1, Abdussamed Yalcin3, Abdulkadir But. Ultrasound-guided vs Laparoscopic-asisted Transversus Abdominis Plane Block for Laparoscopic Cholecystectomy: A Randomized Prospective Study. JARSS 2023;31(1):55-61 Carney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG. The Transversus Abdominis Plane Block Provides Effective Postoperative Analgesia In Patients Undergoing Total Abdominal Hysterectomy. Anesth Analg. 2008 Dec;107(6):2056-60. doi: 10.1213/ane.0b013e3181871313. PMID: 19020158 Mercan M, Gürmen ES. Evaluation of the Determinativeness of Platelet/Lymphocyte and Neutrophil/Lymphocyte Ratios in the Diagnosis of Acute Abdomen . Manisa Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2023;10(1): 1-6. Coskun A, Yavasoglu I, Sargin G, Ok IM, Bircan M, Avcil M, Kadikoylu G, Bolaman Z. The Role Of Mean Platelet Volume In Patients With Non-Specific Abdominal Pain In An Emergency Department. Prz Gastroenterol. 2015;10(3):156-9. doi: 10.5114/pg.2015.49042. Epub 2015 Feb 10. PMID: 26516381; PMCID: PMC4607690. Yıldız Ö, Bedel C, Beceren NG. ve Tomruk Ö. Can Mean Platelet Volume Be Used As A Marker In Patients With Abdominal Pain? Genel Tıp Derg 2020;30(2):87-91 Turgut HC, Alkan M, Ataç MS, Altundağ SK, Bozkaya S, Şimşek B, et al. Neutrophil Lymphocyte Ratio Predicts Postoperative Pain After Orthognathic Surgery . Niger J Clin Pract 2017 ; 20 : 1242 – 1245 . Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, et al.Mean Platelet Volume As A Predictor Of Cardiovascular Risk: A Systematic Review And Meta-Analysis . J Thromb Haemost 2010 ; 8 : 148 – 156 . Gasparyan AY, Stavropoulos-Kalinoglou A, Mikhailidis DP, Douglas KM, Kitas GD. Platelet Function In Rheumatoid Arthritis: Arthritic And Cardiovascular Implications . Rheumatol Int 2011 ; 31 : 153 – 164 . Canpolat DG, Dogruel F, Gönen ZB, Yılmaz C, Zararsız G, Alkan A. The Role Of Platelet Count, Mean Platelet Volume, And The Mean Platelet Volume/Platelet Count Ratio In Predicting Postoperative Vomiting In Children After Deep Sedation . Saudi Med J 2016 ; 37 : 1082 – 108 Tuzuner AM, Ucok C, Kucukyavuz Z, Alkis N, Alanoglu Z. Preoperative Diclofenac Sodium And Tramadol For Pain Relief After Bimaxillary Osteotomy. J Oral Maxillofac Surg. 2007 Dec;65(12):2453-8. doi: 10.1016/j.joms.2007.06.622. PMID: 18022468 Canikli Adıgüzel Ş, Akyurt D, Bahadır Altun H, Tulgar S, Ültan Özgen G. Can Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, or Systemic Immune Inflammation Index Be an Indicator of Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy? Cureus. 2023 Jan 19;15(1):e33955. doi: 10.7759/cureus.33955. PMID: 36820108; PMCID: PMC9938425. Postoperatıve Nausea And Vomıtıng .Uyar B S, Dönmez A. Journal of Anesthesia - JARSS 2018 ; 26 ( 3): 120 - 126 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6214832","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":435138600,"identity":"99f500de-e8f6-436d-8816-6bda2b8c791f","order_by":0,"name":"HARUN OZMEN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYLCChAobOX4wo4BYLQ/OpBlLNoC0GBCpg/Fh2+HEDQdATGK08POfTnuQ2JaWuPn86sQPDwwY5PnFDuDXItlwdrtBwjkb42033m6WADrMcObsBPxaDA72bpNIKEuT3Xbj7AaQlgSD24S0HOYFamE7zLh5xtnNP4jTcgykpe2w4gZ+kHXEaJHsAWkBBrLEDd5tFgkGEoT9ws9/dpvkD1BU9p/dfBPIkOeXJqAFASTAKiWIVQ627wApqkfBKBgFo2AkAQAjyUi1jNZoHAAAAABJRU5ErkJggg==","orcid":"","institution":"UNIVERSITY OF HEALTH SCIENCES MERSIN CITY EDUCATION AND RESEARCH HOSPITAL","correspondingAuthor":true,"prefix":"","firstName":"HARUN","middleName":"","lastName":"OZMEN","suffix":""},{"id":435138601,"identity":"f6aef1f2-de26-49e0-b215-aa509d9a653b","order_by":1,"name":"Serkan Doğru","email":"","orcid":"","institution":"UNIVERSITY OF HEALTH SCIENCES MERSIN CITY EDUCATION AND RESEARCH HOSPITAL","correspondingAuthor":false,"prefix":"","firstName":"Serkan","middleName":"","lastName":"Doğru","suffix":""},{"id":435138602,"identity":"193d78db-7371-4aa3-92bd-13efb2959bb2","order_by":2,"name":"Sinan Aslan","email":"","orcid":"","institution":"UNIVERSITY OF HEALTH SCIENCES MERSIN CITY EDUCATION AND RESEARCH HOSPITAL","correspondingAuthor":false,"prefix":"","firstName":"Sinan","middleName":"","lastName":"Aslan","suffix":""},{"id":435138603,"identity":"a3595a68-9109-483c-9e13-562e807dd790","order_by":3,"name":"Çiğdem Yalçın","email":"","orcid":"","institution":"UNIVERSITY OF HEALTH SCIENCES MERSIN CITY EDUCATION AND RESEARCH HOSPITAL","correspondingAuthor":false,"prefix":"","firstName":"Çiğdem","middleName":"","lastName":"Yalçın","suffix":""},{"id":435138604,"identity":"d33b89d4-328a-46b3-904f-3c501633b67b","order_by":4,"name":"Erdi Hüseyin Erdem","email":"","orcid":"","institution":"UNIVERSITY OF HEALTH SCIENCES MERSIN CITY EDUCATION AND RESEARCH HOSPITAL","correspondingAuthor":false,"prefix":"","firstName":"Erdi","middleName":"Hüseyin","lastName":"Erdem","suffix":""},{"id":435138605,"identity":"21d035b3-a734-4541-8e72-d2fb3eab93f0","order_by":5,"name":"Bahar Aydınlı","email":"","orcid":"","institution":"UNIVERSITY OF HEALTH SCIENCES MERSIN CITY EDUCATION AND RESEARCH HOSPITAL","correspondingAuthor":false,"prefix":"","firstName":"Bahar","middleName":"","lastName":"Aydınlı","suffix":""},{"id":435138606,"identity":"bfb49e2d-3e9a-484f-b202-0726a8357ffa","order_by":6,"name":"Mehlika Kuşvuran Kurtay","email":"","orcid":"","institution":"UNIVERSITY OF HEALTH SCIENCES MERSIN CITY EDUCATION AND RESEARCH HOSPITAL","correspondingAuthor":false,"prefix":"","firstName":"Mehlika","middleName":"Kuşvuran","lastName":"Kurtay","suffix":""}],"badges":[],"createdAt":"2025-03-12 20:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6214832/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6214832/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87697162,"identity":"2ccf0b24-385f-40b3-981c-3edc702d8ad2","added_by":"auto","created_at":"2025-07-28 06:24:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":840590,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6214832/v1/acd98e4c-d1b4-442c-862b-465e68831262.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analyzing the Impact of Transvers Abdominis Plane Block, PLR, NLR on Platelet Functions, Postoperative Pain, Analgesic Consumption and Nausea-Vomiting in the Patients who Received Laparoscopic Cholecystectomy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEffective pain control is a critical component of postoperative care, particularly for facilitating early discharge and enhancing recovery following laparoscopic surgery. Traditional pain management strategies typically involve the use of paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids. However, there is a growing trend toward incorporating regional analgesic techniques, either as standalone interventions or in combination with conventional methods, to optimize pain relief while minimizing opioid reliance. This shift aims to reduce opioid-related adverse effects, such as nausea and vomiting, and improve patient outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe transversus abdominis plane (TAP) block, first described by Rafi in 2001 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], has emerged as a widely utilized regional analgesic technique. In 2007, Hebbart et al. further advanced the procedure by demonstrating its enhanced efficacy and safety when performed under ultrasound guidance (USG) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The TAP block involves the administration of local anesthetics into the neurofascial plane between the internal oblique and transversus abdominis muscles, targeting the anterior branches of the thoracic intercostal (T7-T12) and first lumbar (L1) nerves. This technique has gained recognition as an effective opioid-sparing method for postoperative pain management, particularly following laparoscopic cholecystectomy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecent studies have explored the relationship between platelet indices and inflammatory processes, leading to investigations into their potential role in pain physiology. Platelet indices, including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet-large cell ratio (P-LCR), serve as important markers of platelet activation and function, reflecting changes in platelet size and distribution [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Additionally, the neutrophil-to-lymphocyte ratio (NLR) has been associated with postoperative pain intensity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Furthermore, clinical studies have demonstrated that platelet count and indices, which influence the blood serotonin pool, may predict postoperative nausea and vomiting [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These parameters are increasingly recognized as cost-effective and readily accessible biomarkers for predicting and managing surgical inflammation, pain, and opioid-related side effects [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aim of this study was to evaluate the correlation between analgesic consumption, pain scores, nausea and vomiting scores, and their predictability using hemogram parameters and platelet indices in patients undergoing laparoscopic cholecystectomy (LC) under general anesthesia. Specifically, we compared outcomes between patients who received a TAP block for postoperative analgesia and those managed exclusively with conventional analgesic regimens.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthics Statement\u003c/h2\u003e \u003cp\u003e The study protocol was reviewed and approved by the Mersin University Clinical Research Ethics Committee (Approval Number: 2024/7/2024\u0026thinsp;\u0026minus;\u0026thinsp;696).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eThis retrospective study analyzed the medical records of patients who underwent laparoscopic cholecystectomy (LC) at Mersin City Training and Research Hospital between May 2024 and October 2024, accessed through the hospital information management system. Inclusion criteria comprised patients aged 18 to 80 years, classified as ASA (American Society of Anesthesiologists) physical status of I-III, who experienced no surgical or anesthetic complications and were directly admitted to the postoperative service. Exclusion criteria included patients younger than 18 or older than 80 years, those classified as ASA IV, individuals with surgical or anesthetic complications, patients transferred to the intensive care unit postoperatively, pregnant or nursing women, and those with incomplete medical records.\u003c/p\u003e \u003cp\u003ePatients were categorized into two groups based on postoperative pain management: the TAP Group, which received a transversus abdominis plane (TAP) block, and the Control Group (Control-g), which did not receive a TAP block and was managed with conventional analgesics. The TAP Group was further subdivided into TAP-1 (patients who received perioperative and postoperative antiemetics) and TAP-2 (patients who did not receive antiemetics). From the records of 110 patients meeting the inclusion and exclusion criteria, data on operation duration, anesthesia type, perioperative analgesics and antiemetics, postoperative analgesic and antiemetic requirements, pain scores (at 20 minutes, 8 hours, 12 hours, and 24 hours postoperatively), and nausea-vomiting scores were extracted. The groups were compared statistically based on 24-hour analgesic and antiemetic requirements, pain scores (assessed using the Visual Analog Scale, VAS: 0\u0026ndash;10), nausea-vomiting scores (assessed using the Postoperative Nausea and Vomiting Scale, PONVS: 0\u0026ndash;3), and hemogram parameters, including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), platelet distribution width (PDW), plateletcrit (PCT), platelet count (PLT), and mean platelet volume (MPV).\u003c/p\u003e \u003cp\u003eAll patients received a standardized anesthetic regimen, including induction with 2\u0026ndash;3 mg/kg propofol, 1\u0026ndash;3 mcg/kg fentanyl, and 0.6 mg/kg rocuronium, followed by maintenance with sevoflurane or desflurane in a 50% oxygen and 50% air mixture. Laparoscopic cholecystectomy was performed by the same surgeon using a carbon dioxide (CO2) pneumoperitoneum pressure of 10\u0026ndash;11 cmH2O, with patients positioned at 20\u0026ndash;30\u0026deg; Fowler. For postoperative analgesia, all patients received intravenous (IV) paracetamol 1 g and IV tramadol 100 mg perioperatively. Antiemetic prophylaxis included IV metoclopramide 10 mg perioperatively and IV ondansetron 8 mg postoperatively.\u003c/p\u003e \u003cp\u003eThe TAP block was administered before extubation following cholecystectomy. Under ultrasound guidance, a bilateral posterior TAP block was performed by the same anesthesiologist using 20 mL of 0.25% bupivacaine on each side. Extubation was facilitated using 2\u0026ndash;3 mg/kg sugammadex. Postoperative analgesia was managed with IV paracetamol 1 g or IV diclofenac sodium 75 mg, as per the prescribed orders. Pain intensity was assessed using the Visual Analog Scale (VAS: 0\u0026ndash;10), while nausea and vomiting were evaluated using the Postoperative Nausea and Vomiting Scale (PONVS: 0\u0026ndash;3).\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eQualitative data were presented as numbers and percentage where quantitative values as mean and standart deviation. The distribution of the data were analysed using one-sample Kolmogorov-Smirnov test. Categorical data was analysed using Chi-square test. Comparisons between groups were performed by Kruskal-Wallis test where posthoc analyses were completed using Tukey\u0026rsquo;s HSD test. The correlation analysis was conducted by Spearman\u0026rsquo;s correlation (rho). All analyses were completed using Statistical Package for social Sciences program (SPSS Inc, Chi, IL) version 20. Statistical significance was accepted as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 110 patients were enrolled in this study. The mean age of the patients were 42.45\u0026thinsp;\u0026plusmn;\u0026thinsp;10.73 where 32 (29.1%) of them were female (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The operation time in TAP 1 is slightly higher than in Control-g (p\u0026thinsp;=\u0026thinsp;0.020; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The VAS values of 8th and 12th h in Control-g is increased compared to TAP 2 (p\u0026thinsp;=\u0026thinsp;0.025, p\u0026thinsp;=\u0026thinsp;0.001; respectively). The 24th h VAS value of TAP 2 is lower than TAP 1 (p\u0026thinsp;=\u0026thinsp;0.007). The AR of 8th h in Control-g was found higher compared to TAP 2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The 12th h AR of TAP 2 was elevated than the others (p\u0026thinsp;=\u0026thinsp;0.010; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The AR in 24th h of Control g was elevated than the other groups (p\u0026thinsp;=\u0026thinsp;0.033; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The number of paracetamol administration in Control-g at 12th h was increased compared to other groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The Hb value of TAP 1 was found elevated compared to Control-g (p\u0026thinsp;=\u0026thinsp;0.030; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The WBC value of TAP 2 was significantly higher than in Control-g (p\u0026thinsp;=\u0026thinsp;0.048; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The RDW value of TAP 1 was found elevated compared to TAP 2 (p\u0026thinsp;=\u0026thinsp;0.042; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The 8th and 12th h NV score were significantly increased in Control-g compared to TAP 2 (p\u0026thinsp;=\u0026thinsp;0.002, p\u0026thinsp;=\u0026thinsp;0.045; respectively; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). There was no correlation found in TAP 2 and Control-g between Plt, PCT, MPV, PDW and NV scores in first, 8th, 12th, and 24th hours postoperatively (ρ\u0026thinsp;\u0026lt;\u0026thinsp;0.200, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Additionally, there was no correlation detected in TAP 1, TAP 2 and Control-g between Plt, PCT, MPV, PDW, Plt/Lymp ratio, Neut/Lymp ratio and VAS in first, 8th, 12th, and 24th hours, AR in first, 8th, 12th, and 24th hours postoperatively (ρ\u0026thinsp;\u0026lt;\u0026thinsp;0.400, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTAP 1\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTAP 2\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControl-g\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.77\u0026thinsp;\u0026plusmn;\u0026thinsp;10.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.75\u0026thinsp;\u0026plusmn;\u0026thinsp;10.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41.23\u0026thinsp;\u0026plusmn;\u0026thinsp;10.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (26.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 (73.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOperation time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.69\u0026thinsp;\u0026plusmn;\u0026thinsp;9.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.78\u0026thinsp;\u0026plusmn;\u0026thinsp;10.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44.71\u0026thinsp;\u0026plusmn;\u0026thinsp;9.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.030*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eKruskal-Wallis test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eTukey\u0026rsquo;s HSD test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eIntragroup comparison for age:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.924; TAP 1-Control-g : p\u0026thinsp;=\u0026thinsp;0.542; TAP 2-Control 2: p\u0026thinsp;=\u0026thinsp;0.829\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eIntragroup comparisons for operation time:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.721; TAP 1-Control-g: \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.020*\u003c/b\u003e; TAP 2-Control 2: p\u0026thinsp;=\u0026thinsp;0.199\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe VAS of the groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTAP 1\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTAP 2\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl-g\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS 20th min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS 8th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.049*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS 12th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS 24th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.008*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eKruskal-Wallis test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTukey\u0026rsquo;s HSD test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for VAS 20th min:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.992; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.989; TAP 2-Control-g: p\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for VAS 8th h:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.408; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.548; TAP 2-Control-g : \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.025*\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for VAS 12th h:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.107; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.364; TAP 2-Control-g: \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001*\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for VAS 24th h:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.007*\u003c/b\u003e; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.606; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.101\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of analgesic requirement and analgesic administration among groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTAP 1\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTAP 2\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl-g\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNAR-0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNAR-8th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (65.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNAR-12th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNAR-24th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.036*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParacet-0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParacet-8th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParacet-12th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParacet-24th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNSAID-0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNSAID-8th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.05*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNSAID-12th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNSAID-24th h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNAR,non analgesic requirement; NA, not applicable.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBiochemical findings of the groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTAP 1\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTAP 2\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl-g\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.028*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7782.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1901.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14112.57\u0026thinsp;\u0026plusmn;\u0026thinsp;23237.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7355\u0026thinsp;\u0026plusmn;\u0026thinsp;1715.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4691.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1621.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4658.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1369.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4361.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1279.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.604\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphocyte\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2307.77\u0026thinsp;\u0026plusmn;\u0026thinsp;760.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2455.35\u0026thinsp;\u0026plusmn;\u0026thinsp;694.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2163.91\u0026thinsp;\u0026plusmn;\u0026thinsp;694.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonocyte\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e439.3\u0026thinsp;\u0026plusmn;\u0026thinsp;142.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e439.64\u0026thinsp;\u0026plusmn;\u0026thinsp;115.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e426.95\u0026thinsp;\u0026plusmn;\u0026thinsp;131.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEosinophile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e210\u0026thinsp;\u0026plusmn;\u0026thinsp;217.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193.21\u0026thinsp;\u0026plusmn;\u0026thinsp;115.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e197.82\u0026thinsp;\u0026plusmn;\u0026thinsp;158.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e263916.66\u0026thinsp;\u0026plusmn;\u0026thinsp;70117.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e282928.57\u0026thinsp;\u0026plusmn;\u0026thinsp;78842.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e281673.91\u0026thinsp;\u0026plusmn;\u0026thinsp;70974.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRDW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85.27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.92\u0026thinsp;\u0026plusmn;\u0026thinsp;6.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.12\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.608\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.68\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.36\u0026thinsp;\u0026plusmn;\u0026thinsp;8.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlt/Lymp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123.5\u0026thinsp;\u0026plusmn;\u0026thinsp;43.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122.3\u0026thinsp;\u0026plusmn;\u0026thinsp;39.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e175.64\u0026thinsp;\u0026plusmn;\u0026thinsp;263.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeut/Lymp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.874\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eKruskal-Wallis test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTukey\u0026rsquo;s HSD test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for Hb:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.699; TAP 1-Control-g: \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.030*\u003c/b\u003e; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.275\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for WBC:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.088; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.985; TAP 2-Control-g: \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.048*\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for Neutrophil:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.995; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.550; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.658\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for Lymphocyte:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.693; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.640; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.211\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for Monocyte:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;\u0026gt;\u0026thinsp;0.05; TAP 1-Control-g : p\u0026thinsp;=\u0026thinsp;0.907; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.915\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for Eosinophil:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.920; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.945; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.993\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for Plt:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.555; TAP 1-Control-g : p\u0026thinsp;=\u0026thinsp;0.518; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.997\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for RDW:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.042*\u003c/b\u003e; TAP 1-Control-g : p\u0026thinsp;=\u0026thinsp;0.798; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.124\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for MCV:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.611; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.632; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.988\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for MPV:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.999; TAP 1-Control-g : p\u0026thinsp;=\u0026thinsp;0.944; TAP 2-Control-g : p\u0026thinsp;=\u0026thinsp;0.967\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for PCT:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.943; TAP 1-Control-g : p\u0026thinsp;=\u0026thinsp;0.984; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.982\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for PDW:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.633; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.588; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.151\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for Plt/Lymp:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;\u0026gt;\u0026thinsp;0.05; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.372; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.409\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparison for Neut/Lymp:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTAP 1-TAP 2: p\u0026thinsp;=\u0026thinsp;0.782; TAP 1-Control-g: p\u0026thinsp;=\u0026thinsp;0.872; TAP 2-Control-g: p\u0026thinsp;=\u0026thinsp;0.476\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of nausea-vomiting scores of the groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTAP 1\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTAP 2\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl-g\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNV-0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNV-8h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNV-12h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.045*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNV-24h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eMann-Whitney U test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere is no correlation presented in TAP 1, TAP 2 and Control-g between Plt, MPV, PCT, MPV, PDW, Plt/Lymp ratio, Neut/Lymp ratio and VAS in first, 8th, 12th, and 24th hours, NSAID in first, 8th, 12th, and 24th hours postoperatively (ρ\u0026thinsp;\u0026lt;\u0026thinsp;0.300, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe present study revealed that the 6th and 12th hour Visual Analog Scale (VAS) scores were significantly lower in the TAP-2 group (patients who received a transversus abdominis plane (TAP) block without antiemetics) compared to the Control-g (patients who did not receive a TAP block). Additionally, nausea and vomiting scores at the 8th and 12th hours were significantly higher in the Control-g group than in the TAP-2 group. The analgesic requirement at the 8th hour was also higher in the Control-g compared to the TAP-2 group. However, no significant correlation was found between platelet indices (PLT, PCT, MPV, PDW), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and postoperative pain scores or analgesic requirements in the TAP-1, TAP-2, or Control-g.\u003c/p\u003e \u003cp\u003eNumerous studies have explored pain management strategies following laparoscopic cholecystectomy (LC). Recent trends emphasize opioid-sparing analgesic regimens to reduce side effects and shorten hospital stays. A meta-analysis by Bisgard et al., which included 64 randomized studies with 5,018 patients, highlighted the use of preoperative dexamethasone, intraoperative local anesthetics, and multimodal analgesia with NSAIDs as effective strategies, with opioids reserved for cases where these methods failed [\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Yacobsson\u0026rsquo;s review discussed TAP blocks as an alternative to intrathecal and epidural morphine analgesia, particularly in obese patients undergoing LC or colon surgery. The review emphasized the need for further research integrating TAP blocks into multimodal analgesia protocols, alongside local infiltration and intrathecal opioid techniques [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies comparing unilateral and bilateral TAP blocks for post-LC analgesia have demonstrated reduced tramadol consumption in patients receiving TAP blocks, though no significant differences were observed in nausea-vomiting (NV) scores or ondansetron consumption [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Siddiqui et al.\u0026rsquo;s meta-analysis noted heterogeneous outcomes for TAP blocks in various surgeries, including LC, but consistently highlighted their role in reducing opioid use and delaying the need for rescue analgesics [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearch comparing posterior and lateral TAP block approaches has shown that both techniques provide effective analgesia in the early postoperative period (0\u0026ndash;12 hours), though the posterior approach may offer longer-lasting analgesia. However, the efficacy of both techniques beyond 12 hours remains debated [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Sahap et al. found that TAP blocks, whether administered under ultrasound guidance or laparoscopically, significantly reduced VAS scores and tramadol consumption compared to controls, with no significant difference between the two TAP block methods [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The broader spread of local anesthetic in the posterior approach has been noted as a potential advantage [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, bilateral TAP blocks were performed using a posterior approach, with 20 mL of 0.25% bupivacaine administered on each side. The TAP-2 group exhibited lower VAS scores at 6 and 12 hours and reduced analgesic consumption in the first 8 hours compared to the control group. No opioids were used postoperatively, and 24-hour diclofenac sodium requirements were significantly higher in the control group, consistent with literature supporting the efficacy of TAP blocks in providing high-quality analgesia.\u003c/p\u003e \u003cp\u003eStudies investigating the relationship between platelet indices and inflammatory processes have explored their potential role in pain physiology. Rathe et al. demonstrated a significant correlation between preoperative and postoperative NLR and post-arthroplasty pain, suggesting that NLR values could guide analgesic decisions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Elevated NLR and PLR have been associated with inflammation and pain, while platelet indices such as MPV, PDW, and PCT have been linked to platelet activation and function [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearch on nonspecific abdominal pain (NAP) and chest pain has identified MPV as a potential biomarker for pain and inflammation [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Yıldız et al. proposed MPV as a useful indicator in emergency abdominal pain cases [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Turgut et al. found that higher NLR correlated with increased postoperative analgesic consumption in orthognathic surgery, while Yaşlı et al. highlighted the role of PLT and PCT levels in predicting postoperative pain and edema [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith the results of these studies, the authors asserted that the use of analgesic medications which enhance platelet function could be more effective for postoperative pain management when compared to opioids. On the other hand, some studies show that there is a correlation between MPV and inflammatory conditions and postoperative nausea and vomiting. This correlation makes us think that the higher PLT count could be the most effective predictor for postoperative pain and it is also seen that there is a significant correlation between the higher PCT level and analgesic consumption in postoperative 24 hours [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In their study, T\u0026uuml;z\u0026uuml;ner et al. compared the use of postoperative nonselective siklooksijenaz-1 enzyme (COX-1) and (COX-2) inhibitor diclofenac sodium, tramadol and placebo in terms of analgesic consumption and it was found that the use of analgesics was higher in the placebo group. Although it is not statistically significant in this study, diclofenac group was the one with the less and the least analgesic consumption when compared to tramadol [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe retrospective study by Adıg\u0026uuml;zel et al. on the predictive value of NLR, PLR, SII as biomarkers for inflammation in patients undergoing LC is similar to our study in LC patients undergoing TAP block, if we take our control group as an example. In this study, the authors found only a weak statistical association between PDW and the dose of tramadol used. However, they stated that these parameters were ineffective in predicting pain and tramadol consumption after LC. They recommended randomized clinical trials on this subject[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these findings, our study found no significant correlation between platelet indices (PLT, PDW, MPV, PCT, PLR, NLR) and postoperative pain scores or analgesic requirements. This discrepancy may be attributed to the retrospective design of our study, which limited our ability to control for confounding variables.\u003c/p\u003e \u003cp\u003ePostoperative Nausea and Vomiting, defined as nausea, retching, or vomiting within 48 hours post-surgery, affects 20\u0026ndash;30% of surgical patients without prophylaxis. Laparoscopic procedures, including LC, are known risk factors for PONV, exacerbated by the use of inhalation anesthetics and opioids [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u0026Ouml;z\u0026ccedil;ift\u0026ccedil;i et al. found no significant difference in NV scores or ondansetron consumption between patients receiving unilateral or bilateral TAP blocks and controls [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Platelet serotonin levels have been implicated in PONV pathogenesis, with some studies suggesting that MPV and PLT may predict PONV risk [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In our study, nausea and vomiting scores were significantly lower in the TAP-2 group at 8 and 12 hours, likely due to the block\u0026rsquo;s effect on peritoneal and abdominal wall innervation.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the sample size was constrained by the use of a single surgeon to standardize surgical technique. Second, the retrospective design precluded postoperative hemogram analysis, limiting our ability to compare preoperative and postoperative platelet indices. Additionally, the lack of data on NSAID effects on platelet indices and the serotonin pool necessitates further prospective research with larger sample sizes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePostoperative pain and PONV are critical factors affecting patient comfort and recovery. Our findings suggest that TAP blocks not only provide effective analgesia but also reduce PONV, likely due to their impact on peritoneal and abdominal wall innervation. While platelet indices have been implicated in inflammation and pain, our study did not find a significant correlation, highlighting the need for prospective, controlled studies to further elucidate these relationships.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etransvers abdominis plane\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUSG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eultrasonography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePVI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eplatelet variable index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePLT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eplatelet\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePLR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eplatelet -lymphocyte ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMPW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emean platelet volume\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePDW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eplatelet distribution width\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethrombocytocrit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eP-LCR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eplatelet large cell ratio are the\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNLR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eneutrophile-lymphocyte ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003evisual analog skala\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePONVS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epostoperatif nausea-vomiting scores\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNSAI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003enonsteroid antiinflamatuar\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elaparoscopic cholecystectomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePNV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epostoperatif nausea-vomiting\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Mersin University Ethics Committee (Approval number: 2024/7/2024-696). The need for informed consent was waived because of the retrospective design of the study and the use of anonymized personal information.\u003c/p\u003e\n\u003cp\u003eConsent to participate: \u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication:\u0026nbsp;\u003c/em\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests:\u0026nbsp;\u003c/em\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClinical trial number:\u0026nbsp;\u003c/em\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e :No funding\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design of this study.\u003c/p\u003e\n\u003cp\u003eMaterial preparation and data collection were performed by HO, SA, \u0026Ccedil;Y, EHE, MK.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Analysis was performed by SD and HO.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The first draft of the manuscript was written by BA,SD and HO, and all the authors commented on the previous versions of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All authors have reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor\u0026rsquo;s Details\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHarun \u0026Ouml;zmen*, Serkan Doğru, \u0026Ccedil;iğdem Yal\u0026ccedil;ın, Erdi H\u0026uuml;seyin Erdem, Bahar Aydınlı, Mehlika Kurtay( Mersin City Hospital, Department of Anesthesiology and Reanimation, \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Mersin, Turkey)\u003c/p\u003e\n\u003cp\u003eSinan Aslan (Mersin City Hospital, Department of General Surgery, \u0026nbsp;Mersin, Turkey )\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements:\u0026nbsp;\u003c/em\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eCorresponding author: Harun \u0026Ouml;zmen\u003c/p\u003e\n\u003cp\u003eCorresponding author e-mail:[email protected]\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePrior Presentations:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eNo potential conflict of interest relevant to this article was reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e:\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRB number:\u003c/strong\u003e 2024-696 \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch registration number\u003c/strong\u003e: 2793419\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCoşarcan, S. 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PMID: 18022468\u003c/li\u003e\n\u003cli\u003eCanikli Adıg\u0026uuml;zel Ş, Akyurt D, Bahadır Altun H, Tulgar S, \u0026Uuml;ltan \u0026Ouml;zgen G. Can Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, or Systemic Immune Inflammation Index Be an Indicator of Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy? Cureus. 2023 Jan 19;15(1):e33955. doi: 10.7759/cureus.33955. PMID: 36820108; PMCID: PMC9938425.\u003c/li\u003e\n\u003cli\u003ePostoperatıve Nausea And Vomıtıng .Uyar B S, D\u0026ouml;nmez A. \u003cem\u003eJournal of Anesthesia\u003c/em\u003e - \u003cem\u003eJARSS 2018\u003c/em\u003e; \u003cem\u003e26\u003c/em\u003e (\u003cem\u003e3): 120\u003c/em\u003e - \u003cem\u003e126\u003c/em\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"transverse abdominus plane block, analgesia, analgesic consumption, nausea, vomiting","lastPublishedDoi":"10.21203/rs.3.rs-6214832/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6214832/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eThe transversus abdominis plane (TAP) block is widely utilized for postoperative analgesia following laparoscopic cholecystectomy. The posterior approach, in particular, has been shown to provide effective analgesia due to its superior distribution of local anesthetic within the plane.\u003c/p\u003e\u003ch2\u003eAim:\u003c/h2\u003e \u003cp\u003eThis study aimed to compare analgesic consumption, pain scores, nausea and vomiting scores, and hemogram parameters between laparoscopic cholecystectomy patients who received bilateral TAP block and those who did not receive the block and were managed with conventional analgesics.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed the medical records of 109 patients who underwent laparoscopic cholecystectomy. Patients were categorized into three groups based on whether they received a TAP block or not. Demographic data, pain scores (using the Visual Analog Scale, VAS), nausea and vomiting scores, analgesic consumption, and the administration of antiemetics were evaluated.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe study demonstrated that the 6th and 12th hour VAS scores were significantly lower in the TAP-2 group compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, the 24-hour VAS scores in the TAP-2 group were significantly lower than those in the TAP-1 group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Nausea and vomiting scores at 8 and 12 hours were significantly higher in the Control group compared to the TAP-2 group (p\u0026thinsp;=\u0026thinsp;0.002 and p\u0026thinsp;=\u0026thinsp;0.045, respectively). Analgesic requirements at the 8th hour were significantly higher in the Control group, where no block was administered, compared to the TAP-2 group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant correlation was observed between platelet (Plt), procalcitonin (PCT), mean platelet volume (MPV), platelet distribution width (PDW), platelet-to-lymphocyte ratio (Plt/Lymp), neutrophil-to-lymphocyte ratio (Neut/Lymp), and postoperative pain scores or analgesic requirements in the TAP-1, TAP-2, and Control groups (ρ\u0026thinsp;\u0026lt;\u0026thinsp;0.400, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003ePatients who underwent bilateral TAP block exhibited significantly lower analgesic consumption and pain scores during the first 8 hours postoperatively compared to those who did not receive the block. Additionally, postoperative nausea and vomiting scores were significantly reduced in patients who received the TAP block. These findings suggest that the TAP block is an effective adjunct for enhancing postoperative pain management and reducing opioid-related side effects in laparoscopic cholecystectomy patients.\u003c/p\u003e","manuscriptTitle":"Analyzing the Impact of Transvers Abdominis Plane Block, PLR, NLR on Platelet Functions, Postoperative Pain, Analgesic Consumption and Nausea-Vomiting in the Patients who Received Laparoscopic Cholecystectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-31 12:00:50","doi":"10.21203/rs.3.rs-6214832/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a3726c71-f68a-4dc4-9867-e3df2b27b9df","owner":[],"postedDate":"March 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-28T06:23:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-31 12:00:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6214832","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6214832","identity":"rs-6214832","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}