Background:Pain associated with laparoscopic cholecystectomy is most severe during the first 24 h and the port sites are the most painful. Recent multimodal approaches target incisional pain instead of visceral pain which has led to the emergence of abdominal fascial plane blocks. This study embraces a novel combination of two independently effective fascial plane blocks, namely rectus sheath block and subcostal transversus abdominis plane (TAP) block to alleviate postoperative pain.Study Objective:The aim is to evaluate the effectiveness of the combination of rectus sheath block and subcostal TAP block, to compare its efficacy with that of subcostal TAP block alone and with conventional port site infiltration (PSI) in alleviating postoperative pain in patients undergoing laparoscopic cholecystectomy.Methodology:This prospective, randomized control, pilot study included 61 patients scheduled for elective laparoscopic cholecystectomy and distributed among three groups, namely Group 1: Combined subcostal TAP block with rectus sheath block (n = 20); Group 2: Oblique subcostal TAP block alone (n = 21); and Group 3: PSI group as an active control (n = 20).Results:Combined group had significantly lower pain scores, higher satisfaction scores, and reduced rescue analgesia both in early and late postoperative periods than the conventional PSI group.Conclusion:Ultrasound-guided combined fascial plane blocks is a novel intervention in pain management of patients undergoing laparoscopic cholecystectomy and should become the standard of care.

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Background: The present study compared the recovery from desflurane and sevoflurane anaesthesia in patients after prolonged surgery using Index of Consciousness (IoC) monitoring scale. Materials and Methods: A total of 50 patients between 18 to 60 years of age, scheduled to undergo prolonged surgeries (lasting for more than 120 minutes) were included in this study and randomly divided in two groups (Group A: Desflurane; Group B: Sevoflurane) of 25 patients each. Results: The patients who received Desflurane had better recovery characteristics than Sevoflurane. Results showed that for attaining value of IoC-95, mean time required by patients of group A was 1.82 (± 0.50) minutes as compared to 5.36 (± 0.95) minutes by group B. Similarly for attaining value of IoC-99 (i.e. state of complete consciousness), mean time required by patients of group A was 11.04 (± 1.62) minutes as compared to 22.84 (± 4.85) minutes by group B. The results were significantly different (p< 0.05) for both the values of IoC. Conclusion: The present study concludes that inhalation based desflurane anaesthesia has a faster recovery than sevoflurane anaesthesia in prolonged surgeries, when both are guided by IoC monitoring.

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