Comparison of Analgesic Efficacy of Ultrasound Guided Subcostal Transversus Abdominis Plane Block with Port Site Infiltration Following Laparoscopic Cholecystectomy

Abstract

Background: Patients have significant pain following laparoscopic cholecystectomy. Several modalities have been used to manage this pain. Subcostal transversus abdominis plane (TAP) block is one of the components of multimodal analgesia and has been described as an effective technique for postoperative pain management. This study compares the impact of subcostal TAP block with port site local infiltration following laparoscopic cholecystectomy for postoperative pain and opioid consumption.Methods: This is a prospective, randomized, interventional study. Sixty patients were enrolled and divided into two groups having 30 patients in each group. Group A received bilateral ultrasound guided subcostal TAP block with 10 mL of 0.25% bupivacaine after the completion of surgery. Group B received similar amount of local anesthetic infiltrated over all the laparoscopic port sites. Pain at rest and on movement was assessed using VAS scale in post-operative period at 0 min, 30 min, 2, 4, 6, 12 and 24 hours. Time of first rescue analgesic requirement and total opioid consumption over 24 hours were recorded.Results: Patients receiving Subcostal TAP block had reduced postoperative pain as compared to port site infiltration and statistically significantly in first two hours after surgery. The 24 hours opioids consumption was significantly less (125mg ±25.42 versus 175mg ±25.42, p <0.001) in Subcostal TAP block group. Time for request of first rescue analgesic was prolonged in patients receiving the Subcostal TAP block (3.20±0.84 hours vs 1.70±0.65 hours, p <0.001). Conclusions: Ultrasound guided bilateral Subcostal TAP block provides effective post-operative analgesia and reduces opioid consumption in patients undergoing laparoscopic cholecystectomy. Keywords: Laparoscopic cholecystectomy; post-operative analgesia; subcostal TAP block.

Comparison of Subcostal Transversus Abdominis Plane Block With Port Site Infiltration of Local Anaesthesia in Laparoscopic Cholecystectomy

“…Baral et al 17 , in 2019 revealed the 24 hours' opioids consumption was significantly less (125 mg ± 25.42 versus 175 mg ± 25.42, p<0.001) in Subcostal TAP block group. This difference may be due to difference in study method and the type of blockade such as TAP, blind, subcostal or posterior method.…”

A Meta-Analysis of Randomized Controlled Trials Concerning the Efficacy of Transversus Abdominis Plane Block for Pain Control After Laparoscopic Cholecystectomy

“…All included studies were of moderate or high quality based on JADAD Score ( Table 2 ). Out of 23 included studies, 14 studies ( 16 – 18 , 23 – 25 , 27 , 30 , 31 , 34 – 38 , 40 ) were conducted in Caucasian individuals, with the remaining nine studies ( 19 – 22 , 26 , 28 , 29 , 32 , 33 ) were conducted on an Asian population.…”

Comparison of laparoscopy-guided with ultrasound-guided subcostal transversus abdominis plane block in laparoscopic cholecystectomy – A prospective, randomised study

“…The subcostal approach to the TAP block has been documented to be effective for upper abdominal surgeries as it blocks the anterior cutaneous branches of the intercostal nerves (T7-T10). [ 8 ] Several studies have established the role of ultrasound-guided subcostal TAP block in providing better pain scores and diminishing morphine consumption in LC. [ 9 10 11 ] But to perform a UG subcostal TAP block requires an additional skill for anaesthesiologists and not all of them are trained in performing UG nerve blockade.…”

“…But we used paracetamol 6 th hourly as part of the multimodal regime. [ 8 ] Khan et al . compared the UG posterior TAP block with the subcostal approach with 63 patients in each group.…”

“…were able to demonstrate reduced consumption of tramadol and pethidine respectively following UG subcostal TAP block. [ 6 8 ] Rajanbabu et al . compared postoperative pain scores and analgesic consumption between bilateral TAP block under direct laparoscopic vision with 15 mL of 0.1% ropivacaine on each side and routine port site infiltration with 30 mL of 0.1% ropivacaine following robotic-assisted gynaecologic surgery.…”