Comparison of efficacy of thoracic paravertebral block with oblique subcostal transversus abdominis plane block in open cholecystectomy

Abstract

Background and Aims: Sensory afferent nerve branches of lower six thoracic and upper lumbar nerves innervate the anterior abdominal wall and are the therapeutic focus of local anesthetics to provide analgesia for the abdominal surgical incision. Central neuraxial and regional analgesia can provide better control of pain due to right subcostal incision used in open cholecystectomy and attenuate the need for opioids. The earlier studies which showed the benefit of the thoracic paravertebral block (TPVB) for analgesia after upper abdominal surgeries did not compare TPVB with oblique subcostal transversus abdominis plane (OSTAP) block. Therefore, the current study compares the analgesic efficacy of TPVB and OSTAP block in open cholecystectomy. Material and Methods: Seventy consenting adults scheduled for open cholecystectomy were allocated to one of the two groups: ultrasound-guided TPVB (Group I) and ultrasound-guided OSTAP block (Group II). The primary objective of this study is to assess and compare tramadol consumption in 48 h in both the groups along with VAS in post anesthesia care unit, and then at 2, 4, 6, 8, 12, 24, and 48 h. The secondary objective of the study is to assess the incidence of PONV. Results: The number of doses of rescue analgesia required was less in Group I when compared with Group II ( P < 0.001). Patients in Group I had significantly lower pain scores than Group II. Although in the initial 8 h, both groups had comparable pain scores, after 8 h, these scores were significantly lower in patients in Group I. Less postoperative nausea and vomiting was seen in Group I patients (11.7%) in comparison to Group II (18.1%). Conclusion: Ultrasound-guided TPVB is superior to OSTAP block because of its association with decreased postoperative opioid consumption, lower VAS score, and reduction in opioid-related side effects. Thus, it should be strongly considered as a part of multimodal analgesia regimen in upper abdominal surgeries.

Analgesic effects of ultrasound guided paravertebral block versus transversus abdominis plane block in hepatic patients undergoing laparoscopic cholecystectomy

“…These results are supported by previous studies conducted in open cholecystectomy, 13 major gynaecological surgery, 11 and upper abdominal surgeries. 12 Our results go in accordance with those of Jindal, et al 15 who compared ultrasound-guided thoracic PVB with oblique subcostal TAP block in patients scheduled for open cholecystectomy. They revealed that patients in PVB group had lower pain score from 8 to 24 hours after surgery, less postoperative tramadol consumption, and reduction in the incidence of postoperative nausea and vomiting as opioid related adverse events than patients of TAP block group.…”

“…This can explain the haemodynamic stability throughout the procedure. Also, Jindal et al 15 informed that patients received either PVB or TAP block scheduled for open cholecystectomy showed stable haemodynamic parameters and no need for vasoactive drugs during the intraoperative period.…”

Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomized, controlled trial

“…Since postoperative pain is triggered by many reasons, pain control is provided with multimodal analgesia. It is argued that the use of regional anesthesia and analgesia in multimodal analgesia is important in pain conditions and to overcome the neuroendocrine stress response to traumas [ 16 ].…”