Comparison of ultrasound-guided bilateral subcostal transversus abdominis plane block and port-site infiltration with bupivacaine in laparoscopic cholecystectomy

Abstract

Background and Aims:Many patients experience moderate-to-severe pain after laparoscopic cholecystectomy. We aimed to compare the efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane (TAP) block with port-site infiltration for post-operative analgesia after laparoscopic cholecystectomy.Methods:Patients undergoing elective laparoscopic cholecystectomy under general anaesthesia were divided into two groups of 40 each to receive ultrasound-guided bilateral subcostal TAP block (T) with 0.25% bupivacaine 20 ml each side or port-site infiltration with 0.5% bupivacaine 5 ml each at 4 ports (I) at the end of the surgery before extubation. All patients received paracetamol 1 g intravenous 8th hourly. Tramadol 1 mg/kg intravenous bolus and diclofenac 1 mg/kg intravenous infusion were used as the first- and second-line rescue analgesics when Numerical Rating Scale (NRS) ≥4, or when the patient complained of pain. NRS at 1, 2, 3, 6, 12 and 24 h after surgery, time to first analgesic request and total dose of analgesics in 24 h were recorded. Chi-square test and independent t-test were used to compare qualitative and quantitative data, respectively.Results:Time to first analgesic (mean±SD) in Group I and Group T was 292.7 ± 67.03 and 510.3 ± 154.55 min and mean tramadol required was141.8 ± 60.01 mg and 48.69 ± 36.14 mg, respectively (P = 0.001 for both). Mean NRS at 2, 3, 6, 12 and 24 h was significantly lower in Group T.Conclusion:Ultrasound-guided bilateral subcostal TAP block provides superior post-operative analgesia after laparoscopic cholecystectomy compared to port-site infiltration.

Efficacy of The Subcostal Transversus Abdominis Plane Block In Laparoscopic Cholecystectomy: A Comparison With Conventional Port- Site Infiltration

“…21 In our study we found that differences in 24 hours VAS score was statistically significant. In study conducted by Suseela et al 22 with sample size of 40 in each group found ultrasound guided Subcostal TAP block is superior to port-site infiltration in providing post-operative analgesia after laparoscopic cholecystectomy with reduced pain scores(p<0.001) which is consistent with our study. Bhalekar et al reported lower VAS score in Subcostal TAP group than control group at 0hr (2.1 vs 4.2), 2hr (2.1 vs 4.2), 4hr (2.0 vs 4.1), 8hr (1.8 vs 4.0), 16hr (1.7 vs 3.9) and 24hr (1.5 vs 3.7) .…”

Ultrasound-guided bilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A randomized controlled trial

“…[ 10 ] recommended the use of paracetamol or nonsteroidal anti-inflammatory drugs preoperatively and LA infiltration at port sites to curb pain after LC. The other modalities such as TAP[ 11 ] and OSTAP block[ 4 ] tried so far mostly cover the somatic component and pain from parietal peritoneum, but the visceral pain of dissection of the gallbladder from the liver bed is left uncovered. The paravertebral block affects both somatic and visceral pain[ 12 ] but has its own set of disadvantages.…”

“…Patient-controlled analgesia with opioids, port-site infiltration, intraperitoneal instillation with local anesthetics (LA), transversus abdominis plane (TAP) block,[ 3 ] and oblique subcostal transversus abdominis plane (OSTAP) block, paravertebral block have been tried. [ 4 ] Except paravertebral block, these techniques affect only somatic pain and can be inadequate in some cases. [ 2 ] Thus, the quest for a better analgesic modality is ongoing.…”

Efficacy of laparoscopic-guided transversus abdominis plane block for patients undergoing robotic-assisted gynaecologic surgery: A randomised control trial

“…Studies have shown that TAP blocks performed by either blind or under ultrasound guidance are effective in providing analgesia in laparoscopic surgeries. [45789] Blind TAP blocks are performed after locating the triangle of Petit using the double pop loss of resistance technique. [12] It is associated with a high incidence of penetrative injuries and a higher failure rate.…”

“…[123] It is also used in laparoscopic surgeries to reduce postoperative pain and opioid requirements. [4567] Studies have examined the effectiveness of TAP block on relieving postoperative pain in laparoscopic procedures with conflicting results. Many studies showed reduction in postoperative pain and opioid consumption with TAP block.…”