Comparison of Ultrasound-Guided Modified BRILMA Block with Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy – A Randomized Controlled Trial

Abstract

Background and Aims Subcostal Transversus Abdominis Plane (TAP) block is the standard practice for postoperative analgesia following laparoscopic cholecystectomy. This study aimed to compare the efficacy of modified BRILMA Block (blocking the BRanches of Intercostal nerves at the Level of Mid-Axillary line) with Subcostal TAP block for pain relief following laparoscopic cholecystectomy. Methods Sixty cases scheduled for laparoscopic cholecystectomy were randomly divided into two groups: modified BRILMA block (Group B) and Subcostal TAP block (Group T). General anesthesia was standardized for both groups. Blocks were performed with 20 mL of 0.2% Ropivacaine under ultrasound guidance after induction of anesthesia. Patients were administered morphine through patient controlled analgesia (PCA) pump with a bolus dose of 1 mg, 10 min lockout interval, and a basal infusion rate of 0.1 mg/h. The pain was assessed by the Visual Analog Scale (VAS) scores of one to ten. The total morphine consumption, time to first request for rescue analgesia, and VAS scores at rest and with movement, and complications, if any, were recorded. Results The morphine consumption in Group B was 5.67 ± 1.98 mg and in Group T was 5.17 ± 1.85 mg, which was found to be statistically insignificant (p-value = 0.317). The time to first request for rescue analgesia was 759.33 ± 80.29 min in Group B which was comparable to 854 ± 93.01 min in Group T and statistically insignificant (p-value = 0.295). The average VAS scores at rest as well as on movement were comparable in both the groups during the entire 24 h postoperative period. No complications were encountered in our study. Conclusion Ultrasound-guided modified BRILMA block is equally efficacious as subcostal TAP block in providing postoperative analgesia with similar morphine consumption and no significant difference in VAS scores at rest and movement following laparoscopic cholecystectomy. Trial Registration Number CTRI/2020/02/023457.

Transversus Abdominis Plane Block as a Strategy for Effective Pain Management in Patients with Pain during Laparoscopic Cholecystectomy: A Systematic Review

“…Subcostal US-TAP blockade is associated with lower postoperative opioid consumption compared with US-BRILMA [ 93 ]. Likewise, the time to request rescue analgesia was higher with the US-BRILMA blockade than with the US-TAP subcostal blockade [ 93 ].…”

“…Subcostal US-TAP blockade is associated with lower postoperative opioid consumption compared with US-BRILMA [ 93 ]. Likewise, the time to request rescue analgesia was higher with the US-BRILMA blockade than with the US-TAP subcostal blockade [ 93 ]. In addition, US-ESP blockade was found to result in less pain between 2 and 24 h postoperative compared with OSTAP blockade [ 77 ].…”

“…When bilateral double transversus abdominis plane blockade (BD-TAP) was compared with sham control, higher pain sensation was observed postoperatively in the control group at rest (2 h), during coughing (2, 6, and 48 h), and during walking (2, 6, and 48 h), with no change between the two groups at 24 h [ 91 ]. Ultrasound-guided modified BRILMA block (US-BRILMA) was compared with US-TAP block (subcostal), and it was found that postoperative Morphine consumption was higher in the US-BRILMA group (5.67 mg) than in the US-TAP block group (5.17 mg) [ 93 ]. The time to request rescue analgesia was higher in the US-BRILMA group (845) than in the US-TAP group (759.33) [ 93 ].…”

“…Ultrasound-guided modified BRILMA block (US-BRILMA) was compared with US-TAP block (subcostal), and it was found that postoperative Morphine consumption was higher in the US-BRILMA group (5.67 mg) than in the US-TAP block group (5.17 mg) [ 93 ]. The time to request rescue analgesia was higher in the US-BRILMA group (845) than in the US-TAP group (759.33) [ 93 ]. The efficacy of erector spinae block and oblique subcostal transversus abdominis block was compared, and the mean pain of the two groups between 2 and 24 h differed, with the OSTAP block group reporting more pain experience (2.27 to 0.70) [ 92 ]).…”