Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Comparison with conventional port-site infiltration

Abstract

Background:Pain experienced following laparoscopic cholecystectomy is largely contributed by the anterior abdominal wall incisions. This study investigated whether subcostal transversus abdominis (STA) block was superior to traditional port-site infiltration of local anesthetic in reducing postoperative pain, opioid consumption, and time for recovery.Materials and Methods:Forty-three patients presenting for day case laparoscopic cholecystectomy were randomly allocated to receive either an ultrasound-guided STA block (n = 21) or port-site infiltration of local anesthetic (n = 22). Visual analog pain scores were measured at 1 and 4 h postoperatively to assess pain severity, and opioid requirement was measured in recovery and up to 8 h postoperatively. The time to discharge from recovery was recorded.Results:STA block resulted in a significant reduction in serial visual pain analog score values and significantly reduced the fentanyl requirement in recovery by >35% compared to the group that received local port-site infiltration (median 0.9 vs. 1.5 μcg/kg). Furthermore, STA block was associated with nearly a 50% reduction in overall 8-h equivalent morphine consumption (median 10 mg vs. 19 mg). In addition, STA block significantly reduced median time to discharge from recovery from 110 to 65 min.Conclusion:The results suggest that STA block provides superior postoperative analgesia and reduces opioid requirement following laparoscopic cholecystectomy. It may also improve theater efficiency by reducing time to discharge from the recovery unit.

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

“…Compared with local infiltration, TAP block significantly reduced the six-hour VAS pain score 50,51,54 by 1.4 (95% CI, -2.2 to -0.6; P \ 0.001); however, this difference was not significant at 12 hr 52,53 and 24 hr [51][52][53]55 ( Table 2). The TAP block significantly reduced 24-hr morphine consumption by 5.0 mg (95% CI, -9.5 to -0.5; P = 0.004) ( to -0.7; P \ 0.001) at 12 hr (Fig.…”

“…Six studies [50][51][52][53][54][55] investigated the efficacy of TAP block vs local anesthetic infiltration at the wound site. Compared with local infiltration, TAP block significantly reduced the six-hour VAS pain score 50,51,54 by 1.4 (95% CI, -2.2 to -0.6; P \ 0.001); however, this difference was not significant at 12 hr 52,53 and 24 hr [51][52][53]55 ( Table 2).…”

Eficácia analgésica do bloqueio ecoguiado do plano transverso do abdome – revisão sistemática

“…29---33 Em três foi comparado com placebo 29,30 ou intervenção; 28 e em dois com infiltração de AL nos pontos de entrada dos cateteres para cirurgia laparoscópica. 32,33 Em todos os casos foi feito no pré-operatório e bilateral. Em quatro casos, [29][30][31][32] uma abordagem medioaxilar foi usada e uma subcostal.…”

“…Em quatro casos, [29][30][31][32] uma abordagem medioaxilar foi usada e uma subcostal. 33 Nos ECR em que o TAP é comparado com TAP placebo ou não intervenção, [29][30][31] El-Dawlatly et al 29 compararam o efeito do TAP vs não-intervenção na colecistectomia laparoscópica e mostraram uma diminuição no consumo de morfina intraoperatória (8,6 mcg vs 23 mcg, p < 0,01) e diminuição do uso de morfina nas primeiras 24 horas (10,5 mg vs 22,8 mg, p < 0,05). Nem EVA, nem os efeitos secundários da morfina foram avaliados.…”

“…Em ECR que comparam TAP vs infiltração de AL nas incisões da colecistectomia laparoscópica 31,32 Ortiz et al 32 fizeram uma abordagem medioaxilar e não encontraram diferenças em EVA ou no consumo de analgésicos nas primeiras 24 horas ou em NVPO. Mas, recentemente, Tolchard et al, 33 com o uso de uma abordagem subcostal, mostraram que o TAP diminui o EVA em movimento, nas medidas mais precocee (oito horas, p < 0,01) e o consumo de morfina nas primeiras oito horas (9, 2 mg vs 16,8 mg, p < 0,01). Os efeitos secundários da morfina não foram avaliados.…”