Ultrasound guided bilateral subcostal transversus abdominis plane block vs port site infiltration in laproscopic cholecystectomy for post operative pain relief: A randomised control trial.

Dr.Snigdha Singh; Dr. Arun kumar

Volume : VIII, Issue : VIII, August - 2019

Ultrasound guided bilateral subcostal transversus abdominis plane block vs port site infiltration in laproscopic cholecystectomy for post operative pain relief: A randomised control trial.

Dr. Snigdha Singh, Dr. Arun Kumar

Abstract :

Background: Patients experience severe pain after laparoscopic cholecystectomy mostly due to incision on anterior abdominal wall. This pain can be reduced by various methods like anterior abdominal wall blocks, port site infiltration, or systemic analgesics. This study aimed at comp� the efficacy of analgesia of ultrasound-guided bilateral subcostal transversus abdominis plane (TAP) block given after induction with port-site infiltration after surgery for analgesia post operatively after laparoscopic cholecystectomy. Methods: Patients posted for elective laparoscopic cholecystectomy under general anaesthesia were taken in the study. A total of 100 patients were involved. They were divided into two groups of 50 each. One group received ultrasound-guided bilateral subcostal TAP block (T) with 0.25% ropivacaine 15 ml each side after induction or port-site infiltration with 0.25% ropivacaine 5 ml each at 4 ports (P) at the end of the surgery before extubation. All patients received paracetamol 1 g intravenous 8th hourly. Tramadol 1 mg/kg intravenous bolus were the first line of rescue analgesia and is not to be repeated before 6 hours and diclofenac 1 mg/kg intravenous infusion was used as second-line rescue analgesics when VISUAL ANALOGUE SCORE (VAS) ≥3, or when the patient complained of pain. VAS was assessed at 0,1, 2, 3, 4, 5, 6 and 12 hours after surgery, total duration of analgesia and total dose of analgesics in 24 h were recorded. Results: Duration of analgesia was significantly longer in group T as compared to group P (p<0.01). Mean duration of analgesia in group T was 490� 80 mins whereas that in group P was 170� 62.1min. Mean tramadol required was 49 � 30 mg and 140 � 50.1 mg, respectively. Mean VAS at 0, 1, 2, 3, 6, 12 and 24 h was significantly lower in Group T. Conclusion: Ultrasound-guided bilateral subcostal TAP block provides longer duration and superior quality of post-operative analgesia after laparoscopic cholecystectomy compared to port-site infiltration. It also reduced intraoperative analgesic requirement significantly.