Efficacy of Ultrasound Guided Bilateral Subcostal Transversus Abdominis Plane (Tap) Block versus Port- Site Instillation of Bupivacaine in Laparoscopic Cholecystectomy for Post Operative Analgesia at Tertiary Care Centre, Ahmedabad

Post Operative Analgesia in Laparoscopic Cholecystectomy

Abstract

Background: In this double blinded, randomized controlled clinical study, we have investigated whether ultrasound guided bilateral subcostal transversus abdominis plane (STAP) block was superior to port site instillation of the local anaesthetic in reducing postoperative pain and total rescue analgesic consumption. Hence the aim of the present study was to compare efficacy of ultrasound-guided bilateral subcostal transverses abdominis plane block versus port-site Instillation (Intraperitoneal instillation) of bupivacaine for post operative analgesia. Subjects and Methods: Sample was randomized by computer generated randomization sheet of allocation for 80 patients. All patients stand on an equal chance of getting into any group. Group T- 40 patients to receive ultrasound-guided bilateral subcostal TAP block with 0.25% bupivacaine 20 ml on each side (total 40 ml) at the end of the surgery before extubation Group I- 40 patients to receive port-site instillation with 0.25% bupivacaine (total 40 ml) at the end of the surgery before extubation. Results: Patients were administered aqueous solution of Injection Diclofenac 75 mg diluted intravenously as rescue analgesic when VAS >=4 or patient complain of pain. Mean time to first rescue analgesic requirement in the postoperative period for group T was 519.80114.45 minutes and group I was 344.40137.09 minutes. There was statistically highly significant difference found in the mean time for first rescue analgesic requirement between groups T and I (p<0.001). Conclusion: Ultrasound guided Subcostal TAP block is effective and found to be superior in providing post operative pain relief after laparoscopic cholecystectomy with following advantages, in comparison to port site instillation: reduced pain scores, longer duration of analgesia and less post operative analgesic requirement and complications.