Analgesic efficacy of ultrasound guided transversus abdominis plane block versus local anesthetic infiltration in adult patients undergoing single incision laparoscopic cholecystectomy: A randomized controlled trial

Ejas P Bava, Rashmi Ramachandran, Vimi Rewari, Chandralekha, Virinder Kumar Bansal, Anjan Trikha, Ejas P Bava, Rashmi Ramachandran, Vimi Rewari, Chandralekha, Virinder Kumar Bansal, Anjan Trikha

Abstract

Background: Transversus abdominis plane (TAP) block has been used to provide intra- and post-operative analgesia with single incision laparoscopic (SIL) bariatric and gynecological surgery with mixed results. Its efficacy in providing analgesia for SIL cholecystectomy (SILC) via the same approach remains unexplored.

Aims: The primary objective of our study was to compare the efficacy of bilateral TAP block with local anesthetic infiltration for perioperative analgesia in patients undergoing SILC.

Settings and design: This was a prospective, randomized, controlled, double-blinded trial performed in a tertiary care hospital.

Materials and methods: Forty-two patients undergoing SILC were randomized to receive either ultrasound-guided (USG) bilateral mid-axillary TAP blocks with 0.375% ropivacaine or local anesthetic infiltration of the port site. The primary outcome measure was the requirement of morphine in the first 24 h postoperatively.

Statistical analysis: The data were analyzed using t-test, Mann-Whitney test or Chi-square test.

Results: The 24 h morphine requirement (mean ± standard deviation) was 34.57 ± 14.64 mg in TAP group and 32.76 ± 14.34 mg in local infiltration group (P = 0.688). The number of patients requiring intraoperative supplemental fentanyl in TAP group was 8 and in local infiltration group was 16 (P = 0.028). The visual analog scale scores at rest and on coughing were significantly higher in the local infiltration group in the immediate postoperative period (P = 0.034 and P = 0.007, respectively).

Conclusion: USG bilateral TAP blocks were not effective in decreasing 24 h morphine requirement as compared to local anesthetic infiltration in patients undergoing SILC although it provided some analgesic benefit intraoperatively and in the initial 4 h postoperatively. Hence, the benefits of TAP blocks are not worth the effort and time spent for administering them for this surgery.

Keywords: Local anesthetic infiltration; morphine requirement; single incision laparoscopic cholecystectomy; single incision laparoscopic surgery; transversus abdominis plane block.

Figures

Figure 1
Figure 1
Photograph showing single incision laparoscopic cholecystectomy being done through the single port
Figure 2
Figure 2
Flow of patients in the study
Figure 3
Figure 3
Intraoperative heart rate (mean ± standard deviation) (y axis) in patients in the two groups. P<0.05 was considered to be statistically significant (x axis-time in minutes). *Statistically significant
Figure 4
Figure 4
Intraoperative mean arterial pressure (mmHg) (mean ± standard deviation) (y axis) in patients in the two groups. P<0.05 was considered to be statistically significant (x axis-time in minutes)

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