The efficacy of oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy - a prospective, placebo controlled study

Caius Mihai Breazu, Lidia Ciobanu, Adina Hadade, Adrian Bartos, Călin Mitre, Petru Adrian Mircea, Daniela Ionescu, Caius Mihai Breazu, Lidia Ciobanu, Adina Hadade, Adrian Bartos, Călin Mitre, Petru Adrian Mircea, Daniela Ionescu

Abstract

Introduction: Pain control after a laparoscopic cholecystectomy can represent a challenge, considering the side effects due to standard analgesia methods. Recently the transversus abdominis plane block (TAP Block) has been used as a part of multimodal analgesia with promising results. The subcostal approach (OSTAP Block), a variant on the TAP block, produces reliable unilateral supraumbilical analgesia. This study evaluated the efficacy of the OSTAP block with bupivacaine in laparoscopic cholecystectomy compared with the placebo OSTAP block.

Material and methods: Sixty ASA I/II adult patients listed for elective laparoscopic cholecystectomy were randomly allocated in one of two groups: Group A (OSTAP placebo) received preoperatively bilateral OSTAP block with sterile normal saline and Group B (OSTAP bupivacaine) received bilateral preoperatively OSTAP block with the same volumes of 0.25% bupivacaine. Twenty-four hours postoperative opioid consumption, the dose of opioid required during surgery, opioid dose in the recovery unit (PACU) and PACU length of stay were evaluated. The quality of analgesia was assessed by the Visual Analogue Scale (VAS) at specific interval hours during 24 h, at rest and with movement.

Results: The mean intraoperative opioid consumption showed a significant difference between the two groups, (385 ± 72.52 mg in group A vs 173.67 ± 48.60 mg in group B, p < 0.001). The mean 24 h opioid consumption showed a statistically significant difference between groups (32 ± 26.05 mg vs 79 ± 16.68 mg, p < 0.001). PACU length of stay was significantly lower for group B patients compared with group A patients (20.67 ± 11.27 min vs 41.67 ± 12.41 min, p < 0.001). The OSTAP bupivacaine group had a statistically significant lower pain score than the OSTAP placebo group at 0, 2, 4, 6, 12, 24 h, both at rest and with movement. No signs or symptoms of local anaesthetic systemic toxicity or other complications were detected.

Conclusion: OSTAP block with bupivacaine 0.25% can provide effective analgesia up to 24 hours after laparoscopic cholecystectomy when combined with conventional multimodal analgesia regimen.

Keywords: analgesia; laparoscopic cholecystectomy; oblique subcostal transversus abdominis plane block; pethidine.

Conflict of interest statement

Conflict of interest Nothing to declare

Figures

Fig. 1
Fig. 1
A – Placement of ultrasound probe for subcostal TAP blocks; B – Ultrasound anatomy of TAP (transversus abdominis plane) at the fascia layer between TAM (transversus abdominis muscle) and RAM (rectus abdominis muscle)
Fig. 2
Fig. 2
Flowchart of participants through the study

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