Comparison of Subcostal Transversus Abdominis Block with Intraperitoneal Instillation of Levobupivacaine for Pain Relief after Laparoscopic Cholecystectomy: A Prospective Study

Hariom Khandelwal, Kumar Parag, Ashutosh Singh, Nidhi Anand, Nishith Govil, Hariom Khandelwal, Kumar Parag, Ashutosh Singh, Nidhi Anand, Nishith Govil

Abstract

Background: There are several methods employed in the management of postoperative pain after laparoscopic cholecystectomy such as conventional systemic analgesics, including paracetamol, non-steroidal anti-inflammatory drugs, systemic opioids, and thoracic epidural analgesia with all having its limitations and side effects.

Aims: The present study aims to compare ultrasound-guided subcostal transversus abdominis (STA) block with intraperitoneal instillation of levobupivacaine in reducing postoperative pain, total analgesic consumption, nausea and vomiting, and recovery time in patients after elective laparoscopic cholecystectomy.

Settings and design: A prospective study was conducted between January 2017 and December 2017 in 80 patients undergoing elective laparoscopic cholecystectomy after approval of the Institutional Ethical Committee (Reference No: SGRR/IEC/05/16).

Materials and methods: Patients were randomly divided into two equal-sized (n = 40) study groups. Group 1 patients received ultrasonography-guided STA block with 0.25% levobupivacaine both sides and Group 2 patients received 0.25% levobupivacaine through intraperitoneal route.

Statistical analysis: Quantitative data were expressed in mean and standard deviation. Qualitative data were expressed in proportion and percentages. Independent t-test was applied to compare the means of quantitative data and the Chi-square test was used to compare categorical data. P < 0.05 was considered to be statistically significant. Survival curve was drawn using the log-rank test for comparing two groups.

Results: Patient characteristics regarding age, gender, and weight were comparable in the two groups. The mean Numerical Rating Scale scores were less in Group 1 than in Group 2 in the first 6 h, which was found to be statistically significant. There was no significant difference noted in pain scores after 6 h up to 24 h in postoperative area among the two groups. Pain scores for shoulder tip pain were lower in Group 2 as compared to Group 1 in the first 24 h, which was not significant statistically.

Conclusion: STA block is a better modality for analgesia compared to intraperitoneal instillation in patients undergoing elective laparoscopic cholecystectomy.

Keywords: Intraperitoneal levobupivacaine; Numerical Rating Scale; laparoscopic cholecystectomy; subcostal transversus abdominis block; ultrasonography.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Numerical rating score for pain at rest scores at immediate postoperative period, at 1, 2, 4, 6, 12, and 24 h
Figure 2
Figure 2
Numerical rating score for pain at movement scores at different time intervals
Figure 3
Figure 3
Shoulder pain at different time intervals
Figure 4
Figure 4
Kaplan–Meier survival plot for time to first analgesic request

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