Comparison of Ultrasound-Guided Modified BRILMA Block with Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy - A Randomized Controlled Trial

Ravi Saravanan, Rajagopalan Venkatraman, Urkavalan Karthika, Ravi Saravanan, Rajagopalan Venkatraman, Urkavalan Karthika

Abstract

Background and aims: Subcostal Transversus Abdominis Plane (TAP) block is the standard practice for postoperative analgesia following laparoscopic cholecystectomy. This study aimed to compare the efficacy of modified BRILMA Block (blocking the BRanches of Intercostal nerves at the Level of Mid-Axillary line) with Subcostal TAP block for pain relief following laparoscopic cholecystectomy.

Methods: Sixty cases scheduled for laparoscopic cholecystectomy were randomly divided into two groups: modified BRILMA block (Group B) and Subcostal TAP block (Group T). General anesthesia was standardized for both groups. Blocks were performed with 20 mL of 0.2% Ropivacaine under ultrasound guidance after induction of anesthesia. Patients were administered morphine through patient controlled analgesia (PCA) pump with a bolus dose of 1 mg, 10 min lockout interval, and a basal infusion rate of 0.1 mg/h. The pain was assessed by the Visual Analog Scale (VAS) scores of one to ten. The total morphine consumption, time to first request for rescue analgesia, and VAS scores at rest and with movement, and complications, if any, were recorded.

Results: The morphine consumption in Group B was 5.67 ± 1.98 mg and in Group T was 5.17 ± 1.85 mg, which was found to be statistically insignificant (p-value = 0.317). The time to first request for rescue analgesia was 759.33 ± 80.29 min in Group B which was comparable to 854 ± 93.01 min in Group T and statistically insignificant (p-value = 0.295). The average VAS scores at rest as well as on movement were comparable in both the groups during the entire 24 h postoperative period. No complications were encountered in our study.

Conclusion: Ultrasound-guided modified BRILMA block is equally efficacious as subcostal TAP block in providing postoperative analgesia with similar morphine consumption and no significant difference in VAS scores at rest and movement following laparoscopic cholecystectomy.

Trial registration number: CTRI/2020/02/023457.

Keywords: intercostal nerves; laparoscopic cholecystectomy; pain management; patient-controlled analgesia; ultrasound-guided; visual analog scale.

Conflict of interest statement

The authors declare no conflicts of interest in this work.

© 2021 Saravanan et al.

Figures

Figure 1
Figure 1
Modified BRILMA Block.
Figure 2
Figure 2
Subcostal Transversus Abdominis Plane Block.
Figure 3
Figure 3
CONsolidated Standards Of Reporting Trials (CONSORT) flow chart.
Figure 4
Figure 4
VAS score at rest. Values are in mean with p-value at the top. * p-value (not significant).
Figure 5
Figure 5
VAS score on movement. Values are in mean with p-value at the top. * p-value (not significant).

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Source: PubMed

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