A comparison of analgesic efficacy between oblique subcostal transversus abdominis plane block and intravenous morphine for laparascopic cholecystectomy. A prospective randomized controlled trial

Abstract

BackgroundThe ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block provides a wider area of sensory block to the anterior abdominal wall than the classical posterior approach. We compared the intra-operative analgesic efficacy of OSTAP block with conventional intravenous (IV) morphine during laparoscopic cholecystectomy.MethodsForty adult patients undergoing laparoscopic cholecystectomy under standard general anesthesia, were randomly assigned for either bilateral OSTAP block using 1.5 mg/kg ropivacaine on each side (n = 20) or IV morphine 0.1 mg/kg (n = 20). The intra-operative pulse rate, systolic and diastolic blood pressure and mean arterial blood pressure were monitored every five minutes. Repetitive boluses of IV fentanyl 0.5 µg/kg were given as rescue analgesia when any of the above-mentioned parameters rose more than 15% from the baseline values. Time to extubation was documented. Additional boluses of IV morphine 0.05 mg/kg were administered in the recovery room if the recorded visual analogue score (VAS) was more than 4. Nausea and vomiting score, as well as sedation score were recorded.ResultsThe morphine group required more rescue fentanyl as compared to the OSTAP block group but the difference was not significant statistically. Time to extubation was significantly shorter in the OSTAP block group (mean [SD] 10.4 [2.60] vs 12.4 [2.54] min; P = 0.021). Both methods provided excellent analgesia and did not differ in postoperative morphine requirements. No between-group differences in sedation score and incidence of nausea and vomiting were demonstrated.ConclusionsUltrasound-guided OSTAP block has an important role as part of balanced anesthesia. It is as efficacious as IV morphine in providing effective analgesia during laparoscopic cholecystectomy.

Comparison of Transversus Abdominis Plane Block and IV Patient-Controlled Analgesia after Lower Abdominal Surgery

“…It was suggested that the application of TAP block before surgery decreases the peroperative use of opioids remarkably (10). However, we applied TAP block after surgery because we observed, in our preliminary study, that preoperative TAP block, especially in high doses, caused the surgeon to have difficulties in determining the anatomy and prolonged the duration of surgery in upper abdominal operations such as inguinal hernia and varicocele.…”

Analgesic efficacy of pre‐operative stellate ganglion block on postoperative pain relief: a randomised controlled trial

“…Sedation was assessed using a four‐point scale (0: completely alert; 1: sleepy occasionally but rousable; 2: asleep often but rousable; 3: asleep and unrousable) . Nausea and vomiting were assessed using a four‐point scale (0: no nausea and vomiting; 1: slight nausea resolving without treatment; 2: slight nausea and/or vomiting responding to treatment; 3: nausea and/or vomiting not responding to treatment) .…”

Essentials of Our Current Understanding

“…Subsequent studies have shown marginal benefit of TAP blocks in reducing opioid consumption or pain scores. [72][73][74][75] Overall, TAP blocks do not have a routine place in laparoscopic cholecystectomy, given the low pain scores that can be achieved with systemic multimodal analgesia and local anesthetic infiltration of port sites. 72,75 Bariatric surgery Two RCTs have examined the analgesic efficacy of TAP blocks in laparoscopic gastric (roux-en-Y) bypass surgery, with conflicting results.…”