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

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.

Comparison of ultrasound-guided bilateral subcostal transversus abdominis plane block and port-site infiltration with bupivacaine in laparoscopic cholecystectomy

“…In another study post-operative morphine consumption and pain scores were assessed after giving TAP block or port-site infiltration after single-incision laparoscopic cholecystectomy. [ 19 ] In contrast to our study, they found that TAP block was not effective in reducing the 24 h morphine consumption even though it provided analgesia in the early post-operative period.…”

A Meta-Analysis of Randomized Controlled Trials Concerning the Efficacy of Transversus Abdominis Plane Block for Pain Control After Laparoscopic Cholecystectomy

“…For the primary outcome of pain control at rest and during coughing, out of 23 studies, 22 studies were included in the analysis for which references have been provided in Table 3 . Some of the included studies had reported data only for one or two timepoints for post-operative pain score either for 0 or 6 or 12 or 24 h at rest or during coughing ( 17 , 18 , 20 , 22 – 24 , 26 , 28 , 30 , 36 – 38 ). A single study by El-Dawlatly et al ( 27 ) only provided the data for morphine consumption.…”

Laparoscopic-guided transversus abdominis plane block versus trocar site local anesthetic infiltration in gynecologic laparoscopy

“…Various studies have compared ultrasound-guided TAP block with trocar site local anesthetic infiltration. The results varied from significant reduction [33] to non-significant reduction [34] in cumulative morphine use at 24 h with TAP blocks compared with local anesthetic infiltration. A recent trial [35] has reported that ultrasound-guided TAP block has no significant clinical benefit over trocar site local anesthetic infiltration in laparoscopic nephrectomy.…”