Excellent postoperative analgesia with the addition of hyaluronidase to lignocaine for subcostal TAP block used in conjunction with systemic analgesia for laparoscopic cholecystectomy

Abstract

Subcostal transversus abdominis plane (TAP) blocks provide good postoperative analgesia for laparoscopic cholecystectomies. We hypothesised that adding hyaluronidase may improve the efficacy of this technique by increasing spread of the local anaesthetic (LA). In this case, we performed a bilateral ultrasound-guided subcostal TAP block using lignocaine (40 mL 1%) with hyaluronidase (75 IU/mL) for postoperative analgesia following elective laparoscopic cholecystectomy. It was used in combination with intraoperative morphine, diclofenac and paracetamol. Regular paracetamol was administered postoperatively. We monitored serial serum lignocaine levels and recorded the patient's visual analogue scale (VAS) pain scores postoperatively. We found that the patient experienced excellent analgesia throughout the postoperative period and that the serum lignocaine levels did not exceed the therapeutic range.

Ultrasound-guided combined fascial plane blocks as an intervention for pain management after laparoscopic cholecystectomy: A randomized control study

“…[ 3 ] Central neuraxial blockade and intraperitoneal lavage of local anesthetic have been super ceded by TAP block, PSI and supplementary opioid analgesia. [ 4 5 ]…”

“…[ 6 7 8 ] Pain associated with laparoscopic cholecystectomy is mediated by segmental innervation by nociceptor afferent pathways along the trans-abdominal fascial plane. [ 5 8 ] Hebbard et al . described the ultrasound-guided continuous oblique subcostal TAP (OSTAP) block which provides analgesia to entire abdomen continuously, especially for supra-umbilical incision.…”

“…[ 13 ] Subcostal TAP block provides excellent postoperative analgesia for laparoscopic cholecystectomy with good opioid sparing effects, faster recovery profile, and reliable unilateral supra-umbilical analgesia. [ 4 5 7 13 14 ]…”

Effects of intravenously infused lidocaine on analgesia and gastrointestinal function of patients receiving laparoscopic common bile duct exploration

“…The pain threshold increases at low plasma concentration which, if exceeds 5 μg/ml, may result in convulsion. 8 …”

The transversus abdominis plane block: Case for optimal tap

“…[ 15 16 ] Hyaluronidase added to lignocaine in a bilateral subcostal TAP block for laparoscopic cholecystectomy was found to be associated with excellent analgesia throughout the post-operative period. [ 17 ] However, addition of clonidine to a TAP block with bupivacaine in women undergoing elective caesarean delivery did not produce significant change in pain scores. [ 18 ]…”