<p>Effect of ultrasound-guided peripheral nerve blocks of the abdominal wall on pain relief after laparoscopic cholecystectomy</p>

Abstract

The aim of this study was to compare the effect of an ultrasound-guided transversus abdominis plane block (TAPB) and rectus sheath block (RSB) combination, an ultrasound-guided posterior TAP block combined with the local anesthetic infiltration (LAI) and LAI alone on pain relief after laparoscopic cholecystectomy (LC). Patients and methods: One hundred eighty patients who were American Society of Anesthesiologists class Ι or Π were included in this randomized, double-blind, noninferiority study. All patients underwent three-port LC and were divided into 3 groups. The LAI group had ropivacaine mixed with dexmedetomidine injected around the trocar entrance site preoperatively. The TL group underwent ultrasound-guided posterior TAPB combined with LAI, and the TR group underwent ultrasound-guided TAPB combined with RSB. Postoperative pain was evaluated at the first, 4th, 8th, 24th, and 48th hours. If the visual analogue scale (VAS) score (including incisional pain, visceral pain or shoulder pain) was >3, intravenous dezocine (0.05 mg/kg) was injected slowly. Sleep quality, total consumption of dezocine and time to unassisted walking were recorded. The Global Satisfaction Score (GSS) for analgesia was also assessed within 48 hrs. Results: No difference was found in sleep quality, time to unassisted walking, or requirement for dezocine. We also found no difference in VAS scores at each time point within 48 hrs after LC among the 3 groups, but the GSS for analgesia in the LAI group was significantly increased within 48 hrs compared with the other two groups. Conclusion: Ultrasound-guided peripheral nerve blocks of the abdominal wall can significantly relieve postoperative pain in patients undergoing LC; however, patients receiving LAI expressed more satisfaction than patients in whom other methods were used. LAI is an easy and effective method that can be recommended for routine clinical practice in LC patients who are not converted to an open procedure.

Novel Regional Nerve Blocks in Clinical Practice: Evolving Techniques for Pain Management

“…This study also utilized the VAS pain scale at different time points to determine and compare analgesia between the groups. Results showed the differences were not considerable between the three groups (43). It was concluded in this study that pain relief with TAPB was equivalent to LAI but provided little benefit in patients undergoing laparoscopic cholecystectomies.…”

“…Wu et al (43) performed a study comparing TAPB and local anesthetic infiltration (LAI) for postoperative analgesia in laparoscopic cholecystectomies. This study included one hundred eighty patients separated into three groups: LAI group using ropivacaine plus dexmedetomidine all over the trocar site before the surgery, TL group using posterior TAPB plus LAI, and the TR group using TAPB plus RSB.…”

Postoperative analgesic effect of ultrasound‐guided rectus sheath block and local anesthetic infiltration after laparoscopic cholecystectomy: Results of a prospective randomized controlled trial

“…Some reports supported the analgesic effects of LA. Wu et al compared the effect of ultrasound‐guided transversus abdominis plane block (TAPB) and an RSB combination, ultrasound‐guided posterior TAPB combined with LA, and LA alone on pain relief after LC, 13 and they found no difference in VAS scores at each timepoint within 48 hours after LC among the three groups; however, patients receiving LA at the trocar insertion sites expressed more satisfaction than patients in the other two groups. Molfino et al also reported that both TAPB and LA provided the same benefits in terms of the primary outcomes for LC, but LA was more effective for postoperative analgesia, easier to apply, and safer than other analgesic methods 14 …”

Effects of Abdominal Wall Blocks on Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Study

“…The local anesthetic used was a mixture of 0.25% ropivacaine and 1 μg/kg dexmedetomidine. In addition, a total of 40 mL of mixed local anesthetic was used for bilateral TAPB and 20 mL was used for bilateral RSB in group R, according to a previous study [ 26 ]. In group C, the same volume of normal saline was injected in the same positions and in the same way.…”