Ultrasound Guided versus Peripheral Nerve Stimulator Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy: A Randomised Clinical Study

Abstract

Introduction: The Transversus Abdominis Plane (TAP) block is a relatively simple technique that provides analgesia that, as part of a multimodal analgesic treatment, may be useful in the prevention of postoperative pain. Ultrasound (USG) versus Peripheral Nerve Stimulator (PNS) guided TAP blocks are being frequently given postoperatively for pain these days in laparoscopic cholecystectomy. Aim: To assess the analgesic efficacy of USG guided and PNS guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy. Materials and Methods: The randomised clinical study was conducted in the Department of Anaesthesiology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India, from March 2020 to June 2021. Ninety adult patients were enrolled and randomly allocated into three groups. Group 1 (n=30) received bilateral USG-guided TAP block with 20 mL of 0.375% ropivacaine along with standard postoperative analgesia regimen. Group 2 (n=30) received bilateral PNS-guided TAP block with 20 mL 0.375% ropivacaine along with standard postoperative analgesia regimen. Group 3 (Control) (n=30) received standard postoperative analgesia regimen consisting of inj. paracetamol iv 1 gm (6 hourly) and inj. diclofenac 75 mg i.v. (12 hourly). Each patient was assessed for VAS score, duration of analgesia, total analgesic consumption and patient satisfaction for 24 hours postoperatively. Results: The average mean VAS score in first 24 hrs was 2.04±0.80 in group 1, 2.10±0.70 in group 2 and 3.18±0.63 in group 3. The duration of analgesia was least in group 3 (5.8±2.31 hrs) followed by group 2 (9.67±2.47 hrs) and maximum in group 1 (11.87±2.97 hrs). The total tramadol requirement in first 24 hrs postoperatively was 126.67±44.98 mg in group 1, 140±62.15 mg in group 2 and 226.67±63.97 mg in group 3. Conclusion: Postoperative analgesia with USG and PNS guided TAP block enables better pain control and less analgesic consumption. PNS guided TAP block is good alternative when compared with control for postoperative analgesia when USG machine is not available.

Analgesic benefits of pre-operative versus postoperative transversus abdominis plane block for laparoscopic cholecystectomy: a frequentist network meta-analysis of randomized controlled trials

“…In total, 22 of the included studies compared pre-operative TAP block with a control [ 22 , 23 , 25 , 27 – 29 , 31 , 33 , 35 – 43 , 45 , 46 , 49 , 52 , 54 ], 11 evaluated the effect of postoperative TAP block compared with a control block [ 24 , 26 , 30 , 32 , 34 , 44 , 47 , 48 , 50 , 51 , 53 ], and only one directly compared pre-operative TAP block with postoperative TAP block [ 11 ]. A total of 2317 patients were enrolled in the included trials: 456 patients were randomised to the postoperative TAP block group, 773 to the pre-operative TAP block group, and the remaining to the control group.…”

Comparison of USG guided with Anatomical Landmark guided TAP Block following Total Abdominal Hysterectomy

“…Reference Article: Kapil Prajapati et al 6 The research will involve 60 patients who fulfil the criteria for inclusion in the study. The following study groups will be assigned to patients for the study:…”