Abstract PR496: The Analgesic Efficacy of Ultrasound Guided Bilateral Subcostal Vs. Posterior Transversus Abdominis Plane Block After Laparoscopic Cholecystectomy: A Randomized Controlled Trial : Anesthesia & Analgesia

Secondary Logo

Journal Logo

E Poster discussion: Regional anaesthesia

Abstract PR496: The Analgesic Efficacy of Ultrasound Guided Bilateral Subcostal Vs. Posterior Transversus Abdominis Plane Block After Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Khan, K. K.1,*; Khan, R. I.1

Author Information
Anesthesia & Analgesia 123(3S):p 629-630, September 2016. | DOI: 10.1213/01.ane.0000492881.57230.2e
  • Free

Background & Objectives: Even though TAP block has been successfully used for postoperative pain managementl after abdominal surgeries but different approaches for this TAP block has not been compared for postoperative analgesia after laparoscopic cholecystectomy.

Primary objective: To compare the mean static and dynamic numeric rating scale (NRS) at 24 hours postoperatively of the two groups of patients undergoing Laparoscopic cholecystectomy, and receiving either Ultrasound guided bilateral Posterior-TAP block (P-TAP) or bilateral Subcostal-TAP block (S-TAP).

Secondary objectives: To compare the post-operative mean opioid consumption, mean nausea and vomiting scale, sedation scores, surgical outcome and patient satisfaction between the two groups.

Materials & Methods: We conducted a double blinded randomized controlled trial in 70 patients, admitted electively for laparoscopic cholecystectomy. After induction of general anaesthesia, patients were randomly allocated in to two groups using draw/ballot method. Group 1 received ultrasound guided bilateral P-TAP-Block with 20ml, 0.375% bupivacaine on each side, and Group 2 received bilateral S-TAP-Block with same concentration and volume, whereas, both the groups also received standard of care analgesia postoperatively i.e: I/V Ketorolac 30mg every 8 hourly, I/V Tramadol 50mg every 8hourly and PRN and I/V Paracetamol 1000mg every 6 hourly. The patients and staff providing postoperative care and the doctor assessing the pain after surgery were blinded to group assignment.

Results: Our study results showed a statistically significant difference in the mean NRS for static pain at 24 hours in the S-TAP group, suggesting improved analgesic impact of S-TAP as compared to P-TAP while it did not showed any statistically significant difference in mean dynamic pain score and other secondary outcomes.

Conclusion: Ultrasound guided bilateral S- TAP block, as a part of multimodal analgesia provides better postoperative analgesia without any complications after Laparoscopic Cholecystectomy as compared to P-TAP block technique.

References:

McDonnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesthesia & Analgesia. 2007;104(1):193-7.

El-Dawlatly A, Turkistani A, Kettner S, Machata A-M, Delvi M, Thallaj A, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy†. British journal of anaesthesia. 2009;102(6):763-7.

Hebbard P. Subcostal transversus abdominis plane block under ultrasound guidance. Anesthesia & Analgesia. 2008;106(2):674-5.

Disclosure of Interest: None declared

Copyright © 2016 International Anesthesia Research Society