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. Total 90 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 (six 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 hours 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.

Keywords

• duration of surgery
• pain control
• rescue analgesic
• satisfied