Unilateral Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy for Pain Control Comparison with Conventional Port Site and Peritoneal Infiltration

Abstract

Objective: To compare image-guided unilateral subcostal transversus abdominis plane (STA) block with infiltration of local anaesthetic both port site and peritoneal for post-operative analgesia for laparoscopic gall bladder surgery. Study Design: Quasi-experimental study Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Quetta Pakistan, from Nov 2018 to Apr 2019. Methodology: The study sample (n=80) was divided into two Groups, one for image-guided subcostal transversus abdominis plane block and the other for peritoneal and port site infiltration of local anaesthetic. Anaesthesia was induced with intravenously administered propofol, atracurium, nalbuphine, and intraoperative non-opioid analgesia with ketorolac following which endotracheal intubation was done. The level of abdominal pain was assessed. Results: The mean opioid consumption at the 24th post-operative hour was 22.75±8.55 in Group-A and 43.20±11.80 in GroupB. Mean total opioid consumption was 111.40±35.99 and 218.90±63.91 in Group-A and B, respectively. The mean VAS score at the 24th post-operative hour was 1.20±0.96 in Group- A and 3.12±1.63 in Group-B. The results showed a significant mean difference between opioid consumption and VAS pain score at the 24th hour (p<0.05). Conclusion: The unilateral Subcostal transversus abdominis plane block proved a superior alternative to port site and peritoneal infiltration combined for laparoscopic cholecystectomy.

Keywords

• Laparoscopic cholecystectomy
• Port site and peritoneal infiltration
• Ultrasound guided unilateral subcostal transversus abdomenis plane block