Research Article

A Comparative Study to Evaluate the Effectiveness of Perioperative Multi Modal Analgesia with Ultrasound Guided Bilateral Subcostal TAP Block for Post-Operative Analgesia in Patients undergoing Elective Laparoscopic Cholecystectomy under General Anaesthes

Abstract

Background: Laparoscopic cholecystectomy is usually performed as a day care procedure for diseases involving the gall bladder. Pain in the immediate post-operative period is due to multiple factors and hence different modalities of pain relief are used. The present study was conducted to study the effectiveness of Peri-operative Multi-Modal Analgesia with Ultrasound guided Bilateral Subcostal TAP block for Post-operative analgesia in 60 patients undergoing elective laparoscopic cholecystectomy.
Methods: In this hospital based, randomized prospective interventional study patients were randomly allocated into 4 groups of 15 in each group, Group B received Bilateral Ultrasound guided Subcostal TAP Block with 20 ml of 0.25% Bupivacaine, Group P received Tab Pregabalin tablet 150 mg, Group D received Inj Dexamethasone 8 mg IV and Group C was the control group. The hemodynamic changes like heart rate, blood pressure, saturation was monitored both intra and post operatively. The post-operative VAS scoring, duration of analgesia, time for first rescue analgesic and the total dose of analgesics in 24 hours were noted.
Results: The VAS Scores indicated that Group B> P> D> C provided better analgesia to the patients with a P Value of < 0.01. Group B took the longest mean duration (6.8± 1.15 hours) to take the 1st rescue analgesic and least mean total dose of rescue analgesic in 24 hours followed by Group P, Group D and Group C which was statistically significant.
Conclusion: USG guided B/L TAP Block was superior to other modalities in providing postoperative analgesia for patients undergoing laparoscopic cholecystectomy.

[1] Goldberg SF, Pozek JJ, Schwenk ES, Baratta JL, Beausang DH, Wong AK. Practical management of a regional anesthesia-driven acute pain service. Adv Anesth. 2017; 35: 191-211.
[2] Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists‟ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016; 17: 131- 57.
[3] Kadam RV, Field JB. Ultrasound-guided continuous transverse abdominis plane block for abdominal surgery. J Anaesthesiol Clin Pharmacol. 2011; 27:333–6.
[4] Niraj G, Searle A, Mathews M, Misra V, Baban M, Kiani S, et al. Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy. Br J Anaesth. 2009; 103:601-5.
[5] Mc Donnell 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. Anesth Analg. 2007; 104:193–7.
[6] Mc Donnell JG, Curley G, O‟Donnell B, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after caesarean section: A prospective randomized controlled trial. Anesth Analg. 2008; 106:186–91.
[7] Shibata Y, Sato Y, Fujiwara Y, Komatsu T. Transversus abdominis plane block. Anesth Analg. 2007; 105(3):883.
[8] Hebbard P. Subcostal transversus abdominal plane block under ultrasound guidance. Anesth Analg. 2008; 106:674–75.
[9] Wall and Melzack‟s Textbook of pain. 5th ed. Elsevier Churchill Livingstone; Philadelphia, 2006.
[10] Suseela I, Anandan K, Aravind A, Kaniyil S. Comparison of ultrasound-guided bilateral subcostal transversus abdominis plane block and port-site infiltration with bupivacaine in laparoscopic cholecystectomy. Indian J Anaesth. 2018; 62:497-501.
[11] Vrsajkov V, Mančić N, Mihajlović D, Milićević ST, Uvelin A, Vrsajkov JP. Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy. Braz J Anesthesiol. 2018; 68 (2):149-153.
[12] Barazanchi AWH, MacFater WS, Rahiri JL, Tutone S, Hill AG, Joshi GP. PROSPECT collaboration. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth. 2018; 121(4):787-803.
[13] Breazu CM, Ciobanu L, Hadade A, Bartos A, Mitre C, Mircea PA, et al. The efficacy of oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy - a prospective, placebo controlled study. Romanian Journal of Anaesthesia and Intensive Care. 2016; 23(1):12-18.
[14] Baral B, Poudel PR. Comparison of Analgesic Efficacy of Ultrasound Guided Subcostal Transversus Abdominis Plane Block with Port Site Infiltration Following Laparoscopic Cholecystectomy. J Nepal Health Res Counc. 2019;0 16 (41):457- 461.
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IssueVol 9 No 3 (2023): Summer QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v9i3.13122
Keywords
Transversus abdominis plane block Bupivacaine Dexamethasone Pregabalin Laparoscopic cholecystectomy Post-operative analgesia
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How to Cite
1.
Dhanpal R, Mudalagirigowda S, Chandrashekar D. A Comparative Study to Evaluate the Effectiveness of Perioperative Multi Modal Analgesia with Ultrasound Guided Bilateral Subcostal TAP Block for Post-Operative Analgesia in Patients undergoing Elective Laparoscopic Cholecystectomy under General Anaesthes. Arch Anesth & Crit Care. 2023;9(3):253-258.