Background: There are several methods employed in the management of postoperative pain after laparoscopic cholecystectomy such as conventional systemic analgesics, including paracetamol, non-steroidal anti-inflammatory drugs, systemic opioids, and thoracic epidural analgesia with all having its limitations and side effects.
Aims: The present study aims to compare ultrasound-guided subcostal transversus abdominis (STA) block with intraperitoneal instillation of levobupivacaine in reducing postoperative pain, total analgesic consumption, nausea and vomiting, and recovery time in patients after elective laparoscopic cholecystectomy.
Settings and design: A prospective study was conducted between January 2017 and December 2017 in 80 patients undergoing elective laparoscopic cholecystectomy after approval of the Institutional Ethical Committee (Reference No: SGRR/IEC/05/16).
Materials and methods: Patients were randomly divided into two equal-sized (n = 40) study groups. Group 1 patients received ultrasonography-guided STA block with 0.25% levobupivacaine both sides and Group 2 patients received 0.25% levobupivacaine through intraperitoneal route.
Statistical analysis: Quantitative data were expressed in mean and standard deviation. Qualitative data were expressed in proportion and percentages. Independent t-test was applied to compare the means of quantitative data and the Chi-square test was used to compare categorical data. P < 0.05 was considered to be statistically significant. Survival curve was drawn using the log-rank test for comparing two groups.
Results: Patient characteristics regarding age, gender, and weight were comparable in the two groups. The mean Numerical Rating Scale scores were less in Group 1 than in Group 2 in the first 6 h, which was found to be statistically significant. There was no significant difference noted in pain scores after 6 h up to 24 h in postoperative area among the two groups. Pain scores for shoulder tip pain were lower in Group 2 as compared to Group 1 in the first 24 h, which was not significant statistically.
Conclusion: STA block is a better modality for analgesia compared to intraperitoneal instillation in patients undergoing elective laparoscopic cholecystectomy.
Keywords: Intraperitoneal levobupivacaine; Numerical Rating Scale; laparoscopic cholecystectomy; subcostal transversus abdominis block; ultrasonography.
Conflict of interest statement
There are no conflicts of interest.
[Subcostal Transversus Abdominis Plane Block Can Improve Analgesia After Laparoscopic Cholecystectomy]V Vrsajkov et al. Rev Bras Anestesiol 68 (2), 149-153. PMID 29277312. - Randomized Controlled TrialOur results show that subcostal transversus abdominis plane block can provide superior postoperative analgesia and reduction in opioid requirements after laparoscopic cho …
Comparison of Ultrasound-Guided Bilateral Subcostal Transversus Abdominis Plane Block and Port-Site Infiltration With Bupivacaine in Laparoscopic CholecystectomyI Suseela et al. Indian J Anaesth 62 (7), 497-501. PMID 30078851.Ultrasound-guided bilateral subcostal TAP block provides superior post-operative analgesia after laparoscopic cholecystectomy compared to port-site infiltration.
[Ultrasound-guided Transversus Abdominis Plane Block in Patients Undergoing Laparoscopic Cholecystectomy: Comparison of Efficacy of Bupivacaine and Levobupivacaine on Postoperative Pain Control]A Yıldırım Ar et al. Rev Bras Anestesiol 68 (5), 455-461. PMID 29937216.Bupivacaine and levobupivacaine showed similar efficacy at TAP block in patients undergoing laparoscopic cholecystectomy.
Addition of Dexmedetomidine to Ropivacaine in Subcostal Transversus Abdominis Plane Block Potentiates Postoperative Analgesia Among Laparoscopic Cholecystectomy Patients: A Prospective Randomized Controlled TrialB Sarvesh et al. Anesth Essays Res 12 (4), 809-813. PMID 30662112.Addition of dexmedetomidine to ropivacaine in TAP block prolongs postoperative analgesia and reduces opioid consumption without any major adverse effects.
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