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Surgical Endoscopy

, Volume 33, Issue 1, pp 179–183 | Cite as

Local infiltration versus laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: double-blinded randomized control trial

  • Rohan C. SiriwardanaEmail author
  • Sumudu K. Kumarage
  • Bhagya M. Gunathilake
  • Suchintha B. Thilakarathne
  • Jeevani S. Wijesinghe
Article
  • 129 Downloads

Abstract

Background

Transverse abdominal plane block (TAP) is a new technique of regional block described to reduce postoperative pain in laparoscopic cholecystectomy (LC). Recent reports describe an easy technique to deliver local anesthetic agent under laparoscopic guidance.

Methods

This randomized control trial was designed to compare the effectiveness of additional laparoscopic-guided TAP block against the standard full thickness port site infiltration. 45 patients were randomized in to each arm after excluding emergency LC, conversions, ones with coagulopathy, pregnancy and allergy to local anesthetics. All cases were four ports LC. Interventions—Both groups received standard port site infiltration with 3–5 ml of 0.25% bupivacaine. The test group received additional laparoscopic-guided TAP block with 20 ml of 0.25% bupivacaine subcostally, between the anterior axillary and mid clavicular lines. As outcome measures the pain score, opioid requirement, episodes of nausea and vomiting and time to mobilize was measured at 6 hourly intervals.

Results

The two groups were comparable in the age, gender, body mass index, indication for cholecystectomy difficulty index and surgery duration. The pain score at 6 h (P = 0.043) and opioid requirement at 6 h (P = 0.026) was higher in the TAP group. These were similar in subsequent assessments. Other secondary outcomes were similar in the two groups.

Conclusion

Laparoscopic-guided transverses abdominis plane block using plain bupivacaine does not give an additional pain relief or other favorable outcomes. It can worsen the pain scores. Pre registration: The trial was registered in Sri Lanka clinical trial registry—SLCTR/2016/011 (http://www.slctr.lk/trials/357)

Keywords

Cholecystectomy/laparoscopic Analgesics Post-operative/prevention Randomized control trial Nerve blocks 

Notes

Acknowledgements

We acknowledge professor A Pathmeswaran for providing statistical assistance during designing the trial. We also acknowledge Ms. Vishaka Lakchani, Ms. Nisansala, Dr. Gavindya Wijayagunawardana for data collection. Data of this study will be made available on request.

Compliance with ethical standards

Disclosures

Rohan C Siriwardana, Sumudu K Kumarage, Bhagya M Gunathilake, Suchintha Thilakarathne, and Jeevani S Wijesinghe have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Leader PC, Matthews T, Krzeminska K, Dehn TCB (2004) Routine day-case laparoscopic cholecystectomy. Br J Surg 91:312–316CrossRefGoogle Scholar
  2. 2.
    McKellar DP, Johnson RM, Dutro JA, Mellinger J, Bernie WA, Peoples JB (1995) Cost-effectiveness of laparoscopic cholecystectomy. Surg Endosc 9:158–163CrossRefGoogle Scholar
  3. 3.
    Lam CM, Murray FE, Cuschieri A (1996) Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy in Scotland. Gut 38:282–284CrossRefGoogle Scholar
  4. 4.
    Reynolds W (2001) The First laparoscopic cholecystectomy. JSLS J Soc Laparoendosc Surg 5:89–94Google Scholar
  5. 5.
    Mitra S, Khandelwal P, Roberts K, Kumar S, Vadivelu N. (2012) Pain relief in laparoscopic cholecystectomy—a review of the current options. Pain Pract 12: 485–96CrossRefGoogle Scholar
  6. 6.
    Inan A, Sen M, Dener C (2004) Local anesthesia use for laparoscopic cholecystectomy. World J Surg 28(8):741–744CrossRefGoogle Scholar
  7. 7.
    Papagiannopoulou P, Argiriadou H, Georgiou M, Papaziogas B, Sfyra E, Kanakoudis F (2003) Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy. Surg Endosc Other Interv Tech 17(12):1961–1964CrossRefGoogle Scholar
  8. 8.
    El-Dawlatly AA, Turkistani A, Kettner SC, MacHata AM, Delvi MB, Thallaj A et al (2009) Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth 102:763–767CrossRefGoogle Scholar
  9. 9.
    Ma J, Jiang Y, Tang S, Wang B, Lian Q, Xie Z et al (2017) Analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block. Medicine (Baltimore) 96(10):e6309CrossRefGoogle Scholar
  10. 10.
    Bhatia N, Arora S, Jyotsna W, Kaur G (2014) Comparison of posterior and subcostal approaches to ultrasound-guided transverse abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy. J Clin Anesth 26(4):294–299CrossRefGoogle Scholar
  11. 11.
    Favuzza J, Delaney CP (2013) Laparoscopic-guided transversus abdominis plane block for colorectal surgery. Dis Colon Rectum 56:389–391CrossRefGoogle Scholar
  12. 12.
    Elamin G, Waters PS, Hamid H, O’Keeffe HM, Waldron RM, Duggan M et al. (2016) Efficacy of a laparoscopically delivered transversus abdominis plane block technique during elective laparoscopic cholecystectomy: prospective, double-blind randomized trial. J Am Coll Surg 221(2): 335–44CrossRefGoogle Scholar
  13. 13.
    Abdallah FW, Chan VW, Brull R (2012) Transversus abdominis plane block: a systematic review. Reg Anesth Pain Med 37:193–209CrossRefGoogle Scholar
  14. 14.
    McDermott G, Korba E, Mata U, Jaigirdar M, Narayanan N, Boylan J et al (2012) Should we stop doing blind transversus abdominis plane blocks? Br J Anaesth 108(3):499–502CrossRefGoogle Scholar
  15. 15.
    Berteau C, Filipe-Santos O, Wang T, Roja HE, Granger C, Schwarzenbach F (2015) Evaluation of the impact of viscosity, injection volume, and injection flow rate on subcutaneous injection tolerance. Med Dev Evid Res 8:473–484Google Scholar
  16. 16.
    Heise T, Nosek L, Dellweg S, Zijlstra E, Prstmark KA, Kildegaard J et al (2014) Impact of injection speed and volume on perceived pain during subcutaneous injections into the abdomen and thigh: a single-centre, randomized controlled trial. Diabetes Obes Metab 16(10):971–976CrossRefGoogle Scholar
  17. 17.
    Tran TMN, Ivanusic JJ, Hebbard P, Barrington MJ (2009) Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth 102(1):123–127CrossRefGoogle Scholar
  18. 18.
    Lissauer J, Mancuso K, Merritt C, Prabhakar A, Kaye AD, Urman RD (2014) Evolution of the transversus abdominis plane block and its role in postoperative analgesia. Best Pract Res Clin Anaesthesiol 28(2):117–126CrossRefGoogle Scholar
  19. 19.
    Gadsden J, Ayad S, Gonzales JJ, Mehta J, Boublik J, Hutchins J (2015) Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries. Local Reg Anesth 8:113–117CrossRefGoogle Scholar
  20. 20.
    Ortiz J, Suliburk JW, Wu K, Bailard NS, Mason C, Minard CG et al (2012) Bilateral transversus abdominis plane block does not decrease postoperative pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites. Reg Anesth Pain Med 37:188–192CrossRefGoogle Scholar
  21. 21.
    Tolchard S, Martindale S, Davies R (2012) Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Comparison with conventional port-site infiltration. Journal of Anaesthesiology Clinical Pharmacology 28(3):339–343CrossRefGoogle Scholar
  22. 22.
    Peng K, Ji FH, Liu HY, Wu SR (2016) Ultrasound-guided transversus abdominis plane block for analgesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Med PrincPract 25(3):237–246Google Scholar
  23. 23.
    Malik O, Kaye AK, Kaye A, Belani K, Urman RD (2017) Emerging roles of liposomal bupivacaine in anesthesia practice. J Anaesthesiol Clin Pharmacol 33(2): 151–156Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Surgery, Faculty of Medicine RagamaUniversity of KelaniyaKelaniyaSri Lanka

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