Local infiltration versus laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: double-blinded randomized control trial
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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.
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.
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.
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)
KeywordsCholecystectomy/laparoscopic Analgesics Post-operative/prevention Randomized control trial Nerve blocks
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
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.
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