Comparative study on Postoperative Analgesia with Transversus Abdominis Plane block to Local Anesthetic Infiltration with Ropivacaine in Laparoscopic Cholecystectomy

Abstract

Introduction: Pain is distressing and detrimental in post-operative patients. We compared post operative analgesia provided by the ultrasound guided transversus abdominis plane block to the local anesthetic infiltration of ropivacaine in patients who underwent laparoscopic cholecystectomy.

Methodology: We conducted comparative, interventional study among 100 patients. The patients were randomly assigned into two groups having 50 in each group. The TAP block group received 20 ml of 0.2% Ropivacaine each on bilateral transversus abdominis plane with ultrasound guidance at the end of surgery. For Local infiltration group (n=50), 20 ml of 0.2% ropivacaine was deposited intraperitoneally in the gall bladder bed and under the right crus of diaphragm before abdominal de-sufflation. Local infiltration group also received infiltration with ropivacaine (0.2%) 20 ml total on three port sites. Visual analog scale at rest and movement measured at 2, 4, 8, 12 and 24 hours after intervention was our primary outcome. Secondary outcome measures were duration of analgesia, total pethidine consumption and ketorolac consumption for the first 24 hours postoperative period.

Results: Visual analogue pain score at rest at 2, 4 and 8 hours and on movement at 2 hours and 4 hours was significantly lower in TAP block group compared to Local infiltration group. TAP block group had significant difference in duration of analgesia compared to Local infiltration group (361 vs 153 min, p < 0.05). TAP block group also had significantly lower consumption of pethidine and ketorolac during the first 12 hours compared to Local infiltration group (p <0.05).

Conclusion: Transversus abdominis block had lower pain score, increased duration of postoperative analgesia and reduced requirement of rescue drugs in the post operative period compared to combined port site and intraperitoneal local infiltration.