A O02 How effective is the right subcostal laparoscopically-guided transversus abdominis plane block on pain control after laparoscopic cholecystectomy? A randomised controlled trial

Abstract

Abstract Background The transversus abdominis plane (TAP) block is effective on pain relief after laparoscopic cholecystectomy (LC). The procedure can be done under laparoscopic or ultrasound guidance and is often performed by injecting multiple abdominal areas. Data on the efficacy of the loco-regional block performed in the right subcostal region only are scanty. This study compared the effect of the right subcostal TAP block under laparoscopic guidance to the infiltration of local anesthetic to the port sites only (ILA) on pain relief, after elective LC. Methods A sample of 60 participants, 30 per arm, was estimated (two-sided a = 0.05%, power = 80%). Subjects having day-case (DC) LC were randomized into TAP block and ILA. Participants received Bupivacaine 0.5% 30 ml: TAP block – 20 ml in TAP block + 10 ml into the midline ports; ILA – 20 ml into the midline ports + 10 ml into the right-sided ones. Pain scores at rest at 1-hour post-surgery and at discharge, were evaluated with the Visual Analogue Scale score system. DC rate, Quality of Recovery-15 questionnaires, oral intake of opioids at day 3 and 7, were assessed too. Results Subjects in the ILA group were all women (p=0.0007) and younger (43.8 vs 37.7 years, p=0.023) than the TAP block. The median postoperative pain scores were 0 vs 1 at 1 hour (95% CI -1.99 to 1, p=0.60), 0 vs 1.5 at discharge (95% CI -2 to 0.99, p=0.55). The DC rate was 93.1% vs 93.5% (p=0.39). Six (10%) patients remained in hospital after surgery (postoperative pain [3], nausea [1], challenging surgical procedure [1], late theatre schedule [1]). Questionnaire scores and oral opioids intake did not differ between groups, on postoperative day 3 and 7. Conclusions The laparoscopically-guided right subcostal TAP block did not provide additional benefit to ILA on pain control, after LC.