FTP7.7 Does bilateral combined Transversus Abdominis Plane (TAP) and rectus sheath block reduce postoperative pain after “hot laparoscopic cholecystectomy” compared to trocar site local anaesthetic infiltration?

Abstract

Abstract Introduction Post-operative pain is the commonest reason for prolonged hospital stay and readmission following laparoscopic cholecystectomy. We aim to assess whether bilateral transversus abdominis plane (TAP) and rectus sheath block reduces post-operative pain compared to local anaesthetic (LA) wound infiltration following “hot” laparoscopic cholecystectomies. Methods Prospective study involving 15 patients who underwent laparoscopic cholecystectomy in dedicated “hot lists” between October and December 2022. Post-operative pain scores were recorded 4 hours, 3 days, and 5 days post-procedure. Pain scores of patients who received bilateral TAP and rectus sheath blocks were compared with those who received LA wound infiltration with 0.5% Levobupivacaine. Results 9 patients received TAP and rectus sheath blocks, and 6 patients received LA infiltration. The time from start of anaesthesia to start of surgery in the TAP block group was significantly higher than the LA group (P=0.039). There was no statistical difference in pain scores on the pain analogue scale (1-10) between groups at 4 hours (P=0.73), 3 days (P=0.27), or 5 days (P=0.33) post-surgery. There was no statistical difference between the 2 groups in length of hospital stay post-procedure (P=0.75), or in re-admission rates due to poorly controlled post-operative pain (P=0.58). Conclusion Bilateral TAP and rectus sheath blocks do not significantly reduce pain post “hot laparoscopic cholecystectomy” any more than LA wound infiltration. Given the extra time taken to perform TAP and rectus sheath blocks, a larger study population would be required to more reliably assess their benefits, given the importance of avoiding overrunning of the “hot list”.