Abstract
The serratus intercostal plane block (SIPB) is a recently defined interfascial plane block. The oblique subcostal transversus abdominis plane block (OSTAP) is another type of interfascial plane block, and it is also used as a part of multimodal analgesia in patients undergoing laparoscopic cholecystectomy (LC). In this retrospective study, we evaluated the effects of the bilateral OSTAP and a combination of the right SIPB and bilateral rectus sheath block (RSB) on the postoperative pain and analgesia requirement in patients undergoing LC. Data of the patients who underwent LC between May 2018 and November 2018 were evaluated retrospectively. Postoperative pain was evaluated using the numeric rating scale (NRS), and 24-hour tramadol consumption and rescue analgesia requirements were compared. Bilateral OSTAP was applied to 47 patients, and SIPB+RSB was applied to 25 patients. Postoperative pain scores were similar between the two groups. In the first 24 hours, tramadol requirement in the SIPB+RSB group was significantly lower than in the OSTAP block group (p<0.001). There was no statistically significant difference between the NRS averages at different time frames between the two block groups. We found that when SIPB is used as a part of multimodal analgesia in a combination with RSB in LS, it improves the quality of analgesia and decreases the analgesic requirement compared to patients undergoing a bilateral OSTAP block. Randomized controlled trials are necessary to compare the effects of SIPB alone and in a combination with other blocks in LC.
Highlights
Laparoscopic cholecystectomy (LC) is a minimally invasive surgical procedure that leads to less pain when compared to conventional open surgery [1]
Bilateral oblique subcostal transversus abdominis plane (OSTAP) was applied to 47 patients, and serratus intercostal plane block (SIPB)+rectus sheath block (RSB) was applied to 25 patients
We found that when SIPB is used as a part of multimodal analgesia in a combination with RSB in LS, it improves the quality of analgesia and decreases the analgesic requirement compared to patients undergoing a bilateral OSTAP block
Summary
Laparoscopic cholecystectomy (LC) is a minimally invasive surgical procedure that leads to less pain when compared to conventional open surgery [1]. While opioids and nonsteroidal anti-inflammatory drugs can be used in the treatment of the postoperative pain, regional anesthesia techniques are used as a part of multimodal analgesia plans [2,3,4]. First described by Hebard in 2009, the oblique subcostal transversus abdominis plane (OSTAP) block is a regional anesthesia technique used in middle and upper abdominal surgeries [5, 6]. Blocking the cutaneous branches of the intercostal nerves in the mid-axillary line (BRILMA) is a recently described block used to provide effective analgesia in breast surgery [10,11,12]. In modified BRILMA, called serratus intercostal plane block (SIPB), a local anesthetic is applied more caudally from the 8th rib compared to the usual 4-5th rib. We have referred to this block as SIPB
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