Laparoscopically guided transversus abdominis plane block offers better pain relief after laparoscopic cholecystectomy: results of a triple blind randomized controlled trial.

Abstract

Transversus abdominis plane (TAP) block is a regional anaesthetic technique providing analgesia to the parietal peritoneum, muscles and skin of the anterior abdominal wall innervated by somatic nerves T6 to L1. We present the results of our randomized triple blind study comparing laparoscopically guided TAP block with the commonly used port site local anaesthetic infiltration for pain relief after laparoscopic cholecystectomy. A hundred patients with symptomatic gallstones planned for laparoscopic cholecystectomy were randomized into two groups of TAP block and port site infiltration. Group A received 4-quadrant TAP block with 10ml of 0.25% bupivacaine at each of the four sites guided laparoscopically and port site infiltration with 10ml of normal saline at each of the 4 ports for blinding the surgeon. Group B received port site infiltration with 0.25% bupivacaine, and infiltration with normal saline at TAP block sites for blinding the surgeon. Post-operative pain (at 3, 6, 24h and 1-week post-operative) (VAS), time to return to activities of daily living and patient satisfaction (Capuzzo Score) were recorded by an observer blinded towards the groups of the patients. The median VAS at 3, 6, 24h, at discharge, and 1-week post-operative were lesser in Group A compared to Group B (p ≤ 0.001 for all). The median duration of hospital stay was also lesser in Group A compared to Group B (p = 0.48, not significant) as was the time to return to activities (p < 0.05). The median Capuzzo score was higher in Group A compared to Group B (p < 0.001). This study shows that laparoscopically guided TAP block is a safe and easy-to-use technique. It reduces the severity of post-operative pain, helps in quick recovery, early discharge and improved patient satisfaction after laparoscopic cholecystectomy. Clinical Trials Registry of India 020227.