Unilateral transversus abdominis plane block and port-site infiltration : Comparison of postoperative analgesic efficacy in laparoscopic cholecystectomy.

Abstract

To compare the analgesic efficacy of unilateral subcostal transversus abdominis plane (TAP) block with local anesthetic infiltration, applied to the port site in patients undergoing laparoscopic cholecystectomy (LC). GroupT received a unilateral subcostal TAP block, groupI received a local anesthetic infiltration at port sites, and groupC was the control group. GroupsT andI received 20 mL 0.25% bupivacaine. Intravenous patient-controlled analgesia with tramadol was similarly applied to all groups. Postoperative pain levels during rest and cough were evaluated using anumeric rating scale (NRS). Nausea and vomiting were evaluated using postoperative nausea vomiting scores (PONV) at 1, 3, 6, 12 and 24 h and tramadol consumption was also determined. Patient satisfaction was evaluated using aLikert-type scale. Postoperative resting NRS scores were lower in groupT than the other groups at 1h and 12h (p = 0.007 and p = 0.016), while NRS values during cough were statistically significant at 1h (p = 0.004). The 24‑h tramadol consumption was different: groupT 229 ± 33 mg, groupI 335 ± 95 mg, and groupC 358 ± 66 mg (p < 0.001). The percentages of patients reporting that they would prefer the applied postoperative pain control method again were 83.3%, 62.5% and 70.8% in groupsT, I and C, respectively (p = 0.118). Unilateral subcostal TAP block was superior to local anesthetic infiltration at port sites after LC, in terms of low opioid consumption. Unilateral subcostal TAP block is recommended as part of amultimodal analgesic protocol.