Subcostal Transversus Abdominis Research Articles

COMPARATIVE STUDY TO ASSES ANALGESIC EFFICACY AND OPIOID SPARING EFFECT OF USG GUIDED SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE BLOCK WITH INTRAPERITONEAL INSTILLATION OF BUPIVACAINE IN PATIENT UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY FOR POSTOPERATIVE PAIN RELIEF.

Background- Intensity of pain in early post-operative period after laparoscopic cholecystectomy is signicant. There are several methods employed in the management of postoperative pain after laparoscopic cholecystectomy such as conventional systemic analgesics, including paracetamol, non-steroidal anti-inammatory drugs, systemic opioids, and thoracic epidural analgesia with all having its limitations and side effects. Objective- The present study aims to compare ultrasound-guided subcostal transversus abdominis (STA) block with intraperitoneal instillation of bupivacaine in reducing postoperative pain, total analgesic consumptions after elective laparoscopic cholecystectomy. Materials and methods: 60 adult patients were randomly divided into 2 groups of 30 in each. The selected patients were randomly divided into two groups Group 1, patients received USG guided tap block before surgery. Group 2 patients received 40 ml of 0.25 % bupivacaine after surgery, instillation done by surgeon intraperitoneally at gall blabber bed and under the domes of diaphragm. Statistical analysis: In all Quantitative data were expressed in mean and standard deviation. Qualitative data were expressed in proportion and percentages. To nd the signicant difference between the bivariate samples in independent groups the Unpaired sample t-test and the Mann-Whitney U test was used. Above statistical tools the probability value > .05 was considered as signicant level. Results: The mean Numerical Rating Scale scores were less in Group 1 than in Group 2 from 1 hours to 24 hours and it was statistically signicant. Demand of rescue analgesia was higher in group 2 when compared to group 1 and it was statistically signicant. Conclusion: TAP block is a better modality for analgesia compared to intraperitoneal instillation in patients undergoing elective laparoscopic cholecystectomy

Comparison of Subcostal Transversus Abdominis Block with Intraperitoneal Instillation of Levobupivacaine for Pain Relief after Laparoscopic Cholecystectomy: A Prospective Study.

Background:There are several methods employed in the management of postoperative pain after laparoscopic cholecystectomy such as conventional systemic analgesics, including paracetamol, non-steroidal anti-inflammatory drugs, systemic opioids, and thoracic epidural analgesia with all having its limitations and side effects.Aims:The present study aims to compare ultrasound-guided subcostal transversus abdominis (STA) block with intraperitoneal instillation of levobupivacaine in reducing postoperative pain, total analgesic consumption, nausea and vomiting, and recovery time in patients after elective laparoscopic cholecystectomy.Settings and Design:A prospective study was conducted between January 2017 and December 2017 in 80 patients undergoing elective laparoscopic cholecystectomy after approval of the Institutional Ethical Committee (Reference No: SGRR/IEC/05/16).Materials and Methods:Patients were randomly divided into two equal-sized (n = 40) study groups. Group 1 patients received ultrasonography-guided STA block with 0.25% levobupivacaine both sides and Group 2 patients received 0.25% levobupivacaine through intraperitoneal route.Statistical Analysis:Quantitative data were expressed in mean and standard deviation. Qualitative data were expressed in proportion and percentages. Independent t-test was applied to compare the means of quantitative data and the Chi-square test was used to compare categorical data. P < 0.05 was considered to be statistically significant. Survival curve was drawn using the log-rank test for comparing two groups.Results:Patient characteristics regarding age, gender, and weight were comparable in the two groups. The mean Numerical Rating Scale scores were less in Group 1 than in Group 2 in the first 6 h, which was found to be statistically significant. There was no significant difference noted in pain scores after 6 h up to 24 h in postoperative area among the two groups. Pain scores for shoulder tip pain were lower in Group 2 as compared to Group 1 in the first 24 h, which was not significant statistically.Conclusion:STA block is a better modality for analgesia compared to intraperitoneal instillation in patients undergoing elective laparoscopic cholecystectomy.

Efficacy of the Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy: Comparison With Conventional Port Site Infiltration

Background and objectives: Pain experienced following laparoscopic cholecystectomy is largely contributed by the anterior abdominal wall incisions. This study investigated whether subcostal transversus abdominis (STA) block was superior to traditional port-site infiltration of local anaesthetic in reducing postoperative pain, opioid consumption and time for recovery. Methods: This study was a prospective, randomized, comparative study conducted in the Department of Anaesthesiology, at a tertiary hospital in Chennai. A total of 42 American Society of Anesthesiologists grades 1 and 2 patients undergoing elective laparoscopic cholecystectomy aged between 20 and 60 years were randomly allocated into two groups of 21 each. Group US received ultrasound-guided STA block, whereas group C received conventional port-site infiltration. Visual analogue pain scores were measured at 1, 4 and 8 h postoperatively to assess pain severity and opioid requirement was measured in recovery and up to 8 h postoperatively. The time to discharge from recovery was recorded. Results: STA block resulted in a significant reduction in serial visual pain analogue scores and significantly reduced fentanyl requirement in recovery unit compared to the group that received local port-site infiltration. Furthermore, STA block was associated with overall reduced 8 h equivalent morphine consumption. In addition, STA block significantly reduced median time to discharge from recovery unit. Conclusion: The results suggest that STA block provides superior postoperative analgesia and reduces opioid requirement following laparoscopic cholecystectomy. It may also improve theatre efficiency by reducing time to discharge from the recovery unit.

Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Comparison with conventional port-site infiltration

Background:Pain experienced following laparoscopic cholecystectomy is largely contributed by the anterior abdominal wall incisions. This study investigated whether subcostal transversus abdominis (STA) block was superior to traditional port-site infiltration of local anesthetic in reducing postoperative pain, opioid consumption, and time for recovery.Materials and Methods:Forty-three patients presenting for day case laparoscopic cholecystectomy were randomly allocated to receive either an ultrasound-guided STA block (n = 21) or port-site infiltration of local anesthetic (n = 22). Visual analog pain scores were measured at 1 and 4 h postoperatively to assess pain severity, and opioid requirement was measured in recovery and up to 8 h postoperatively. The time to discharge from recovery was recorded.Results:STA block resulted in a significant reduction in serial visual pain analog score values and significantly reduced the fentanyl requirement in recovery by >35% compared to the group that received local port-site infiltration (median 0.9 vs. 1.5 μcg/kg). Furthermore, STA block was associated with nearly a 50% reduction in overall 8-h equivalent morphine consumption (median 10 mg vs. 19 mg). In addition, STA block significantly reduced median time to discharge from recovery from 110 to 65 min.Conclusion:The results suggest that STA block provides superior postoperative analgesia and reduces opioid requirement following laparoscopic cholecystectomy. It may also improve theater efficiency by reducing time to discharge from the recovery unit.