The Analgesic Efficacy of Pre-Operative Subcostal Transverse Abdominis Plane Block in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Prospective Comparative Study

Abstract

Introduction: The purpose of this study was to evaluate the effectiveness of transverse abdominis plane block for postoperative pain relief after laparoscopic cholecystectomy. Primary outcome is post-operative movement and Resting Pain scores in patients undergoing laparoscopic cholecystectomy. Secondary outcome is amount of pain relief provided by rescue analgesics in the first 24 hours after surgery.

Material and Methods: The Department of Anesthesiology examined Saveetha Medical College and Hospital patients from March 2021 to September 2022 in a prospective randomized double-blind controlled trial. This study was approved by the ethics committee. All patients received a detailed explanation of the operation and may consent. The formula from Openepi.info26 required 40 participants per group to attain a 95% confidence interval and an 80% power of study. This study included 88 persons, evenly divided by gender into two 44-person groups. Participants received either normal general anesthesia or pre-operative USG-guided Subcostal TAP block. As required by institutional procedures, they had a 12-lead electrocardiogram, chest radiograph, and hemoglobin, total count, platelet count, Renal Function test, and random blood glucose test before surgery. Airways were examined, including mouth opening, Modified Mallampatti Score, thyromental distance, neck mobility, and upper lip bite test. After verifying the patient was fit and graded according to ASA Risk Stratification, they were advised on the anesthetic plan. Patients were also advised about post-operative multimodal analgesics and how SCTAP block would help them manage pain. Patients were recruited and instructed about the Numeric pain scale and rescue analgesia once they consented to the trial. The study comprised informed consent patients who met inclusion criteria.

Results: It was observed that the bulk of the study population, which consisted of 88 individuals overall, was female. Only one-third of the participants in the research were men. Among those who received subcostal TAP block the dermatome levels were checked for sensory block by using pinprick sensation testing and sensation to ICE. The dermatome levels were found to reach until T₁₁ in around 68.2% and attained T₁₂ in around 24.98% of the population. Overall, 24-hour consumption across Group S was about 147.73 +/- 30.22 gm whereas that in group C was 211.36 +/- 32.10 gm. The difference was statistically significant.

Conclusion: This research concludes that intra-operative analgesia is achieved with the pre-operative administration of ultrasound guided bilateral subcostal transverse abdominis plane block, which is also linked with significantly lower resting and movement pain levels in the post-operative period.