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Comparison of the ultrasound guided subcostal transversus abdominis plane block and port site infiltration of local anaesthesia for post-operative pain management in the adult patients undergoing laparoscopic cholecystectomy

Author: 
Dr. Konipati Hemasrilaxmi, Dr Namita Saraswat, Dr. Sanjeev Sharma and Dr. Alka Gupta
Subject Area: 
Health Sciences
Abstract: 

Pain management is necessary for optimal post-operative care in surgical patients. Abdominal wall blocks like Transversus Abdominis plane (TAP) block are new hallmark of multimodal pain strategy for post-operative analgesia. Study Objective: To compare the ultrasound-guided subcostal TAP block and port site infiltration using 0.25% levobupivacaine for post-operative analgesia. Primary objective is to compare the duration and quality of analgesia between two groups. Secondary objective is to study the hemodynamic parameters and adverse effects like Hypotension and nausea and vomiting. Design: Randomized Comparative Study. Patients and Interventions: We enrolled sixty adult patients, divided into two groups. Group A received ultrasound guided bilateral subcostal TAP block with 10ml of 0.25% levobupivacaine and Group B received port site infiltration with 0.25% levobupivacaine, 5ml at each 4 ports before extubation. Measurements: The post-operative pain was assessed by visual analog score(VAS). VAS more than 4 or when patient complained of pain, injection tramadol 1mg kg-1 was given as first rescue analgesic drug. VAS score was assessed at 15minutes, 30minutes, 1hour, 1.5hours, 2hours, 4hours and 6hours after extubation and the time to first rescue analgesic dose were recorded. The data was statistically analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Qualitative variables were correlated using Chi-Square test. Results: Postoperative VAS score in Group A were significantly reduced at 15 minutes, 30minutes, 1hour, 2hours, 4hours and 6hours (P < 0.001). The time taken to administer the first rescue analgesic dose was more in the Group A (1.93 ± 0.45) in comparison to Group B (1.2 ± 0.25) with P value < 0.001. Conclusion: The duration and quality of analgesia with ultrasound guided subcostal TAP Block was better than port site infiltration.

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