DOI: http://dx.doi.org/10.18203/2349-2902.isj20210928

Efficacy of laparoscopic guided transversus abdominis plane block in post operative analgesia requirement in elective laparoscopic cholecystectomy

Hanuman Ram Khoja, Dhanush Kumar Kunchagi, Praveen Kumar Joshi, Prabha Om

Abstract


Background: Minimal invasive surgery has many advantages. In order to maintain and control  pain, one of the most effective technique is Transversus abdominis plane (TAP) block technique. Aim of the study was to demonstrate the efficacy of laparoscopic guided transversus abdominis plane block in post-operative analgesia requirement in elective laparoscopic cholecystectomy.

Methods: It was a hospital based prospective interventional study. Sample size was calculated at 0.05 α error and 80% study power assuming mean difference of VAS score between TAP block +/A group  and TAP block- /B group is 1 and standard deviation of VAS score 1.3 among patients undergoing elective laparoscopic cholecystectomy.

Results: A total of 60 patients were enrolled in this study. The mean age of group A was 48.56 years and for group B was 43.53 years. In group A 80% patients were females and for group B 83.3% patients were females. There was significant difference in VAS score at immediate post operation, at 1 hour, at 6 hours, at 18 hours and at 24 hours as p value was <0.0001 for all these groups. The mean VAS score was recorded less in group A at all the time duration compared to group B.

Conclusions: With advantages like maximum safety, efficacy, potential for lower visceral injury risk and shorter operational time and other numerous advantages (decreased analgesic requirements, etc.)  laparoscopic-guided TAP block counts as an ideal abdominal field block in the patients.


Keywords


Laparoscopic guided, Laparoscopic cholecystectomy, Transversus abdominis plane, TAP block, VAS

Full Text:

PDF

References


Kapoor T, Wrenn SM, Callas PW, Jaish W. Cost analysis and supply utilization of laparoscopic cholecystectomy. Minim Invasive Surg. 2018;2018:7838103.

Tian Y, Wu SD, Su Y, Kong J, Yu H, Fan Y. Laparoscopic subtotal cholecystectomy as an alternative procedure designed to prevent bile duct injury: Experience of a hospital in Northern China. Surg Today. 2009;39:510-3.

Jatzko GR, Lisborg PH, Perti AM, Stettner HM. Multivariate comparison of complications after laparoscopic cholecystectomy and open cholecystectomy. Ann Surg. 1995;221:381-6.

Velpen V, Shimi SM, Cuschieri A. Outcome after cholecystectomy for symptomatic gallstone disease and effect of surgical access: laparoscopic vs open approach. Gut. 1993;34:1448-51.

Cleary R, Venables CW, Watson J, Goodfellow J, Wright PD. Comparison of short term outcomes of open and laparoscopic cholecystectomy. Qual Health Care. 1995;4:13-7.

Philips JAE, Lawes DA, Cook AJ, Arulampalam TH, Zaborsky A, Menzies D, et al. The use of laparoscopic subtotal cholecystectomy for complicated cholelithiasis. Surg Endosc. 2008;22:1697-700.

Kulen FT, Tihan D, Duman U, Bayam E, Zaim G. Laparoscopic partial cholecystectomy: a safe and eff ective alternative surgical technique in diffi cult cholecystectomies. Turkish J Surg. 2015;10:515-8.

Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024-6.

Jankovic ZB, Feu FM, McConnell P. An anatomical study of the transversus abdominis plane block: location of the lumbar triangle of Petit and adjacent nerves. Anesth Analg. 2009;109(3):981-5.

Abdallah FW, Chan VW, Brull R. Transversus abdominis plane block: a systematic review. Reg Anesth Pain Med. 2012;37:193-209.

Milan Z, Tabor D, McConnell P, Pickering J, Kocarev M, Feu F, et al. Three different approaches to transversus abdominis plane block: acadaveric study. Med Glas. 2011;8(2):181-4.

Magee C, Clarke C, Lewis A. Laparoscopic TAP block for laparoscopic cholecystectomy: description of a novel technique. Surgeon. 2011;9(6):352-3.

Donnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg. 2007;104(1):193-7.

Ra YS, Kim CH, Lee GY, Han JI. Th e analgesic effect of the ultrasound-guided transverse abdominis plane block after laparoscopic cholecystectomy. Korean J Anesthesiol. 2010;58(4):362-8.

Kadam VR, Howell S, Kadam V. Evaluation of postoperative pain scores following ultrasound guided transversus abdominis plane block versus local infiltration following day surgery laparoscopic cholecystectomy-retrospective study. J Anaesthesiol Clin Pharmacol. 2016;32:80-3.

Siriwardhana RC, Kumarage SK, Gunathilake BM, Thilakarathne SB, Wijesinghe JS. Local infiltration versus laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: double-blinded randomized control trial. Surg Endoscopy. 2019;33:179-83.

Tihan D, Totoz T, Tokocin M, Ercan G. Efficacy of laparoscopic transversus abdominis plane block for elective laparoscopic cholecystectomy in elderly patients. Bosn J Basic Med Sci. 2016;16(2):139-44.

Keller DS, Ermlich BO, Delaney CP. Demonstrating the benefits of transversus abdominis plane blocks on patient outcomes in laparoscopic colorectal surgery: review of 200 consecutive cases. J Am Coll Surg. 2014;219(6):1143-8.

Favuzza J, Delaney CP. Laparoscopic-guided transversus abdominis plane block for colorectal surgery. Dis Colon Rectum. 2013;56(3):389-91.

Favuzza J, Delaney CP. Outcomes of discharge after elective laparoscopic colorectal surgery with transversus abdominis plane blocks and enhanced recovery pathway. J Am Coll Surg. 2013;217(3):503-6.

Alvarez MP, Foley KE, Zebley DM, Fassler SA. Comprehensive enhanced recovery pathway significantly reduces postoperative length of stay and opioid usage in elective laparoscopic colectomy. Surg Endosc. 2014;29(6):1-6.

Keller DS, Ermlich BO, Delaney CP. Demonstrating the benefits of transversus abdominis plane blocks on patient outcomes in laparoscopic colorectal surgery: review of 200 consecutive cases. J Am Coll Surg. 2014;219(6):1143-8.

Elamin G, Waters PS, Hamid H, Keeffe HM, Waldron RM, Duggan MS. Efficacy of a laparoscopically delivered transversus abdominis plane block technique during elective laparoscopic cholecystectomy: a prospective, double-blind randomized trial. J Am Coll Surg. 2015;221(2):335-44.

Dawlatly AA, Turkistani A, Kettner SC, Machata AM, Delvi MB, Thallaj A, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth. 2009;102:763-7.

Owen DJ, Harrod I, Ford J, Luckas M, Gudimetla V. The surgical transversus abdominis plane block- a novel approach for performing an established technique. BJOG. 2011;118(1):24-7.

Chetwood A, Agrawal S, Hrouda D, Doyle P. Laparoscopic assisted transversus abdominis plane block: a novel insertion technique during laparoscopic nephrectomy. Anaesthesia. 2011;66(4):317-8.