Anubhav Vindal, MS, DNB, MRCSEd, FRCSGlas, FACS, FAIS, Hitesh Sarda, MBBS, Pawanindra Lal, MS, DNB, FRCSEd, FRCSGlas, FACS. Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College, New Delhi, India
Introduction: Transversus abdominis plane (TAP) block is a regional anesthetic technique that provides analgesia to the parietal peritoneum, skin and muscles of the anterior abdominal wall innervated by somatic nerves from T6 to L1 spinal segments. It is usually administered either blindly (double pop technique) or under ultrasound guidance. A less commonly used and recently described technique is laparoscopic guided TAP block which can be administered by the surgeon at the time of surgery without the need for any additional equipment.
We present the results of our prospective randomized triple blind study comparing laparoscopically guided 4-quadrant TAP block with the widely used port site local anesthetic infiltration after laparoscopic cholecystectomy.
Methods and Procedures: Hundred patients with symptomatic gallstones planned for laparoscopic cholecystectomy were included in the study and randomized into two groups of TAP block and port site infiltration respectively. All patients received a total of 40 ml of 0.25% bupivacaine as the local anesthetic agent.
Patients in group A received TAP block with bupivacaine in 4 abdominal quadrants: 10 ml each at bilateral subcostal and lumbar regions using a 18G intravenous cannula guided laparoscopically. Correct plane of infiltration was confirmed by observing Doyle’s bulge through the laparoscope. Port site infiltration was done with 40 ml of 0.9% saline (10 ml at each of the 4 port sites) to blind the surgeon.
Patients in group B received infiltration with bupivacaine, 10 ml at each of the 4 port sites and TAP infiltration with 40 ml of 0.9% saline (as described above).
Post-operative pain (at 1, 3, 6, 12, 24 hours and 1 week) (using VAS), time of return to activities of daily living and patient satisfaction (using Capuzzo score) were recorded by an observer who was also blinded.
Results: The mean VAS at 1, 3, 6, 12, 24 hours and 1 week was less in Group A compared to Group B (p=0.831, 0.819, 0.082, <0.05, <0.05 and <0.01 respectively) as was the mean time to return to activities (p<0.01). The mean Capuzzo score (measuring patient satisfaction) was found to be higher in Group A compared to Group B (p<0.001).
Conclusion: TAP block is a safe and easy to use technique that reduces severity of post-operative pain and analgesia requirement after laparoscopic cholecystectomy thereby aiding enhanced recovery, early discharge and improved patient satisfaction. It does not require any special or additional equipment and can be administered by the surgeon himself.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93844
Program Number: P613
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster