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Abstract
Background and Aims The transversus abdominis plane (TAP) block is commonly used for postoperative analgesia. We aimed to compare postoperative analgesic effects and opioid consumption between oblique subcostal (OSTAP), posterior, or dual TAP blocks in laparoscopic cholecystectomy (LC) patients.
Methods In this prospective, randomized-controlled, double-blinded study, 85 patients undergoing LC aged 18-65, and ASA 1-2 were enrolled after ethical approval (NCT04693156). Patients were randomized into three groups. In Group 1 OSTAP, Group 2 posterior TAP, and Group 3 dual (OSTAP and posterior) TAP blocks were performed with 0.5% Bupivacaine, 1% Prilocaine, and saline (each 10mL) ultrasound-guided, right unilaterally and postoperatively; to maintain blindness in Group 1 posterior TAP and Group 2 OSTAP block were performed with saline 30mL. Pain severity by numerical rating scale (NRS), analgesic consumption, and sensory dermatomal involvement (T6-L2) was recorded at 0th-2nd-4th-6th-8th-12th-24th hours. If 7>NRS≥4 dexketoprofen 50mg, if NRS≥7 tramadol 100mg was administered. P<0.05 was considered statistically significant using SPSS 22.0.
Results Seventy-one patients‘ data were analyzed. At initial assessment, 12 patients in Group 1(n=21), six patients in Group 2(n=24), and three patients in Group 3(n=26) had NRS≥4 (p=0.008). None of the patients in Group 3 required tramadol, whereas 33.3% in Group 1 and 8.3% in Group 2 required tramadol (p=0.001). Dermatomal involvement was wider in Group 2 and Group 3 than in Group 1 (p=0.001).
Conclusions With dual TAP block, more effective analgesia is provided than OSTAP block, and posterior TAP block is as effective as dual TAP block therefore both can be chosen for postoperative pain control in LC patients.
Comparison of the rate of resting NRS of 4 and above according to the follow-up hours between the groups. *:The difference between Group 1 and Group 3 is statistically significant. NRS: Numeric Rating Scale
Comparison of a) percentage of tramadol requirement and b) percentage of dexketoprofen requirement between the groups *: The difference between Group 1 and Group 3 is statistically significant. Blue: Group 1, Green: Group 2, Red: Group 3
OSTAP block. The spread of local anesthetic solution is seen on the transversus abdominis plane between the rectus abdominis and transversus abdominis muscles. RA: rectus abdominis muscle, TA: transversus abdominis muscle, TAP: transversus abdominis plane