PRE-INCISION VERSUS LAPAROSCOPIC-ASSISTED TRANSVERSUS ABDOMINIS PLANE (TAP) AND RECTUS SHEATH BLOCK FOR POST-CHOLECYSTECTOMY PAIN MANAGEMENT: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Laparoscopic cholecystectomy is the gold standard treatment for the management of cholelithiasis. The Transversus Abdominis Plane (TAP) block with rectus sheath block is a loco-regional anesthesia technique reducing the need of parenteral analgesics and yields quick recovery after Laparoscopic cholecystectomy.

Objective: To compare the mean post-operative pain score at (3, 6, 12 and 24 hours) after Transversus abdominis plane (TAP) and Rectus sheath block given pre-incision versus laparoscopic-assisted in patients undergoing elective Laparoscopic cholecystectomy at a tertiary care hospital.

Methods: This is a single-center, parallel-group, randomized controlled trial conducted in the General Surgery Department at a tertiary care institute from January 2022 to December 2023. The intervention group received laparoscopic-assisted blocks (TAP and rectus sheath blocks) (LATAP) administered by the surgical team, and the control group received pre-incision blocks (TAP and rectus sheath blocks) (PITAP) administered by an anesthesiologist. The primary outcome was postoperative pain, measured using the visual analog scale at 3, 6, 12, and 24th hours at rest. Secondary outcomes included rescue analgesia, visceral injury, peritoneal entry, and blocks timing.

Results: A total of 224 were included in the study, 112 patients were randomized to each group. Demographics of the patients (i.e. Age, gender, American society of anesthesiologists score, functional class, co-morbidities and BMI) were comparable between the groups. Pain score at third hour post operatively in LATAP and PITAP was 3.38 ± 1.56 vs 3.8 ± 1.7 respectively (P-value= 0.053). Difference in post-operative pain score at 6, 12 and 24 hours was also statistically insignificant. Total rescue analgesia and peritoneal entry between both groups were also statistically insignificant as well. No visceral injury was recorded or observed in both groups. However, mean duration of block between two groups was statistically significant (P-value <0.001) with higher block timings in PITAP group (400.65 ± 108.517 seconds) as compared to LATAP group (142.58 ± 43.464 seconds).

Conclusion: Laparoscopic-assisted TAP block is not inferior to pre-incision TAP block in managing post-operative pain for patients undergoing laparoscopic cholecystectomy, however, the procedure time in LATAP group was shorter than PITAP group. Therefore, we recommend Laparoscopic assisted block to save overall anesthesia and operating room time