Comparison of postoperative analgesic effects of ultrasound-guided intercostal nerve block and transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy: randomized clinical trial.

Abstract

Background: The aim of this study was to compare the postoperative analgesic effects of ultrasound-guided intercostal nerve block and transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy.

Methods: Patients undergoing laparoscopic cholecystectomy for chronic cholecystitis with gallstones were randomly allocated to ultrasound-guided T7-11 intercostal nerve block or subcostal transversus abdominis plane block (both with 40 ml 0.3% ropivacaine). The primary outcome was the dose of tramadol required for remedial analgesia 24 h after surgery. The secondary outcomes included visual analogue scale scores at different time points after surgery, the time of initial use of tramadol for postoperative analgesia, patient satisfaction with postoperative pain control, the time to flatus, and the incidence of postoperative adverse events.

Results: A total of 64 patients were included. Compared with the transversus abdominis plane block group, the intercostal nerve block group had lower visual analogue scale scores at 3 h after surgery (mean(s.d.) of 2.4(0.8) versus 1.6(0.6)), 6 h after surgery (mean(s.d.) of 2.2(0.3) versus 1.4(0.6)), and 8 h after surgery (mean of 1.7(0.5) versus 1.3(0.4)) (P < 0.001, P < 0.001, and P = 0.002 respectively), a lower dose of tramadol for remedial analgesia within 24 h after surgery (median of 100 (interquartile range 0-100) versus 50 (interquartile range 0-50) mg) (P = 0.012), and a significantly delayed time of initial use of tramadol for postoperative analgesia (mean(s.d.) of 9.1(7.5) versus 14.6(8.3) h) (P = 0.015). The incidences of postoperative dizziness and postoperative nausea and vomiting were higher in the transversus abdominis plane block group (47% and 69% respectively) than in the intercostal nerve block group (19% and 41% respectively) (P = 0.032 and 0.035 respectively). Patient satisfaction with postoperative analgesia was higher in the intercostal nerve block group than in the transversus abdominis plane block group (P = 0.037). The time to flatus was similar between the two groups (P > 0.050).

Conclusion: Compared with ultrasound-guided subcostal transversus abdominis plane block, ultrasound-guided T7-11 intercostal nerve block with 0.3% ropivacaine provides better postoperative analgesia, requires a lower dose of tramadol for remedial analgesia 24 h after surgery, and significantly delays the time of initial use of tramadol for postoperative analgesia.