Comparison of Trocar Anesthetic Injection & Transverse Abdominis Plane Block Post Laparoscopic Cholecystectomy.

Abstract

Background and objectives: To compare Trocar site Anesthesia Injection (TAI) and Transversus Abdominis Plane Block (TAPB) using Bupivacaine for immediate and sustained analgesia and patient satisfaction in post cholecystectomy patients to build a strategy for safe and early discharge home reducing number of admissions.

Methods: Prospective, double blind randomized controlled trial on adult patients undergoing elective laparoscopic cholecystectomy in two years by convenience sampling was conducted. TAI and ultrasound guided TAPB using Bupivacaine were compared for analgesia (by VAS score 0-10) and patient satisfaction (by Likert scale 1-5) at 1, 2, 4, 6-8, 12 and 24 hours. Any patient with VAS > 4 was provided analgesia by narcotic (Tramadol) and Ketorolac. Mean, standard deviation and mean Standard error) were calculated by descriptive statistical methods. p < 0.05 was significant.

Results: In total, 297 patients participated. The mean VAS was 3.02 versus 4.69 at 2 hours, 4.40 versus 6.60 at 4 hours, 3.48 versus 2.66 at 8 hours, 6.02 versus 3.66 at 12 hours and 3.41 versus 2.89 at 24 hours for TAPB and TAI group, respectively. Patients in TAI group needed Narcotic injection at 4 hours or at 8 hours while TAPB group needed at 8 hours or12 hours. The difference was significant statistically (p < 0.05). Requirement for analgesia in TAI group was significantly higher than in the TAPB groups (p < 0.05). Patients were less satisfied in TAI group than TAPB group at all hours measured (p < 0.05).

Conclusion: TAPB is superior indicated by longer analgesia, less use of narcotic and increased patient satisfaction level.