Comparison of ultrasound guided transversus abdominis plane block (tap) and local infiltration analgesia during laparoscopic cholecystectomy surgery

ABSTRACT: Aim: Pain after laparoscopic cholecystectomy is usually occured by anterior abdominal wall incision. The aim of this study is comparing the intra- and postoperative analgesic efficacy, opioid consumption and side effects of transversus abdominis plane block to port-site infiltration of local anesthesic. Methods: Seventy-five patients undergoing laparoscopic cholecystectomy operation were randomly allocated to three group. Group T (n=25) received total 30 ml 0.25% levobupivacaine with ultrasound guided bilateral TAP block. Before the operation, Group L (n=25) received local anesthetic infiltration to trocar insertion sites with total 20 ml 0.5% levobupivacain. Group Control (Group K; n=25) did not receive the TAP block or local anesthetic infiltration. Intraoperative usage of fentanyl and analgesic consumption for the first 24hrs, the postoperative visual analog scores eveluated in rest position and while coughing at 1,2,4,8,12,16 and 24. hrs, shoulder pain, nause and vomiting scores were also recorded. Results: Demographic characteristics were similar between groups. There was no statistically significant difference in pain scores at rest and movement, intraoperative fentanyl usage and total analgesic consumption during postoperative 24 hr. Patients who recieved TAP block in first hour mild vomiting rate (20%) were significantly lower than Group K (64%) (p<0.05). Also TAP block group's second hour mild vomiting rate (12%) were significantly lower than Group K's (44%) (p<0.05). Patients in TAP group, awakeness (80%) in first hr were significantly higher than Group K (28%) (p<0.05). Conclusion: Bilateral ultrasound-guided TAP block and local anesthetic infiltration of trocar insertion sites were compared for postoperative analgesic efficacy and statistically significant difference was found. We think that awakeness in first hour in Group T makes this block useful for early recovery. Trying to diffirentiate incisional pain from visceral pain in these patients is diffucult. Because of both TAP block and local anesthetic infiltration show effects especially on incisional pain and there are other components of pain, also there were not significantly difference in postoperative pain scores it would be useful in future studies to eveluate the effects with large patient group, different volume and concentrations. Keywords: Laparoscopic Cholecystectomy, Postoperative Pain, TAP block