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Analgesic efficacy of surgeon-assisted transverse abdominis plane block in patients undergoing open cholecystectomy

Siddharth Parmar, Abdul Nasir Sheikh, Atul Vyas, Garima Puri.


Background: Unavailability of ultrasound and unpredictable success with traditional blind technique makes Transversus Abdominis Plane Block under-utilized in developing country like India.

Aims & Objective: The present study was designed to evaluate the analgesic efficacy of Surgeon-assisted Transversus Abdominis Plane Block as an adjuvant to routine analgesic in reducing pain score during first 12 hours postoperatively in patients undergoing open cholecystectomy.

Material and Methods: This was randomized, double-blinded, controlled, clinical trial carried out in tertiary care, teaching hospital. All the patients received a routine general anaesthesia with standard monitoring. Group A received routine analgesic which included Diclofenac sodium 75 mg intravenously (IV) at 8 hourly and group B received routine analgesic & Transversus Abdominis Plane Block with 15 ml of bupivacaine 0.25% at the end of surgery. Visual analogue score for pain, incidence of post-operative nausea and vomiting and demand of rescue opioid (Tramadol 2 mg/kg IV) in post-operative period were assessed every 2 hourly up to 12 hours after the surgery by an investigator blinded to group allocation.

Results: Transversus Abdominis Plane block reduced visual analogue scale for pain on emergence and at all postoperative time points up to 12 hours (p = 0.0009). The incidence of post-operative nausea and vomiting, and demand of rescue opioid in the first 12 postoperative hours were also reduced (p=< 0.0001). There were no complications attributable to the block.

Conclusion: Transversus Abdominis Plane Block is effective as an adjuvant to routine analgesic to reduce pain after open cholecystectomy and reduces post-operative opioid demand and nausea & vomiting.

Key words: Transversus Abdominis Plane Block; Post-Operative Pain; Bupivacaine; Cholecystectomy

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