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Volume 12 Issue 4 ( October-December ) 2023

Original Articles

Comparison Of Post-Operative Analgesia By Transverse Abdominis Plane (TAP) Block Done Under Laparoscopy Vs Ultrasound (US) Guidance In Patients Of Laparoscopic Cholecystectomy- A Retrospective Observational Study
Dr. Parneet Singh Brar, Dr. Ishaan Bansal, Dr. Sumit Dhuria, Aman Goyal

Introduction: Laparoscopic cholecystectomy is one of the most common surgeries done in the surgical specialty. But the incidence of moderate to severe pain remains high for the first 24 hours post-surgery due to segmental innervation of nociceptor afferent pathways. Therefore, for the management of this post-operative pain, bilateral subcostal TAP block is given. This TAP block is given laparoscopically and under ultrasound guidance. Laparoscopic guided TAP Block has recently been introduced, and there are not many studies regarding this technique. Material and Methods: A retrospective observational study was done on 108 patients with an age range of 18–65 years. The TAP block was done with bilateral injection of 30cc Bupivacaine between layers of internal oblique and transversus abdominis, either under laparoscopic visualization or under US guidance just below the coastal margin in the midclavicular line. The postoperative analgesia assessment was done blindly by the controller with the VAS scale, every half hourly for the first 2 post-operative hours, then every 2 hourly for the next 8 post-operative hours, and later as per need and indication for the next 14 hours, completing 24 hours of assessment for the study. Therefore, the need for rescue analgesia was noticed. Results: Box-plot analysis with Wald-type and ANOVA-type tests was applied, and calculations for testing group and time effects and interaction were made. Significant differences between the two groups were seen during the initial part of the study. Later, the significant difference was reduced with the consequent formulation of the surgeon’s technique of administration. As a result, the post-operative pain with the laparoscopically guided TAP Block significantly improved. With the passage of time, more patients were getting similar results in the control of post-operative pain, either by laparoscopic or ultrasound-guided methods. Conclusion: The laparoscopic guided TAP Block has some advantages over the ultrasound guided TAP Block, as it can be administered in the operating theatre itself within 30 seconds, and there is no requirement for an interventional radiologist in the operating theatre. Also, there is no need for the ultrasound machine in the operative theatre for the administration of the block. Therefore, laparoscopic guided TAP block must be considered as an effective method for post-operative pain management.

 
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