What is it about?
Intraperitoneal Installation using Ropivacaine in Laparoscopic Cholecystectomy Patients
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Why is it important?
Background: Laparoscopic cholecystectomy is one of the most common ambulatory elective procedures. Surgical pain derives significantly from the incisions made in the anterior abdominal wall. Nerve supplying the anterior abdominal wall are derived from T6-L1 afferent nerve which course through the neurofascial plane between the internal oblique and transversus abdominis muscle. The subcostal transverse abdominis plane (TAP) block is better suited for upper abdominal surgery [T7-T11] in relieving postoperative pain. Materials and Methods: 60 patients were randomly allocated into any one of two groups of 30 patients each, by means of computer-generated randomization. Group A patients received bilateral subcoastal TAP block with Ropivacaine 0.25% 40 ml injected under ultrasound guidance. Group B patients received intraperitoneal installation of Ropivacaine 0.25% 40 ml through laparoscopic instrument before laparoscopic port closure. Results: Resting VAS scores were significantly lower in group A than B at 4 hr (p=0.003), 8 hr (p=0.001), 12 hr (p=0.001) and 24 hr (0.001) after the operation. Deep inspiration VAS scores were significantly lower in group A than B at 4 hr (p=0.003), 8 hr (p=0.001), 12 hr (p=0.001) and 24 hr (<0.001) after the operation. Both static and dynamic pain were accompanied by lower analgesic requirement in the subcostal TAP block. Conclusion: Ultrasound guided subcostal TAP block is one of the most effective supplemental techniques as part of the multimodal post-operative analgesic regimen.
Perspectives
Background: Laparoscopic cholecystectomy is one of the most common ambulatory elective procedures. Surgical pain derives significantly from the incisions made in the anterior abdominal wall. Nerve supplying the anterior abdominal wall are derived from T6-L1 afferent nerve which course through the neurofascial plane between the internal oblique and transversus abdominis muscle. The subcostal transverse abdominis plane (TAP) block is better suited for upper abdominal surgery [T7-T11] in relieving postoperative pain. Materials and Methods: 60 patients were randomly allocated into any one of two groups of 30 patients each, by means of computer-generated randomization. Group A patients received bilateral subcoastal TAP block with Ropivacaine 0.25% 40 ml injected under ultrasound guidance. Group B patients received intraperitoneal installation of Ropivacaine 0.25% 40 ml through laparoscopic instrument before laparoscopic port closure. Results: Resting VAS scores were significantly lower in group A than B at 4 hr (p=0.003), 8 hr (p=0.001), 12 hr (p=0.001) and 24 hr (0.001) after the operation. Deep inspiration VAS scores were significantly lower in group A than B at 4 hr (p=0.003), 8 hr (p=0.001), 12 hr (p=0.001) and 24 hr (<0.001) after the operation. Both static and dynamic pain were accompanied by lower analgesic requirement in the subcostal TAP block. Conclusion: Ultrasound guided subcostal TAP block is one of the most effective supplemental techniques as part of the multimodal post-operative analgesic regimen.
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This page is a summary of: Comparing the Postoperative Analgesic Effect of Subcostal Transverse Abdominis Plane Block and Intraperitoneal Installation using Ropivacaine in Laparoscopic Cholecystectomy Patients, Indian Journal of Anaesthesia and Analgesia, January 2019, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.6319.11.
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