Is the application of subcostal transversus abdominis plane block effective for pain control in classical four-port laparoscopic cholecystectomy?

The utilization of transversus abdominis plane (TAP) block for postoperative pain management has proven to be efficacious. The purpose of this inquiry is to evaluate the effectiveness of right-sided TAP blockade guided by ultrasonography (USG) in managing pain subsequent to laparoscopic cholecystectomy. A total of 60 patients were equallydistributed into two groups. The control group was comprised of patients who did not receive a TAP block, whereas the TAP block group consisted of patients who underwent an ultrasound-guided, right-sided unilateral subcostal TAP block with 20 mL of 0.25% bupivacaine. A Verbal Numerical Rating Scale was administered to all participants for pain assessment at postoperative intervals of 0th, 6th, 12th and 24th hours. Additionally, the overall amount of supplementary analgesic used after surgery, age distribution among each gender classification and body mass index range categories as well as operation time duration; use or non-use of drain; and incidence rate for postoperative complications were recorded for each patient individually. The mean age of participants was 47.72 ± 13.80 years, with a female-to-male ratio of 41/19. The control group exhibited significantly higher pain scale measurements than the block group at the postoperative 0th and the postoperative 24th hour. Drain replacement yielded notably higher pain scores for both TAP and control groups at the postoperative 0th hour. Neither BMI nor operation duration had significant effects on postsurgical pain in either patient group—whether or not they received a TAP block treatment. Our research shows that the implementation of a TAP block and exclusion of surgical area drainage placement yield favorable results in mitigating postoperative pain. Notably, BMI and procedure duration do not exhibit any discernible impact on postoperative pain management.

Laparoscopic cholecystectomy; Transversus abdominis plane block; Drain; Pain

[1] Jalali SM, Bahri MH, Yazd SMM, Karoobi M, Shababi N. Efficacy of laparoscopic transversus abdominis plane block on postoperative pain management and surgery side effects in laparoscopic bariatric surgeries. Langenbeck’s Archives of Surgery. 2022; 407: 549–557.

[2] Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001; 56: 1024–1026.

[3] Prabhakar P, Ganapathi HP, Suresh V, Farias A, Manoharan M. Surgeon administered transversus abdominis plane block: anatomic principles and technique. Journal of Robotic Surgery. 2023; 17: 1193–1205.

[4] Bernard L, Lavecchia M, Trepanier G, Mah S, Pokoradi A, McGinnis JM, et al. A double-blinded, randomized trial comparing surgeon-administered transversus abdominis plane block with placebo after midline laparotomy in gynecologic oncology surgery. American Journal of Obstetrics and Gynecology. 2023; 228: 553.e1–553.e8.

[5] Liu KY, Lu YJ, Lin YC, Wei PL, Kang YN. Transversus abdominis plane block for laparoscopic colorectal surgery: a meta-analysis of randomised controlled trials. International Journal of Surgery. 2022; 104: 106825.

[6] Wang P, Chen X, Chang Y, Wang Y, Cui H. Analgesic efficacy of ultrasound-guided transversus abdominis plane block after cesarean delivery: a systematic review and meta-analysis. Journal of Obstetrics and Gynaecology Research. 2021; 47: 2954–2968.

[7] Sahap M, Artykov MS, Gulec H, Yalcin A, But A. Ultrasound-guided vs laparoscopic-asisted transversus abdominis plane block for laparoscopic cholecystectomy: a randomized prospective study. Journal of Advanced Research in Social Sciences. 2023; 31: 55–61.

[8] Karasu D, Yilmaz C, Ozgunay SE, Yalcin D, Ozkaya G. Ultrasound-guided transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy: a retrospective study. Northern Clinics of Istanbul. 2020; 8: 88–94.

[9] Hafeman M, Greenspan S, Rakhamimova E, Jin Z, Moore RP, Al Bizri E. Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysis. Frontiers in Pediatrics. 2023; 11: 1173700.

[10] Wang W, Wang L, Gao Y. A meta-analysis of randomized controlled trials concerning the efficacy of transversus abdominis plane block for pain control after laparoscopic cholecystectomy. Frontiers in Surgery. 2021; 8: 700318.

[11] Sharma R, Damiano J, Al-Saidi I, Dizdarevic A. Chest wall and abdominal blocks for thoracic and abdominal surgeries: a review. Current Pain and Headache Reports. 2023; 27: 587–600.

[12] Grape S, Kirkham KR, Akiki L, Albrecht E. Transversus abdominis plane block versus local anesthetic wound infiltration for optimal analgesia after laparoscopic cholecystectomy: a systematic review and meta-analysis with trial sequential analysis. Journal of Clinical Anesthesia. 2021; 75: 110450.

[13] Ozciftci S, Sahiner Y, Sahiner IT, Akkaya T. Is right unilateral transversus abdominis plane (TAP) block successful in postoperative analgesia in laparoscopic cholecystectomy? International Journal of Clinical Practice. 2022; 2022: 2668215.

[14] Lee THW, Barrington MJ, Tran TMN, Wong D, Hebbard PD. Comparison of extent of sensory block following posterior and subcostal approaches to ultrasound-guided transversus abdominis plane block. Anaesthesia and Intensive Care. 2010; 38: 452–460.

[15] Şahin AS, Ay N, Şahbaz NA, Akay MK, Demiraran Y, Derbent A. Analgesic effects of ultrasound-guided transverse abdominis plane block using different volumes and concentrations of local analgesics after laparoscopic cholecystectomy. Journal of International Medical Research. 2017; 45: 211–219.

[16] Elnabtity AM, Tawfeek M, Keera A, Badran Y. Is unilateral transversus abdominis plane block an analgesic alternative for ureteric shock wave lithotripsy? Anesthesia. 2015; 9: 51–56.

[17] Hotujec BT, Spencer RJ, Donnelly MJ, Bruggink SM, Rose SL, Al-Niaimi A, et al. Transversus abdominis plane block in robotic gynecologic oncology: a randomized, placebo-controlled trial. Gynecologic Oncology. 2015; 136: 460–465.

[18] Keir A, Rhodes L, Kayal A, Khan OA. Does a transversus abdominis plane (TAP) local anaesthetic block improve pain control in patients undergoing laparoscopic cholecystectomy? A best evidence topic. International Journal of Surgery. 2013; 11: 792–794.

[19] Peng K, Ji F, Liu H, Wu S. Ultrasound-guided transversus abdominis plane block for analgesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Medical Principles and Practice. 2016; 25: 237–246.

[20] Altıparmak B, Korkmaz Toker M, Uysal AI, Kuşçu Y, Gümüş Demirbilek S. Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: Randomized, controlled trial. Journal of Clinical Anesthesia. 2019; 57: 31–36.

[21] Baral BK, Poudel PR. Comparison of analgesic efficacy of ultrasound guided subcostal transversus abdominis plane block with port site infiltration following laparoscopic cholecystectomy. Journal of Nepal Health Research Council. 2018; 16: 457–461.

[22] Calini G, Brollo PP, Quattrin R, Bresadola V. Predictive factors for drain placement after laparoscopic cholecystectomy. Frontiers in Surgery. 2022; 8: 786158.

[23] Park JS, Kim JH, Kim JK, Yoon DS. The role of abdominal drainage to prevent of intra-abdominal complications after laparoscopic cholecystectomy for acute cholecystitis: prospective randomized trial. Surgical Endoscopy. 2015; 29: 453–457.

[24] Picchio M, De Cesare A, Di Filippo A, Spaziani M, Spaziani E. Prophylactic drainage after laparoscopic cholecystectomy for acute cholecystitis: a systematic review and meta-analysis. Updates in Surgery. 2019; 71: 247–254.

[25] Qiu J, Li M. Nondrainage after laparoscopic cholecystectomy for acute calculous cholecystitis does not increase the postoperative morbidity. BioMed Research International. 2018; 2018: 8436749.

[26] Tzovaras G, Liakou P, Fafoulakis F, Baloyiannis I, Zacharoulis D, Hatzitheofilou C. Is there a role for drain use in elective laparoscopic cholecystectomy? A controlled randomized trial. The American Journal of Surgery. 2009; 197: 759–763.

[27] Miniksar ÖH, Katar MK. Acute postoperative pain and opioid consumption after laparoscopic cholecystectomy is associated with body mass index: a retrospective observational single-center study. Journal of Health Sciences and Medicine. 2022; 5: 1–6.

[28] Westgate CSJ, Israelsen IME, Jensen RH, Eftekhari S. Understanding the link between obesity and headache- with focus on migraine and idiopathic intracranial hypertension. The Journal of Headache and Pain. 2021; 22: 123.

[29] Yang MMH, Hartley RL, Leung AA, Ronksley PE, Jetté N, Casha S, et al. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open. 2019; 9: e025091.

[30] Grodofsky S, Sinha A. The association of gender and body mass index with postoperative pain scores when undergoing ankle fracture surgery. Journal of Anaesthesiology Clinical Pharmacology. 2014; 30: 248–252.