Efficacy of the Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy: Comparison With Conventional Port Site Infiltration

Background and objectives: Pain experienced following laparoscopic cholecystectomy is largely contributed by the anterior abdominal wall incisions. This study investigated whether subcostal transversus abdominis (STA) block was superior to traditional port-site infiltration of local anaesthetic in reducing postoperative pain, opioid consumption and time for recovery. Methods: This study was a prospective, randomized, comparative study conducted in the Department of Anaesthesiology, at a tertiary hospital in Chennai. A total of 42 American Society of Anesthesiologists grades 1 and 2 patients undergoing elective laparoscopic cholecystectomy aged between 20 and 60 years were randomly allocated into two groups of 21 each. Group US received ultrasound-guided STA block, whereas group C received conventional port-site infiltration. Visual analogue pain scores were measured at 1, 4 and 8 h postoperatively to assess pain severity and opioid requirement was measured in recovery and up to 8 h postoperatively. The time to discharge from recovery was recorded. Results: STA block resulted in a significant reduction in serial visual pain analogue scores and significantly reduced fentanyl requirement in recovery unit compared to the group that received local port-site infiltration. Furthermore, STA block was associated with overall reduced 8 h equivalent morphine consumption. In addition, STA block significantly reduced median time to discharge from recovery unit. Conclusion: The results suggest that STA block provides superior postoperative analgesia and reduces opioid requirement following laparoscopic cholecystectomy. It may also improve theatre efficiency by reducing time to discharge from the recovery unit.