Transverse Abominis Plane (TAP) Block by POP Method: A Novel Technique of Postop-Analgesia Method in Lap Cholecystectomy in a Secondary Care Peripheral Hospital
Journal Title: International Journal of Contemporary Medical Research - Year 2017, Vol 4, Issue 12
Abstract
Introduction: Although laparoscopic cholecystectomy is a minimally invasive procedure, it can cause significant pain in the postop period. It is a challenge for anaesthesiologist to tackle pain relief in the modern era of multimodal analgesia techniques. Recently the transversus abdominis plane block (TAP Block) has been used as a part of multimodal analgesia with promising results. This study evaluated the efficacy of the TAP block with Ropivacaine in laparoscopic cholecystectomy compared with intravenous paracetamol and intramuscular diclofenac sodium in a secondary care peripheral hospital which was devoid of ultra sound machine for USG guided TAP block. Material and Methods: One hundred and twenty adult patients in ASA physical status I and II adult who were scheduled for elective laparoscopic cholecystectomy were selected in this prospective study in a pheripheral hospital. These patients were allocated in one of two groups: Group I received IV paracetamol and IM diclofenac sodium intraoperatively and Group II who received bilateral TAP block with 0.25% Ropivacaine. Twenty-four hours postoperative opioid(Tramodol) consumption, opioid dose in the recovery unit (PACU) and PACU length of stay were evaluated. The quality of analgesia was assessed by the Visual Analogue Scale (VAS) at specific interval of 0 hrs,4,8,12 and 24 hrs during 24 h, at rest and with movement. Results: The mean 24 h opioid/tramadol requirement was statistically significant between the two groups (22.76+/- 10.26mg vs 79+/-16.7 mg, p < 0.001).Length of stay in Post Anaesthesia Care Unit was significantly lower for group II patients compared with group I patients (21.67+/-10.27min vs 40.57+/-13.42 min, p < 0.001). The TAP Ropivacaine group(GroupII) had a significant lower pain score than the IV paracetamol and IM diclofenac Sodium group(GroupI) at 0, 4,8, 12, 24 h, both at rest and with movement. There were no case of local anaesthetic systemic toxicity or other complications were detected in our study. Conclusion: TAP block by POP method with Ropivacaine 0.25% can provide effective analgesia up to 24 hours after laparoscopic cholecystectomy when combined with conventional multimodal analgesia regimen in a secondary care peripheral hospital.
Authors and Affiliations
Krishna Prasad G V, MAnish Bansal
Keywords
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