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Randomized Controlled Trial
. 2023 Feb;44(2):145-154.
doi: 10.15537/smj.2023.44.2.20220407.

Bilateral 4-quadrant laparoscopic-assisted transversus abdominis plane block reduces early postoperative pain after laparoscopic cholecystectomy: A prospective, single-blind, randomized study

Eralp Çevikkalp  1 , Mustafa Narmanlı  1 , Halil Özgüç  1 , Gökhan Ocakoğlu  1
Affiliations
Randomized Controlled Trial

Bilateral 4-quadrant laparoscopic-assisted transversus abdominis plane block reduces early postoperative pain after laparoscopic cholecystectomy: A prospective, single-blind, randomized study

Eralp Çevikkalp et al. Saudi Med J. 2023 Feb.

Abstract

Objectives: To investigate the efficacy of bilateral 4-quadrant laparoscopic-assisted transversus abdominis plane (BLTAP) block in laparoscopic cholecystectomy (LC).

Methods: This study was carried out at Private Medicabil Hospital, Bursa, Turkey, between September 2021 and March 2022. Patients were randomly divided into 4 groups (n=40, each): i) the standard analgesia (SA) group received the block and port-site infiltration with normal saline (NS); ii) the local anesthetic group received the block with NS and port-site infiltration of bupivacaine; iii) the unilateral laparoscopic-assisted transversus abdominis plane (ULTAP) block group received 2-quadrant block with bupivacaine on the right and NS on the left and port-site NS infiltration; and iv) the BLTAP block group received bilateral bupivacaine and port-site NS infiltration. Postoperative 1-, 3-, 6-, 12-, and 24-hours visual analog scale (VAS) pain scores at rest and during cough, opioid requirement, presence of nausea and vomiting, and satisfaction scores were recorded.

Results: The one-hour VAS score at rest was lower in the BLTAP block group than in the SA and ULTAP block groups. The change in VAS score was higher in the SA group than in the BLTAP block group. During cough, the one-hour VAS score was lower in the BLTAP block group than in the SA group. There were no differences among groups in other parameters.

Conclusion: Bilateral 4-quadrant laparoscopic-assisted transversus abdominis plane block technique is more effective than SA, local anesthetic infiltration, and ULTAP block in preventing early postoperative pain after LC.Clinicaltrials.gov No.: NCT04641403.

Keywords: laparoscopic cholecystectomy; pain management; port-site infiltration; postoperative analgesia; regional anesthesia; transversus abdominis plane block.

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Figures

Figure 1
Figure 1
- After randomization, patients were assigned to each group and underwent the procedure. SA: standard analgesia, LA: local anesthesia, BLTAP: bilateral laparoscopic-assisted transversus abdominis plane block, ULTAP: unilateral laparoscopic-assisted transversus abdominis plane block
Figure 2
Figure 2
- Surface landmarks for: A) transversus abdominis plane block; and B) Doyle’s bulge after the injection of local anesthetic.
Figure 3
Figure 3
- The Consolidated Standards of Reporting Trials flow diagram. SA: standard analgesia, LA: local anesthesia, BLTAP: bilateral laparoscopic-assisted transversus abdominis plane, ULTAP: unilateral laparoscopic-assisted transversus abdominis plane
See this image and copyright information in PMC

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