Comparative study ultrasound guided abdominal field blocks versus port infiltration in laparoscopic cholecystectomies for post-operative pain relief

Abstract

Background and Aims: Effective post‑operative analgesia after laparoscopic cholecystectomy is important because it facilitates early amelioration, ambulation and short hospital stay. Aim: To compare the postoperative analgesic efficacy of ultrasound guided abdominal field blocks with port site infiltration with ropivacaine in laparoscopic cholecystectomy. Methods: An observational study was conducted in the Postgraduate Department of Anaesthesiology and Critical Care Medicine in collaboration with the Department of General Surgery, Government Medical College, Srinagar from October 2017 – December 2018. Patients were randomised into two groups to receive either local anaesthetic infiltration of the laparoscopy port sites (n = 40, Group A/standard group) and USAFBs (n = 40, Group B/study group) using a total dose of 30 ml of ropivacaine 0.2% with sterile technique. Randomisation was done by flipping of coin method. The primary objective was to measure magnitude of pain in first 24 hours using numeric rating scores (NRS). To estimate opioid consumption in first 24 hours postoperatively. To assess the quality of pain relief and patient satisfaction on a four point Patient satisfaction scale. Statistical analysis was done using SPSS version 21. Data were compared using the Chi‑square test and students’ t‑test. Results: Duration of analgesia was significantly longer in Group B than group A. Upon inter group comparison of A vs. B the results were statistically significant (p value <0.001). At all time in 24 hrs. Postoperative period (1, 2, 4, 6, 12 and 24 hrs.) NRS score was least in group B then group A with statistically significant difference (p value <0.001). The overall tramadol consumption in Group A was approximately twice (107.5 ± 61.55 mg) as compared to Group B (56.3 ± 39.53mg). Conclusion: STA block in addition with rectus abdominis sheath block is a good alternative for providing perioperative analgesia for upper abdominal surgery such as laparoscopic cholecystectomy and can cover the conventional anatomical port sites as well.