Comparison of ultrasound guided subcostal transversus abdominis plane block with intraperitoneal instillation of levobupivacaine for post-operative pain relief in laparoscopic cholecystectomy

Background & Objective: Postoperative pain is the main source of perioperative stress, morbidity, prolonged hospital stays and overall financial burden to society. Regional anesthesia techniques have been widely used for pain control in day care surgeries, as a part of early recovery after surgery (ERAS). We compared the efficacy of ultrasound guided subcostal Transversus Abdominis Plane Block (sTAP) using levobupivacaine with intra-peritoneal instillation of levobupivacaine for quality and duration of postoperative pain in patients undergoing laparoscopic cholecystectomy under general anesthesia (GA). Methodology: This randomized double-blind trial included one hundred patients posted for laparoscopic cholecystectomy under GA. Patients were randomly divided into two equal groups: Group sTAP received sTAP block, and Group IP received intraperitoneal instillation of levobupivacaine, at the end of surgery before extubation. Quality of postoperative analgesia was compared in terms of Visual Analog Scale (VAS) scores. Duration of analgesia as well as the frequency of side effects in both groups were also compared. Results: Mean duration of surgery was 51.15 ± 9.33 min and 52.42 ± 9.06 min in Group IP and Group sTAP respectively. Demographic parameters were comparable among groups. VAS scores recorded postoperatively in first 24 hours were significantly lower in Group sTAP in comparison to Group IP (P < 0.05), at all intervals. Time to first dose of rescue analgesic required was 2.23 hours vs. 4.91 hours in Group sTAP and Group IP respectively (P < 0.05). Total amount of analgesia required in first 24 hours was significantly lower in Group sTAP (P < 0.05). Nausea and vomiting were reported as common adverse effects among both the study groups with similar prevalence. Conclusions: Based upon the results of our study, we conclude that the post-operative analgesic profile of the ultrasound-guided subcostal transversus abdominis plane block is better than intraperitoneal instillation of levobupivacaine in patients undergoing laparoscopic cholecystectomy under general anesthesia. Keywords: Analgesia; Cholecystectomy; Intraperitoneal instillation; subcostal transversus abdominis plane block; Ultrasound. Citation: Ahmed NS, Alam MDS, Hasan M, Prasad M, Verma A, Juneja P, Ali T. Comparison of ultrasound guided subcostal transversus abdominis plane block with intraperitoneal instillation of levobupivacaine for post-operative pain relief in laparoscopic cholecystectomy. Anaesth. pain intensive care 2025;29(3):392-396. DOI: 10.35975/apic.v29i3.2748 Received: October 30, 2024; Revised: February 14, 2025; Accepted: March 11, 2025