Efficacy of preperitoneal local anesthetic infiltration on post-operative analgesia following laparoscopic cholecystectomy

Introduction: Post-operative pain significantly impairs recovery, delaying hospital discharge after laparoscopic cholecystectomy. Effective pain management facilitates early ambulation, which diminishes the probability of post-operative complications. Objective: This study compares the analgesic efficacy of preperitoneal bupivacaine infiltration with dexamethasone and the transversus abdominis plane (TAP) block. Methods: This prospective, randomized, double-blinded study included 40 patients undergoing laparoscopic cholecystectomy. Group 1 (n = 20) received a TAP block, while Group 2 (n = 20) received preperitoneal bupivacaine for analgesia. The primary outcomes were (i) the level of post-operative pain, assessed using the Visual Analog Scale every 15 min in the 1st post-operative hour, at 2-h intervals up to 12 h, and at 6-h intervals up to 24 h; (ii) time to first request for rescue analgesia; and (iii) the total dose of analgesia. Secondary outcomes included patient-reported sleep quality and the incidence of post-operative nausea and vomiting. Results: The study found that the TAP block provided superior post-operative pain relief compared to preperitoneal infiltration with bupivacaine in patients who underwent laparoscopic cholecystectomy. The TAP block group exhibited significantly lower pain scores at 8 and 12 h postoperatively and experienced a delayed first request for rescue analgesia at 14.6 ± 2.52 h on average, compared with 7.1 ± 1.02 h in the preperitoneal group. Conclusion: The findings establish that TAP block is a more effective analgesic technique than preperitoneal infiltration with bupivacaine for managing post-operative pain in laparoscopic cholecystectomy. Patients receiving TAP block required fewer opioids, had delayed onset of rescue analgesia, and reported lower pain scores at critical post-operative intervals.