THE ROLE OF REGIONAL ANALGESIA IN PREVENTING CHRONIC PAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY: A COMPARATIVE STUDY

Abstract. Chronic postoperative pain after laparoscopic cholecystectomy remains a clinically significant problem that worsens patients’ quality of life, increases the risk of anxiety and depressive disorders, and is associated with sleep disturbances. One of the promising strategies for its prevention is the use of regional analgesia. Objective. To compare the effectiveness of multimodal analgesia alone versus multimodal analgesia combined with either a subcostal TAP block or a right-sided type II QL block in the prevention of chronic postoperative pain and psycho-emotional disorders during the long-term follow-up after laparoscopic cholecystectomy for acute cholecystitis. Materials and Methods. A total of 90 patients with acute cholecystitis undergoing laparoscopic cholecystectomy were included in the study. According to the postoperative analgesic technique, patients were divided into three groups (30 patients each): control – standard multimodal analgesia; TAP block group – multimodal analgesia supplemented with a subcostal TAP block; QL block group – multimodal analgesia supplemented with a right-sided type II QL block. Pain intensity was assessed using the Visual Analogue Scale (VAS) at 1, 3, and 6 months postoperatively; the neuropathic pain component was evaluated with the DN4 questionnaire; psycho-emotional status – with the Beck Anxiety Inventory and the Hospital Anxiety and Depression Scale (HADS); sleep quality – with the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index (PSQI). Results. At 3 months, chronic postoperative pain was detected in 13.3% of patients in the control group, 6.7% in the TAP block group, and was not observed in the QL block group. At 6 months, the incidence of chronic pain remained 6.7% in both the control and TAP block groups, while no cases were reported in the QL block group. A neuropathic pain component (DN4 ≥ 4) was recorded in 6.7% of patients in the control group and 3.3% in the TAP block group, but not in the QL block group. Patients receiving a QL block demonstrated better anxiety, depression, and sleep quality scores across all follow-up periods. Conclusions. The addition of a QL block to multimodal analgesia in laparoscopic cholecystectomy is associated with a reduced incidence of chronic postoperative pain, absence of neuropathic pain, and improved psycho-emotional status and sleep quality in the long-term period, confirming its advantages over TAP block and standard multimodal analgesia.