Comparison Of Ultrasound Guided Bilateral Subcostal Transversusabdominis Plane Block And Port-Site Infiltration With Ropivacaine In Laproscopic Cholecystectomy

Abstract

Introduction: Laparoscopic cholecystectomy is the preferred technique for gallbladder removal, but postoperative pain remains a concern and impacts recovery. Conventional analgesics alone are often insufficient, highlighting the need for multimodal strategies. Ultrasound-guided subcostal TAP block extends analgesia up to T6 and provides effective coverage of the anterior abdominal wall and peritoneum. It has shown superiority in reducing opioid use compared to standard port-site infiltration, making it a valuable option for postoperative pain control in abdominal surgeries.

Materials and methods: After ethical committee  approval and informed consent, 60 ASA I–II female patients (18–65 years, 40–100 kg) scheduled for elective laparoscopic cholecystectomy were randomized (computer-generated) into two groups (n=30 each): Group S received bilateral subcostal TAP block with 20 mL 0.25% ropivacaine per side, and Group P received port-site infiltration with 20 mL (5 mL at four sites). Standard ASA monitoring and general anesthesia induced with propofol, fentanyl, succinylcholine, for maintenance isoflurane and intermittent muscle atracurium was used. All patients received IV paracetamol (1 g) intraoperatively and postoperatively every 8 h; IV tramadol (1 mg/kg) served as rescue analgesia (VAS>3). Postoperative pain was assessed using VAS at 1, 2, 3, 6, 12, and 24 h. Outcomes measured were time to first analgesic request, VAS at first request, duration of analgesia, and total 24-h analgesic requirement. Hemodynamic parameters and adverse events (nausea, vomiting, hematoma, bleeding, allergic reactions) were also recorded.

Results: Group PI showed significantly higher systolic BP at 1 h (p=0.004), 2 h (p=0.002), and 6 h (p=0.002) postoperatively, with no differences at other times. Diastolic BP was higher in Group PI at 1 h (p=0.007) and 2 h (p=0.002). Heart rate was higher at 1 h (p=0.001) and 6 h (p=0.019), while mean arterial pressure was elevated at 1 h (p=0.003) and 6 h (p=0.017). VAS pain scores were lower in the subcostal TAP group at 1, 2, and 12 h (p<0.05), with no differences at other intervals. The mean time to first rescue analgesia was significantly longer in the TAP group (5 h 15 min) compared to port-site infiltration (1 h 10 min). Total rescue analgesic requirement was significantly lower in the TAP group at 6 and 24 h.

Conclusion: Ultrasound-guided subcostal TAP block provides longer postoperative analgesia, lower opioid requirement, and better pain control than port-site infiltration in laparoscopic cholecystectomy. It is safe, effective, and enhances recovery without added complications.