Analgesic Efficacy of Right Subcostal Transversus Abdominis (STA) Block Supplemented by Bilateral Rectus Sheath Block (RSB) under USG Guidance and Its Comparison with Port Site Infiltration of Local Anaesthetic in Laparoscopic Cholecystectomy

Abstract

Background and Aims: Pain after Laparoscopic Cholecystectomy is multifactorial, pain is most intense on the day of surgery with the incisional pain predominating over the visceral pain. Subcostal transversus abdominis (STA) block and Rectus sheath block (RSB) has been proven to reduce the pain from midline abdominal incision in laparoscopic surgery. This study aimed to compare the analgesic efficacy of USG guided subcostal transversus abdominis (STA) Block and rectus sheath block vs port site infiltration of local anesthetic in terms of quality of intraoperative and post-operative pain relief (NRS), need of rescue analgesics, hemodynamic stability and 24 hr postoperative patient satisfaction score.Methods: Sixty patients scheduled for laparoscopic cholecystectomy were randomly allocated to two groups either to receive USG guided right STA and bilateral RSB (n = 30, Group A) or port site infiltration of local anesthetic (n = 30, Group B group). Intraoperative and postoperative hemodynamics, pain score and need of rescue analgesics were monitored.Results: The study group (Group A) had significantly reduced NRS score and tramadol consumption over 24 hr. Total tramadol consumption in patients receiving port site local anaesthetic infiltrations (Group B group) was approximately twice (200 ± 100 mg) as compared to patients in block group (Group A) (100 ± 50 mg) (P < 0.0001). Conclusion: It is concluded that ultrasound-guided STA and RSB produce effective post-operative analgesia for the incisional pain in laparoscopic cholecystectomy surgeries and act as a supplementary method in multimodal analgesia.