Abstract

Background: The postoperative pain after laparoscopic cholecystectomy (LC) is a common concern.

Objectives: To compare the postoperative pain intensity in patients receiving port site local anesthetic (LA) infiltration and m-TAPA (modified thoracoabdominal nerve block through perichondral approach) block

Design: Randomized controlled study

Setting: Tertiary care teaching hospital

Methods: 46 adult patients were randomly allocated to receive LA infiltration in Group I (n=23) or m-TAPA block in Group II (n=23). The postoperative pain using the verbal numerical rating scale (NRS) at 0 ( on transfer to postanaesthesia care unit) , 2, 4, 6,8,12 , and 24 hours (h) ,the proportion of patients requiring rescue analgesics, the time taken for the first request of rescue analgesic, and self -administered Quality of Recovery (QoR) at 24 h after surgery were noted.

Main Outcome Measures: NRS score at 24 hours after surgery and proportion of patients requiring rescue analgesia.

Results: The NRS score (on scale 0 to 10) was significantly higher in Group I compared to Group II at 0, 2, 4, 6, and 8 h after surgery. However, it was comparable in both groups at 24 h postoperatively (median NRS [interquartile range], Group I vs. Group II, 4.00 [3.96-4.82] vs. 4.00 [3.59-4.67], p=0.42). A lesser proportion of patients requested for rescue analgesia in Group II [patients requiring first: second: third rescue analgesics in number (percentage), Group I, 23(100):17(73.9):11(47.8) vs. Group II, 14(60.9):2(8.7):0, P<0.001). The time to request rescue analgesia was longer in Group II (median time 7 [4-8] h vs .2 [2-4] h, p<0.001).Additionally, the patient in Group II reported better postoperative QoR-15 score (Scale 0 to 150).

Conclusion: In patients undergoing LC, the m-TAPA block provided better early postoperative analgesia and improved quality of recovery compared with port-site infiltration, although pain intensity was similar at 24 h.

Trial registration: CTRI/2023/07/055685