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ORIGINAL ARTICLE
Role of Laparoscopic-assisted Transversus Abdominis Plane

Block during Elective Laparoscopic Cholecystectomy

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Apoorv Goel , Roli Bansal , Prakhar Garg , Shyam Kothari 4
AbstrAct
Background: In today’s era of minimally invasive surgery, early postoperative pain reduction, early recovery, and return to normal activities
are also important aspects. This study has been designed to analyze and compare the effect of laparoscopically administered transversus
abdominis plane (TAP) block with port-site infiltration of long-acting local anesthetic agent (0.25% bupivacaine) in cases of elective laparoscopic
cholecystectomy.
Materials and methods: This is a comparative study carried out at St Joseph Hospital, Ghaziabad, from September 2019 to March 2020 on 154
patients who underwent standard four-port laparoscopic cholecystectomy. Seventy-seven patients in group I received TAP block with 0.25%
bupivacaine and seventy-seven patients in group II received 20 mL of 0.25% bupivacaine infiltration over port sites, including 10 mL each at
epigastric and umbilical port and 5 mL each at midclavicular line and anterior axillary line ports, respectively. Various parameters were assessed
during the intraoperative and postoperative periods. The pain was analyzed using visual analog scoring (VAS) for the first 24 hours at an interval
of 3, 6, 12, and 24 hours. A note was made of any additional analgesic requirement.
Results: Postoperative pain at 3, 6, and 12 hours was significantly reduced in group I who received TAP block as compared to those who received
port-site infiltration. Hospital stay duration was significantly shorter in group I.
Conclusion: Laparoscopic-assisted TAP block significantly reduces early postoperative pain, shortens hospital stay after elective laparoscopic
cholecystectomy, and is a safe and cost-effective method without any extra requirement of specialized equipment and skills.
Keywords: Cholelithiasis, Laparoscopic cholecystectomy, Transversus abdominis plane block.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1460

IntroductIon 1,3 Department of General Surgery, Santosh Medical College and
Laparoscopic cholecystectomy is one of the most commonly Hospital, Santosh University, Ghaziabad, Uttar Pradesh, India
performed laparoscopic surgeries. Laparoscopic surgery has 2 Department of Medicine (Division of Nephrology), UCMS and GTB
provided fast recovery, short hospital stay, early return to work, and Hospital, Delhi, India
minimum scar, but postoperative pain management still remains 4 Department of Surgery, St Joseph Hospital, Ghaziabad, Uttar Pradesh,
a concern. 1,2 India
Pain after laparoscopic cholecystectomy can occur within hours Corresponding Author: Apoorv Goel, Department of General Surgery,
usually over the port sites or at the right shoulder or it can be a Santosh Medical College and Hospital, Santosh University, Ghaziabad,
generalized pain. Pain following laparoscopic cholecystectomy Uttar Pradesh, India, e-mail: drapurvgoel@gmail.com
is multifactorial. Pain occurring over port sites is due to somatic How to cite this article: Goel A, Bansal R, Garg P, et al. Role
component whereas pain over right shoulder or diffuse abdominal of Laparoscopic-assisted Transversus Abdominis Plane Block
pain is because of visceral component caused by stretching due during Elective Laparoscopic Cholecystectomy. World J Lap Surg
to pneumoperitoneum. 1–3 On the basis of this theory, various 2021;14(2):87–89.
techniques have been described to reduce this pain. Pain can Source of support: Nil

be mild to severe and even require injectable analgesics, such as Conflict of interest: None
diclofenac sodium or opioids. This pain can delay recovery, lengthen
hospitalization, and hampers routine activity. Pain killers like opioids
and diclofenac sodium have their own adverse effects. 4
There are numerous studies on the reduction of early Various techniques of TAP block had been described.
postoperative pain following laparoscopic cholecystectomy, In 2001, a blind ‘double pop’ technique was defined to infiltrate
including port-site infiltration of local anesthetics, laparoscopically the fascial plane with local anesthetics. Ultrasound-guided TAP
delivered transversus abdominis plane (TAP) block, intraperitoneal block was introduced in 2007, a technique better than blind
5,9
instillation of local anesthetics, and various other methods out of infiltration but still operator dependent. Later laparoscopy-
which TAP block and port-site infiltration with long-acting local guided infiltration of the fascial plane with long-acting local
anesthetic agents are commonly used techniques. 1–3 anesthetics like bupivacaine was introduced. Studies confirmed
TAP block is a technique in which a long-acting local anesthetic that laparoscopy-guided infiltration is more accurate as it is done
drug like bupivacaine is administered into the fascial plane between under direct visualization. 7,8
the fibers of internal oblique and transversus abdominis muscle. This study aim is designed to analyze and compare the effects of
Somatic nerve from T6 to L1 run in this fascial plane to innervate the TAP block with port-site infiltration in cases of elective laparoscopic
anterior abdominal wall layers from skin to parietal peritoneum. 4–9 cholecystectomy.
© Jaypee Brothers Medical Publishers. 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
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