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TAP Block in Lap Cholecystectomy
anesthetic at port sites, intraperitoneal instillation at gallbladder references
bed, and TAP block were used for early postoperative pain
control. 3,8,10 Many studies have shown a significant reduction in 1. Mitra S, Khandelwal P, Roberts K, et al. Pain relief in laparoscopic
cholecystectomy--a review of the current options. Pain Pract
postoperative pain after infiltration at incision sites whereas few 2012;12:485–496. DOI: 10.1111/j.1533-2500.2011.00513.x.
studies had shown no statistical difference in pain or duration 2. Fredman B, Olsfanger D. Residual pneumoperitoneum: a cause of
of stay. 5–16 postoperative pain after laparoscopic cholecystectomy. Can J Surg
In our study, we have analyzed and compared the effect of 1996;39:26–30. DOI: 10.1213/00000539-199407000-00028.
laparoscopically delivered TAP block with port-site infiltration of 3. Lepner U, Goroshina J, Samarütel J. Postoperative pain relief after
0.25% bupivacaine in reduction of early postoperative pain, early laparoscopic cholecystectomy: a randomised prospective double-
recovery, and return to routine activity after elective laparoscopic blind clinical trial. Scand J Surg 2003;92:121–124. Available at: https://
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early postoperative pain specifically at 3, 6 and 12 hours in the randomized, placebo-controlled comparison of local anaesthetic
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the need for additional analgesia was significantly less in patients Available at: https://pubmed.ncbi.nlm.nih.gov/17658101/
receiving TAP block. The hospital stay in TAP block group was 5. Hebbard P, Fujiwara Y, Shibata Y, et al. Ultrasound guided transversus
shorter and statistically significant. abdominis plane block. Anaesth Intensive Care 2007;35:616–617.
TAP block was introduced in 2001 as a blind technique for pain Available at: https://pubmed.ncbi.nlm.nih.gov/18020088/
relief following abdominal surgeries. Later ultrasound-guided TAP 6. El-Dawlatly AA, Turkistani A, Kettner SC, et al. Ultrasound guided
transversus abdominis plane block: description of a new technique
block was introduced, and in 2009, El-Dawlatly et al. conducted a and comparison with conventional systemic analgesia during
study that showed significant pain relief and decreased analgesic laparoscopic cholecystectomy. Br J Anaesth 2009;102:763–767.
requirement post-laparoscopic cholecystectomy in patients DOI: 10.1093/bja/aep067.
6
receiving ultrasound-guided TAP block. In 2011, Chetwood 7. Chetwood A, Agrawal S, Hrouda D, et al. Laparoscopic assisted
et al. described laparoscopically delivered TAP block in cases transversus abdominis plane block: a novel insertion technique
7
of laparoscopic nephrectomy and Magee et al. described during laparoscopic nephrectomy. Anaesthesia 2011;66:317–318.
laparoscopic TAP block in laparoscopic cholecystectomy with DOI: 10.1111/j.1365-2044.2011.06664.x.
11
promising results and significant relief in postoperative pain. 8. Elamin G, Waters PS, Hamid H, et al. Efficacy of a laparoscopically
delivered transversus abdominis plane block technique during
Zaghiyan et al. described the superiority of laparoscopic TAP block elective laparoscopic cholecystectomy: a prospective, double-blind
over ultrasound-guided TAP block. 13 randomized trial. J Am Coll Surg 2015;221(2):335–344. DOI: 10.1016/
Studies by Elamin et al. and Tihan et al. also described the j.jamcollsurg.2015.03.030.
efficiency and superiority of laparoscopic TAP block over port-site 9. Børglum J, Maschmann C, Belhage B, et al. Ultrasound guided bilateral
infiltration of local anesthetic agent. 8,16 dual transversus abdominis plane block: a new four-point approach.
Few studies and a meta-analysis also showed no significant Acta Anaesthesiol Scand 2011;55:658–663. DOI: 10.1111/j.1399-
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cholecystectomy. 10,12,15 (TAP) local anaesthetic block improve pain control in patients
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Another advantage of laparoscopic TAP block is that it can be Int J Surg 2013;11:792–794. DOI: 10.1016/j.ijsu.2013.05.039.
safely given by the operating surgeon and does not require any 11. Magee C, Clarke C, Lewis A. Laparoscopic TAP block for laparoscopic
additional equipment. cholecystectomy: description of a novel technique. Surgeon
Thus with significant early postoperative pain reduction 2011;9(6):352–353. DOI: 10.1016/j.surge.2010.11.027.
and shorter hospital stay, laparoscopically delivered TAP can 12. De Oliveira GS, Castro-Alves LJ, Nader A, et al. Transversus abdominis
be good alternative for postoperative pain relief in elective plane block to ameliorate postoperative pain outcomes after laparoscopic
laparoscopic cholecystectomy; however, its efficiency needs surgery: a meta-analysis of randomized controlled trials. Anesth Analg
2014;118(2):454–463. DOI: 10.1213/ANE.0000000000000066.
to be explored in emergency settings. 13. Zaghiyan KN, Mendelson BJ, Eng MR, et al. Randomized clinical
trial comparing laparoscopic versus ultrasound-guided transversus
conclusIon abdominis plane block in minimally invasive colorectal surgery. Dis Colon
Rectum 2019;62(2):203–210. DOI: 10.1097/DCR.0000000000001292.
Laparoscopically delivered TAP block is a safe and efficient 14. Ishida T, Sakamoto A, Tanaka H, et al. Transversus abdominis plane
method for early postoperative pain relief in cases of block with 0.25% levobupivacaine: a prospective, randomized,
laparoscopic cholecystectomy that can be safely performed double-blinded clinical study. J Anesth 2015;29(4):557–561. DOI:
by an operating surgeon without additional requirement of 10.1007/s00540-015-1993-0.
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AcknowledgMents of trocar insertion sites. Reg Anesth Pain Med 2012;37(2):188–192.
DOI: 10.1097/AAP.0b013e318240957f.
The protocol for the study was approved by the ethical 16. Tihan D, Totoz T, Tokocin M, et al. Efficacy of laparoscopic transversus
committee of the institute. This research did not receive any abdominis plane block for elective laparoscopic cholecystectomy
specific grant from funding agencies in the public, commercial, in elderly patients. Bosn J Basic Med Sci 2016;16(2):139–144.
or not-for-profit sectors. DOI: 10.17305/bjbms.2016.841.

World Journal of Laparoscopic Surgery, Volume 14 Issue 2 (May–August 2021) 89