Abstract
A COMPARATIVE STUDY OF ULTRASOUND-GUIDED TRANSVERSE ABDOMINIS PLANE BLOCK WITH BUPIVACAINE AND ROPIVACAINE FOR POSTOPERATIVE ANALGESIA IN LAPAROSCOPIC CHOLECYSTECTOMY

Dr. Upasna Bhatia*, Dr. Nirja Parmar, Dr. Mona Panchal, Dr. Shyni Abraham and Dr. Charmi Shah

ABSTRACT

Background: Effective and immediate management of postoperative pain after abdominal surgery is the main factor contributing early patients’ recovery. Postoperative pain in laparoscopic surgery arises mainly from the abdominal wall and stretching of the parietal peritoneum. Successful blockade of these relevant intercostal nerves within the transversus abdominis muscle and abdominal oblique internus muscle producing full thickness anaesthesia of anterior abdominal wall. Aim and Objective: The study was designed to compare the better drug among Ropivacaine and Bupivacaine with respect to their analgesic efficacy and safety profile. Methodology: The study was carried out in 60 adult patients of ASA Grade I and II in 18- 65 years of age-group scheduled for elective Laparoscopic Cholecystectomy under general anaesthesia. They were divided into two groups of 30 each. Group A was given 40 ml Inj. Bupivacaine 0.25% (20ml on each side) and Group B was given40 ml Inj. Ropivacaine 0.375% (20ml on each side) USG guided Subcostal TAP Block was given before reversal of anaesthesia and patients were observed for VAS scores 30 mmin,1,2,4,6,8,10,14,16 and 20 hrs postoperatively. Results: The mean heart rate and blood pressure (systolic, diastolic and mean) readings post-operatively remained stable with no statistically significant difference between Bupivacaine and Ropivacaine groups. Mean duration of analgesia in our study was longer in Ropivacaine group (16.51± 5.58 hour) as compared to Bupivacaine group (14.03±2.03) p value 0.025, which was statistically significant. Though the postoperative analgesic requirement (rescue/demand) in Bupivacaine group was clinically earlier and statistically significant as compared to Ropivacaine group. Postoperative VAS score of 6 or more was considered benchmark for providing rescue analgesia in form of injection Diclofenac 75mg IV. The mean VAS scores at extubation was similar in both the groups and inter group comparison was not statistically significant. However, comparison of pain score from 30min to 14 hrs postoperatively showed significant difference in both the groups with Bupivacaine having significantly higher VAS scores and lower VAS scores with Ropivacaine. Thus, suggesting shorter duration of action of 0.25% Bupivacaine as compared to Conclusion: Subcostal TAP Block reduces postoperative pain effectively in laparoscopic Cholecystectomy. 0.375% Ropivacaine when compared with 0.25% Bupivacaine provides a longer duration of analgesia in ultrasound guided TAP block. Thus, it is concluded that Ropivacaine can be used as a safe alternative for Bupivacaine, routinely for TAP block for laparoscopic Cholecystectomy surgeries.

Keywords: laparosopic cholycystetomy; subcostal TAP block; Ropivacaine; Bupivacaine; postoperative analgesia.


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