title: Comparison of posterior and subcostal approaches to ultrasound-guided transverse abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy.
abstract: OBJECTIVE
  To evaluate the effectiveness of subcostal TAP block and to compare its efficacy with that of posterior TAP block in decreasing postoperative pain in patients undergoing laparoscopic cholecystectomy during general anesthesia.
  
  
  METHODS
  Prospective, randomized, double-blind study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  60 adult, ASA physical status 1 and 2 patients of both genders, aged 18-60 years, scheduled for elective laparoscopic cholecystectomy.
  
  
  METHODS
  Patients were randomized to three groups of 20 patients each. Group 1 patients received standard general anesthesia (control group); Group 2 patients received an ultrasound-guided posterior TAP block using 15 mL of 0.375% ropivacaine on each side; and Group 3 patients underwent a subcostal TAP block with 15 mL of 0.375% ropivacaine on each side.
  
  
  METHODS
  The presence and severity of pain during rest and movement, as well as nausea or vomiting and sedation, were assessed in all patients postoperatively on PACU admission, then at 2, 4, 6, 8, 12, and 24-hour intervals. Patients with a visual analog score (VAS) greater than 4, or those requesting analgesic were given intravenous tramadol 2 mg/kg as an initial dose; subsequent 1 mg/kg doses of tramadol, if needed, were given.
  
  
  RESULTS
  Patients who received a subcostal TAP block had significantly lower pain scores at rest and on movement than the control group at all times postoperatively. Although, in the initial postoperative measurement times, the subcostal and posterior TAP groups had comparable pain scores, after 4 hours these scores were significantly lower in patients who had received the subcostal TAP block.
  
  
  CONCLUSIONS
  For incisions mainly involving the supra-umbilical region, subcostal TAP block may be a better alternative than the posterior approach for providing postoperative analgesia.
authors.affiliation: Department of Anaesthesia & Intensive Care, PostGraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India. Electronic address: nidhi.bhatia75@gmail.com.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Bhatia
authors.affiliation: Department of Anaesthesia & Intensive Care, PostGraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Anaesthesia & Intensive Care, PostGraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
authors.forename: Wig
authors.initials: W
authors.lastname: Jyotsna
authors.affiliation: Department of Anaesthesia, Fortis Hospital, Mohali, Punjab 160047, India.
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Kaur
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000577:Amides / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine; D012720:Severity of Illness Index; D013997:Time Factors; D014147:Tramadol / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional / Q000379:methods; D055815:Young Adult
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D014147:Tramadol; D000077212:Ropivacaine
keywords: Laparoscopic cholecystectomy; Peripheral regional anesthesia; Postoperative analgesia; Subcostal transversus abdominis plane block (TAP); Transversus abdominis plane block