title: Efficacy of a Laparoscopically Delivered Transversus Abdominis Plane Block Technique during Elective Laparoscopic Cholecystectomy: A Prospective, Double-Blind Randomized Trial.
abstract: BACKGROUND
  The management of postoperative pain is paramount to facilitate the delivery of day case surgical programs. In recent years, the complexity of procedures carried out has increased to include laparoscopic cholecystectomy. The aim of this study was to evaluate the impact of laparoscopic-assisted 4-quadrant transversus abdominis plane (TAP) block vs periportal local anesthetic wound infiltration in managing postoperative pain.
  
  
  METHODS
  A prospective, randomized, double-blinded trial was conducted with patients undergoing elective laparoscopic cholecystectomy. Patients were randomized using computerized "random number table" into a test group that received laparoscopic-assisted TAP block with bupivacaine with periportal saline injection and a control group that received a laparoscopic-assisted TAP block with saline and periportal bupivacaine. All patients received intraperitoneal instillation of bupivacaine in the gallbladder bed. Postoperative pain scores were recorded using numerical rating scores at rest and coughing at dedicated time points. Statistical analysis was carried out using GraphPad Prism software, version 5 (GraphPad Software) and p < 0.05 was considered significant.
  
  
  RESULTS
  Eighty patients (70 female and 10 male) were enrolled; 40 patients were randomized to each group. Age, American Society of Anesthesiologists score, operative time, and BMI were comparable between the groups. No adverse events were encountered with the administration of TAP blocks. Numerical rating scores were significantly reduced in the test group at 1, 3, and 6 hours at rest (p = 0.025, p = 0.03, and p = 0.007, respectively). Numerical rating score was significantly reduced at 1, 3, and 6 hours during coughing (p = 0.026, p = 0.02, and p = 0.03, respectively). Difference in postoperative analgesic requirements between both groups was statistically insignificant (p = 0.17).
  
  
  CONCLUSIONS
  This analysis has confirmed the therapeutic benefit of laparoscopically delivered TAP blocks in elective laparoscopic cholecystectomy.
authors.affiliation: Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Elamin
authors.affiliation: Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland. Electronic address: peadarwaters@hotmail.com.
authors.forename: Peadar S
authors.initials: PS
authors.lastname: Waters
authors.affiliation: Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
authors.forename: Hytham
authors.initials: H
authors.lastname: Hamid
authors.affiliation: Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
authors.forename: Hannah M
authors.initials: HM
authors.lastname: O'Keeffe
authors.affiliation: Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
authors.forename: Ronan M
authors.initials: RM
authors.lastname: Waldron
authors.affiliation: Discipline of Anesthesia, Mayo General Hospital, Castlebar, Mayo, Ireland.
authors.forename: Michelle
authors.initials: M
authors.lastname: Duggan
authors.affiliation: Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
authors.forename: Waqar
authors.initials: W
authors.lastname: Khan
authors.affiliation: Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland; Department of Surgery, National University of Ireland Galway, Galway, Ireland.
authors.forename: Michael Kevin
authors.initials: MK
authors.lastname: Barry
authors.affiliation: Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
authors.forename: Iqbal Z
authors.initials: IZ
authors.lastname: Khan
mesh_terms: D000009:Abdominal Muscles; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine