title: Analgesic efficacy of ultrasound guided transversus abdominis plane block versus local anesthetic infiltration in adult patients undergoing single incision laparoscopic cholecystectomy: A randomized controlled trial.
abstract: BACKGROUND
  Transversus abdominis plane (TAP) block has been used to provide intra- and post-operative analgesia with single incision laparoscopic (SIL) bariatric and gynecological surgery with mixed results. Its efficacy in providing analgesia for SIL cholecystectomy (SILC) via the same approach remains unexplored.
  
  
  OBJECTIVE
  The primary objective of our study was to compare the efficacy of bilateral TAP block with local anesthetic infiltration for perioperative analgesia in patients undergoing SILC.
  
  
  METHODS
  This was a prospective, randomized, controlled, double-blinded trial performed in a tertiary care hospital.
  
  
  METHODS
  Forty-two patients undergoing SILC were randomized to receive either ultrasound-guided (USG) bilateral mid-axillary TAP blocks with 0.375% ropivacaine or local anesthetic infiltration of the port site. The primary outcome measure was the requirement of morphine in the first 24 h postoperatively.
  
  
  METHODS
  The data were analyzed usingt-test, Mann-Whitney test or Chi-square test.
  
  
  RESULTS
  The 24 h morphine requirement (mean ± standard deviation) was 34.57 ± 14.64 mg in TAP group and 32.76 ± 14.34 mg in local infiltration group (P= 0.688). The number of patients requiring intraoperative supplemental fentanyl in TAP group was 8 and in local infiltration group was 16 (P= 0.028). The visual analog scale scores at rest and on coughing were significantly higher in the local infiltration group in the immediate postoperative period (P= 0.034 andP= 0.007, respectively).
  
  
  CONCLUSIONS
  USG bilateral TAP blocks were not effective in decreasing 24 h morphine requirement as compared to local anesthetic infiltration in patients undergoing SILC although it provided some analgesic benefit intraoperatively and in the initial 4 h postoperatively. Hence, the benefits of TAP blocks are not worth the effort and time spent for administering them for this surgery.
authors.affiliation: Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ejas P
authors.initials: EP
authors.lastname: Bava
authors.affiliation: Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Ramachandran
authors.affiliation: Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vimi
authors.initials: V
authors.lastname: Rewari
authors.affiliation: Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
authors.lastname: Chandralekha
authors.affiliation: Department of Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Virinder Kumar
authors.initials: VK
authors.lastname: Bansal
authors.affiliation: Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anjan
authors.initials: A
authors.lastname: Trikha
keywords: Local anesthetic infiltration; morphine requirement; single incision laparoscopic cholecystectomy; single incision laparoscopic surgery; transversus abdominis plane block