Abstract

Background: Laparoscopic cholecystectomy, despite being minimally invasive, is associated with significant postoperative pain that can delay recovery and discharge. This study aimed to compare the efficacy of subcostal transversus abdominis plane (TAP) block with intraperitoneal instillation of levobupivacaine 0.25% for postoperative pain management following laparoscopic cholecystectomy.
Methods: A prospective, randomized, double-blind study was conducted on 120 patients undergoing elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups: Group T (n=60) received bilateral subcostal TAP block with 20 mL of 0.25% levobupivacaine on each side, and Group I (n=60) received intraperitoneal instillation of 40 mL of 0.25% levobupivacaine. Primary outcome was postoperative pain scores using Visual Analog Scale (VAS) at 2, 6, 12, and 24 hours. Secondary outcomes included time to first analgesic request, total analgesic consumption, patient satisfaction scores, and adverse effects.
Results: Both groups showed significant reduction in postoperative pain compared to historical controls. Group T demonstrated significantly lower VAS scores at 2 hours (3.2±1.1 vs 4.1±1.3, p<0.001), 6 hours (2.8±1.0 vs 3.6±1.2, p<0.001), and 12 hours (2.1±0.9 vs 2.9±1.1, p<0.001) compared to Group I. Time to first analgesic request was longer in Group T (8.4±2.3 hours vs 6.2±1.8 hours, p<0.001). Total tramadol consumption in 24 hours was significantly lower in Group T (150±45 mg vs 210±60 mg, p<0.001). Patient satisfaction scores were higher in Group T (8.2±1.1 vs 7.4±1.3, p<0.001). No significant adverse effects were observed in either group.
Conclusion: Bilateral subcostal TAP block provides superior postoperative analgesia compared to intraperitoneal instillation of levobupivacaine 0.25% following laparoscopic cholecystectomy, with longer duration of analgesia, reduced analgesic requirements, and higher patient satisfaction scores.