Effect Of Ultrasound-guided Peripheral Nerve Blocks Of The Abdominal Wall On Pain Relief After Laparoscopic Cholecystectomy

Objective The aim of this study was to compare the effect of an ultrasound-guided transversus abdominis plane block(TAPB)and rectus sheath block(RSB)combination,an ultrasound-guided posterior TAP block combined with the local anesthetic infiltration(LAI)and LAI alone on pain relief after laparoscopic cholecystectomy(LC).Methods One hundred eighty patients with American Society of Anesthesiologists(ASA)class Ι or Π,aged 18-65 years,weighing 45-91 kg,who underwent three-port LC at the Third Affiliated Hospital of Anhui Medical University(Hefei First People’s Hospital)were included in this randomized,double-blind,non-inferiority study.According to different analgesia methods,the random number table method was used to divide into 3groups(n=180,60 patients in each group): LAI group,TL group(ultrasound-guided posterior TAPB combined with LAI)and TR group(ultrasound-guided subcostal TAPB combined RSB).According to the previous research,the local anesthetics used in these three groups were all mixtures of ropivacaine and dexmedoridine.All operations were performed after the induction of anesthesia.LAI group: A total of 30 ml of 0.5%ropivacaine and 1 μg/kg dexmedetomidine were injected around the trocar entrance site preoperatively.TL group: A total of 60 ml of 0.25% ropivacaine mixed with 1 μg/kg dexmedetopyrimidine was used.The dose of bilateral posterior TAPB under ultrasound guidance was 30 ml,and the dose of three-port local infiltration anesthesia was 30 ml.TR group: The total dose was the same as that in the TL group.The dose of bilateral subcostal TAPB under ultrasound guidance was 40 ml,and the dose of bilateral RSB was 20 ml.Postoperative pain was evaluated at the 1h,4h,8h,24 h,and 48 h hours.If the visual analogue scale(VAS)score(including incisional pain,visceral pain or shoulder pain)was >3,intravenous dezocine(0.05 mg/kg)was injected slowly.Sleep quality,total consumption of dezocine and time to unassisted walking were recorded.The Global Satisfaction Score(GSS)for analgesia was also assessed within 48 hrs.Results No difference was found in sleep quality,time to unassisted walking,or requirement for dezocine.The VAS scores of the LAI group was relatively low at all time points,but no difference was found in VAS scores at each time point within 48 hrs after LC among the 3 groups,the GSS for analgesia in the LAI group was significantly increased within 48 hrs compared with the other two groups(P<0.001).Conclusion Ultrasound-guided peripheral nerve blocks of the abdominal wall can significantly relieve postoperative pain in patients undergoing LC;however,patients receiving LAI expressed more satisfaction than patients in whom other methods were used.LAI is an easy and effective method that can be recommended for routine clinical practice in LC patients who are not converted to an open procedure.