Postoperative use of the ultrasound-guided transversus abdominis plane block led to better analgesia and increased satisfaction after laparoscopic cholecystectomy.

This single-blinded randomized clinical trial was conducted to compare the impact of preemptive vs. postsurgery usage of ultrasound-guided transversus abdominis plane (USG-TAP) block to reduce pain.

Overall, 76 eligible patients were randomized into 2 groups: Preemptive group (PG, n=38) and Postoperative group (POG, n=38). USG-TAP block was performed on subjects utilizing 20 cc of ropivacaine 0.25% following anesthesia induction in the preemptive group, after the end of surgery and prior to extubation in the postoperative group. As standard postoperative analgesia, both groups were administered with patient-controlled IV analgesia containing 20mg/ml acetaminophen plus 0.6mg/ml ketorolac. For rescue analgesia, 20mg meperidine q 4h pro re nata (PRN) was given.

The numerical rating scale (NRS) was used to assess the intensity of pain of the subjects at the time of arrival to the post-anesthesia care unit (PACU) and at 2, 4, 8, 12 and 24 hours. The primary endpoint was the NRS at rest and coughing in PACU and at 2, 4, 8, 12 and 24 hours. The secondary endpoint was the time to initial post-surgical rescue analgesic and level of pain control satisfaction of the subject in the first 24 hours.

The pain score was considerably reduced with the use of USG-TAP block in the POG compared to the PG. Similarly, pain score also decreased at rest notably at eight and twelve hours post-surgery. There was a substantial decrease in pain score after coughing during recovery at two, eight and twelve hours post-operation.

In the POG, patient satisfaction scores were remarkably higher at all times. In terms of the rate of postoperative nausea and vomiting (PONV), a statistically significant difference was noted between both the groups which showed that the subjects in POG had a lower prevalence of the PONV in comparison to the PG. In the POG, the time to first analgesic request was shorter, which was clinically meaningful. No profound differences were observed in terms of consumption of analgesics between both groups.

These results indicate that postoperative TAP block appeared to be more efficient when compared with the preoperative one in reducing pain scores and providing longer analgesia.