Ultrasound-Guided Subcostal Transversus Abdominis Plane Block versus Intraperitoneal Instillation of Levobupivacaine for Postoperative Analgesia after Laparoscopic Cholecystectomy: A Randomized Comparative Study
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Pain after laparoscopic cholecystectomy, though the procedure is minimally invasive, remains a significant contributor to patient discomfort and delayed recovery. This study compared ultrasound-guided subcostal transversus abdominis plane (TAP) block with intraperitoneal instillation of levobupivacaine for postoperative pain relief after laparoscopic cholecystectomy. Methods: Sixty adult patients of ASA grade I-II undergoing elective laparoscopic cholecystectomy were randomized into two equal groups. Group T received an ultrasound-guided subcostal TAP block with 15 mL of 0.125% levobupivacaine on each side before surgery. Group I received intraperitoneal instillation of 30 mL of 0.125% levobupivacaine at the gallbladder bed and sub-diaphragmatic surface before CO2 insufflation. The primary outcome was time to first rescue analgesic request; secondary outcomes were 24-hour analgesic consumption, numerical rating scale (NRS) pain scores, patient satisfaction, and complications. Results: Time to first rescue analgesic was significantly longer in Group T than Group I (10.80 +/- 2.71 vs 7.03 +/- 2.46 hours, p < 0.001). Total tramadol consumption over 24 hours was significantly lower in Group T (120.00 +/- 55.09 mg vs 193.33 +/- 94.44 mg, p < 0.01). NRS scores were significantly lower in Group T at 0, 2, 6 and 12 hours, converging with Group I by 24 hours. Patient satisfaction was significantly higher in Group T (mean score 3.80 +/- 0.41 vs 2.70 +/- 0.75, p < 0.001), and complications were mild and comparable between groups. Conclusion: Ultrasound-guided subcostal TAP block provided a longer duration of analgesia, lower analgesic consumption, and greater patient satisfaction than intraperitoneal instillation of levobupivacaine after laparoscopic cholecystectomy, with a comparable safety profile.
Source: PAIN JOINTS SPINE
Authors: Dr. Saddam Hussain, Hammad Usmani
Institutions: Max Healthcare, Aligarh Muslim University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
Funder: Aligarh Muslim University
OpenAlex ID: W7204445127