# 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. 

## Aims: 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. 

## Settings and Design: This was a prospective, randomized, controlled, double-blinded trial performed in a tertiary care hospital. 

## Materials and 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. 

## Statistical Analysis: The data were analyzed using *t*-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 and *P* = 0.007, respectively). 

## Conclusion: 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. # RESULTS Flow of patients is given in [Figure 2](#). <figure> <p><img src="" /></p> <figcaption>Flow of patients in the study</figcaption> </figure> The demographic parameters were similar among the two study groups \[[Table 1](#)\]. ::::table-wrap

::: caption
Demographic data of patients in the two groups
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![](<>):::: The number of patients requiring intraoperative supplemental fentanyl in the TAP group was 8 and in the control group was 16 (*P* = 0.028\*). The supplemental dosing of fentanyl (median [minimum--maximum]) in the TAP group was 0 µg (0--120) and in the control group was 30 µg (0--120) (*P* = 0.013\*). The total 24 h morphine requirement (mean ± SD) was 34.57 ± 14.64 mg in TAP group and 32.76 ± 14.34 mg in control group (*P* = 0.688). The time to first analgesic demand via the PCA device was similar in both groups (35 min [10--130] in TAP group vs. 40 min [15--230] in control group [median (minimum--maximum)]; *P* = 0.369). Postoperative VAS scores were significantly more in control group at shifting \[[Table 2](#)\]. At 4 h, none of the patients in the TAP group but seven patients (33.3%) in the control group had moderate to severe pain (VAS >3) at rest (*P* = 0.009\*). At 4 h, eight patients (38.1%) in the TAP group and 15 patients (71.4%) in the control group had moderate to severe pain on coughing (*P* = 0.03\*). At 12 h, six patients (28.5%) in the TAP group and 18 patients (85.7%) in the control group had moderate to severe pain on coughing (*P* < 0.001\*). Proportion of patients having moderate to severe pain was not significantly different at other time points. Number of patients with sedation scores >1 in the two groups were similar at all-time points. ::::table-wrap
::: caption
Visual analogue scale score at rest and on coughing in the two groups
(median (minimum-maximum))
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Extracted trial result:
Outcome: The 24 h morphine requirement (continuous)
Intervention: Transversus abdominis plane block with 0.375% ropivacaine
Comparator: local anesthetic infiltration of the port site.
Intervention group size: 21
Intervention mean: 34.57
Intervention standard deviation: 14.64
Comparator group size: 21
Comparator mean: 32.76
Comparator standard deviation: 14.34