Preemptive Deep rectus Sheath block vs Subcostal transversus abdominis plane block for postoperative pain relief in Laparoscopic Cholecystectomy: A randomized double blinded trial

Laparoscopic cholecystectomy is a common procedure for gallbladder disease but patients often experience moderate postoperative pain that may delay recovery. Regional anaesthesia techniques such as the subcostal transversus abdominis plane block and the newer deep rectus sheath block have shown potential for improving postoperative analgesia. This prospective randomized double blinded active controlled interventional study aims to compare the analgesic efficacy of pre-emptive ultrasound guided deep rectus sheath block versus subcostal transversus abdominis plane block in patients undergoing elective laparoscopic cholecystectomy under general anaesthesia.

Fifty six ASA I to III patients aged 18 to 70 years will be randomized into two equal groups of twenty eight each. After induction of general anaesthesia Group 1 will receive a bilateral ultrasound guided deep rectus sheath block with  20 mL of 0.25 percent percent bupivacaine on each side in the pre peritoneal space. Group 2 will receive a bilateral ultrasound guided subcostal transversus abdominis plane block with 20 mL of 0.25 percent bupivacaine deposited between the internal oblique and transversus abdominis muscles.

The primary outcome will be postoperative pain intensity measured using the Visual Analog Scale at rest at predetermined intervals two hourly for the first eight hours and four hourly up to twenty four hours. Secondary outcomes include time to first rescue analgesic, total tramadol and fentanyl requirements, intraoperative hemodynamic changes during pneumoperitoneum, and total procedure time. Data will be analyzed using appropriate statistical tests with a p value less than 0 point 05 considered significant.