Comparison Of Post-Operative Recovery In Single Puncture Subcostal Transversus Abdominis Plane And Rectus Sheath Block With Erector Spinae Plane Block In Patients Undergoing Laparoscopic Cholecystectomy-A Randomized Controlled Study.

Laparoscopic cholecystectomy is considered the gold standard of therapy for symptomatic cholelithiasis

and despite recent advances, majority of the patients still experience poor quality of recovery and pain in

the postoperative period. Untreated postoperative pain has many consequences, including patient

dissatisfaction, transition into chronic pain, delayed discharge from the hospital and increased healthcare

costs. This study aims to compare the post-operative quality of recovery in unilateral Erector Spinae

Block (ESB) versus unilateral single puncture subcostal transversus abdominis plane block and Rectus

sheath block. The study utilizes ropivacaine due to its reversible inhibition of nerve impulses, resulting

in prolonged sensory blockade at lower doses and fewer side effects like cardio-toxicity. Real-time

ultrasound is employed for precise imaging of abdominal wall muscular layers, ensuring accurate needle

placement and local anaesthetic injection, enhancing the efficacy and safety of the block.

The study employs the Quality of Recovery-15 (QoR-15 H), a validated patient-reported outcome

measure, to assess postoperative quality of recovery. This measurement has been found valid, reliable,

and responsive in surgical patients, meeting the requirements for outcome measurement instruments in

clinical trials.

This study also evaluates the duration of postoperative analgesia based on the demand for the, first rescue

analgesia, reduction in total doses of postoperative rescue analgesia, pain scores, and potential side effects

and complications.

Patient will be randomly divided into two groups with 50 patients in each group. Group ES will receive

30 ml of 0.25% isobaric ropivacaine unilaterally in plane below the erector spinae muscle before starting

of surgery. Group TR will receive 20ml of 0.25 % isobaric ropivacaine, unilaterally into plane between

the transversus abdominis and internal oblique muscles and 10ml of 0.25%isobaric ropivacane into plane

between rectus muscle and posterior rectus sheath before starting of the surgery.

Patient will be observed for quality of recovery and duration of postoperative analgesia by time to first

rescue analgesic after ultrasound guided Erector spinae plane block or subcostal transversus abdominis

plane and rectus sheath block in laparoscopic cholecystectomy. The Quality of recovery will be assessed

in patients using QoR-15 H score at 24 hrs, requirement of rescue analgesics in the first 24 hours

postoperatively, the hemodynamic changes perioperatively, any side effects in both the groups.