Comparison of efficacy of posterior and subcostal techniques of ultrasound-guided transverse abdominis plane block in laparoscopic cholecystectomy-Randomized double-blinded study

Laparoscopic cholecystectomy has become the standard of care for gallbladder diseases due to its minimally invasive nature which results in reduced postoperative pain early recovery and decreased hospital stay compared to open surgery However despite its minimally invasive nature patients often experience moderate to severe postoperative pain particularly in the early hours after surgery Effective management of this pain is critical especially as laparoscopic cholecystectomy is commonly performed as an outpatient procedure necessitating rapid recovery and discharge In recent years there has been increasing interest in regional anesthesia techniques such as the transversus abdominis plane block as part of multimodal analgesia strategies TAP block involves the injection of local anesthetic between the internal oblique and transversus abdominis muscles to block afferent nerves of the anterior abdominal wall This technique provides a more localized analgesic effect and reduces the requirement for systemic opioids thus minimizing opioid-related side effects

The TAP block was initially performed using a landmark based blind technique but advancements in ultrasound technology have improved the safety and accuracy of this procedure Two main ultrasound-guided techniques have emerged the posterior and subcostal techniques The posterior TAP block is administered near the triangle of Petit and predominantly provides analgesia T10 to L1 dermatomes making it more suitable for abdominal surgeries On the other hand the subcostal TAP block targets higher dermatomes T7 to T12 and is thus more effective for upper abdominal procedures Given the increasing reliance on outpatient surgery models and the need for effective opioid sparing analgesia evaluating the most effective TAP block approach for laparoscopic cholecystectomy remains an area of ongoing clinical interest This thesis aims to further investigate and compare the efficacy of these regional techniques in providing optimal postoperative analgesia for patients undergoing laparoscopic cholecystectomy