A Study Of the Postoperative analgesic effect between ultrasound guided modified BRILMA block versus subcostal Transversus Abdominis Plane Block in open cholecystectomy under general anesthesia.

The study will be initiated after obtaining approval of Institutional Ethics Committee and informed consent from all patients. Following a detailed pre anesthetic checkup, the patients fulfilling the inclusion criteria will be allocated in one of the two groups e.g. Group B (ultrasound guided modified BRILMA block with injection bupivacaine 0.25%) and Group T (ultrasound guided subcostal transversus abdominis plane block with injection bupivacaine 0.25%) All patients will receive general anaesthesia according to a standard protocol with ASA monitoring after securing IV line with an 18G cannula. Blood pressure, (systolic, diastolic and mean), Heart Rate, ECG, Spo2, Respiratory Rate, ETCO2 will be monitored. After induction of general anesthesia before skin incision, ultrasound guided modified BRILMA block and subcostal transversus abdominis plane block will be administered to the respective group. Proper needle placement will be noted by ultrasound guidance. After correct placement of the needle, the drug (Injection bupivacaine 0.25% 20ml on one side) will be injected after a negative aspiration of blood .For performing modified BRILMA block, the patient was placed in left lateral decubitus with the probe in the sagittal plane at the mid-axillary line at the level of the eighth rib on the right side. The fascial plane between the serratus anterior muscle and the external intercostal muscle was identified. The needle was introduced by an in-plane technique and after confirmation by hydro dissection; 20 mL of 0.25% bupivacaine was administered into the serratus-intercostal fascial plane under ultrasound guidance to visualize the spread of the LA solution. Ultrasound-guided Subcostal TAP block was performed in the supine position with the probe placed below the xiphisternum in the transverse plane and moved laterally parallel to the right costal margin to visualize the muscle layers of the anterior abdominal wall and by in-plane technique. The subcostal TAP plane (between the posterior sheath of rectus abdominis and transversus abdominis muscles) was confirmed by hydro dissection and 20 mL of 0.25% bupivacaine was administered. Then the data will be collected according to the case record form. All the blocks were done by a single experienced anesthesiologist.