EFFECTIVENESS OF PERI-OPERATIVE MULTI MODAL ANALGESIA WITH ULTRASOUND GUIDED BILATERAL SUBCOSTAL TAP BLOCK FOR POST OPERATIVE ANALGESIA IN ELECTIVE LAPROSCOPIC CHOLECYSTECTOMY PATIENTS UNDER GENERAL ANESTHESIA-A COMPARATIVE STUDY.

Surgicalpain is a universal phenomenon affecting all patients perioperatively. Apartfrom the agonizing sensory experience associated with it, acute pain has severaldeleterious effects on the physiology and the psyche of the sufferer(3).Ananticipation of these effects combined with a humanitarian urge to relievepain, play a pivotal role in provision and optimization of postoperativeanalgesia.

 Laparoscopiccholecystectomy is a minimally invasive procedure which is increasinglyperformed as a day care procedure.

 Thoughminimally invasive, pain experienced following laparoscopic cholecystectomy inthe immediate postoperative period may vary from moderate to severe in intensity.

 Painafter laparoscopic cholecystectomy can be divided into three compartments;visceral, parietal and referred shoulder pain.

 Themain sources of pain include pain from incision sites(50-70%),pnemoperitoneum(20-30%),andpost cholecystectomy wound(10-20%) within the liver causing visceral pain. Postoperativelycommon location of the pain is right upper quadrant and port sites.

 Themain objective of treating the post-operative pain is to eradicate or, tominimize the pain and to speed up the healing process without any side effects.

Asa part of multi-modal analgesia, various approaches are employed for achievingsafe and effective post operative analgesia. Clinical application ofconventional perioperative analgesic modalities(eg.opoids,epidural analgesia)waslimited because of their own drawbacks.

 Transversusabdominisplane block (TAP) that delivers local anaesthetic into transversusabdominisplane has been shown to reduce perioperativeopoid use in elective abdominalsurgery,including open appendicectomy,laparoscopic cholecystectomies,caesareansection and laparotomies.

 Theuse of point of care ultrasonography in abdominal blocks increases the successrate and safety of the block .A variant of TAP block is (SCTAP)block where thelocal anesthetic is deposited between the transverse abdominis plane inferiorand parallel to the costal margin. The Subcostal  transverses abdominisplane block provides adequate analgesia for supraumbilical surgeries because ofits greater cranial spread(T6-T10).

 MULTIMODALANALGESIA-Is defined as the use of more than one pharmacological class ofanalgesic medication targeting different receptors along the pain pathway withthe goal of improving analgesia while reducing individual side effects.(1)

 Multi-modalanalgesia in the peri-operative period eliminates over reliance on opoids forpain control and to reduce opoid related side effects.

 Preemptivemulti-modal analgesia,combining non-opoid analgesics,Paracetamol,nonsteroidalani-inflammatory drugs or coxib and local anaesthesia has a longhistory. Local anesthesia improves postoperative pain and facilitates dischargeon the day of surgery(4).

 Thusthe aim of the present study is to summarize the available best evidence andwell established practice for perioperative analgesia in elective laparoscopiccholecystectomy.