Multimodal Analgesia after Laparoscopic Cholecystectomy; A Comparative Study Between Three Different Techniques
F.A.Abd El- Fatah , E.F.Gad Allah, E.S.Abd El-Azeem and E.M.Abd ElAzeem"
Patients undergoing laparoscopic cholecystectomy often experience severe post-operative pain and may develop into chronic pain.current study compared the efficacy and safety of intraperitoneal instillation of bupivacaine alone, intraperitoneal instillation of bupivacaine and dexmedetomidine; and ultra-sound guided transversus abdominis plane block for post-operative pain relief after laparoscopic cholecystectomy.This prospective study was conducted on 90 patients undergoing laparoscopic cholecystectomy. Patients were randomized into three groups: group I [n=30]: patients will be given Intraperitoneal bupivacaine 50 ml 0.25%; group II [n=30]: patients will be given Intraperitoneal bupivacaine 50 ml 0.25% + dexmedetomidine 1Î¼g/kg and group III[n=30]: patients Will receive bilateral in-plane ultrasound guided transversus abdominis plane block with of bupivacaine 0.25% . At the end of surgery. Postoperative VAS pain scores, time to first analgesic requirement, total dose of rescue analgesic, hemodynamic parameters and incidence of postoperative nausea and vomiting were all recorded.VAS scores were significantly lower in group III and group II compared with group I postoperative. Total dose of rescue analgesic was significantly lower in group III compared with group II and group I. Time to the first analgesic dose was significantly longer in group III and group II compared to group I . There was increased incidence of postoperative nausea and vomiting in group III.T A P block is more effective in postoperative analgesia.
Postoperative analgesia, Laparoscopic cholecystectomy, Intraperitoneal instillation, T A P block.