Comparative Study of Pre-Operative Ultrasound Guided Transversus Abdominis Plane Block Versus Post-Operative Ultrasound Guided Transversus Abdominis Plane Block on Perioperative Hemodynamic Status and Post-Operative Analgesic Requirement in Patients Undergoing Laparoscopic Abdominal Surgeries
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 3, Pages 2781-2789
Abstract
Background:Although abdominal laparoscopic surgery is known for less pain compared with that of laparotomy, many patients still complain considerable post-operative pain. Pneumoperitoneum affects several homeostatic systems leading to alteration in cardiovascular, pulmonary physiology and stress response. The benefits of an adequate analgesia include a reduction in stress response of surgery, reduction in perioperative morbidity and effective pain control can also facilitate rehabilitation and accelerates recovery from surgery.Materials and Methods: This is a Randomized control study and single blind study conducted at Done in Hospitals attached to Bangalore Medical College and Research Institute, Bangalore over 10 months -from November 2019 to September 2020. Patients undergoing laparoscopic abdominal surgeries admitted to hospital. Group I (n=40) –will receive ultrasound guided transversus abdominis plane block prior to surgical procedure (starting with skin incision). Group II(n=40) –will receive ultrasound guided transversus abdominis plane block after surgery (following skin suture and closure).
Results: The two groups were comparable in terms of age, sex, weight, ASA grading, mean duration of surgery, mean duration of anesthesia and mean duration of insufflations. The two groups were comparable in terms of intraoperative EtCO2 and respiratory rate. Comparison of heart rate at regular intervals with basal heart rate, P value was significant from 45 minutes to 90 minutes in both the groups. Comparison of SBP at regular intervals with basal SBP, the difference was not statistically significant from 30 minutes to 75 minutes in group I, while the difference was statistically significant in group II. In comparison of DBP at regular intervals with basal DBP, the difference was not statistically significant at intervals of 45 to 90 minutes in both the groups. In comparison of MAP at regular intervals with basal MAP, the difference was not statistically significant at intervals from 30 to 90 minutes in both the groups (Table 4).
Conclusion: For patients undergoing laparoscopic surgery, preoperative TAP block was recommended for duration of surgery <180 min for lower consumption of intraoperative opioids, while postoperative TAP block was better than preoperative manipulation for duration of surgery >180 min, which might obtain lower postoperative pain score, less postoperative analgesics, and higher satisfaction score.
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