Comparative study between ultrasound-guided subcostal transversus abdominis plane block and paravertebral block for postoperative analgesia in laparoscopic cholecystectomy

Abstract

Abstract Background Adequate perioperative analgesia in laparoscopic cholecystectomy (LC) is important for improving patient outcomes. The subcostal transversus abdominis plane (STAP) block and the thoracic paravertebral block (PVB) are types of regional anesthesia that have been used for postoperative analgesia in upper abdominal surgery. Aim The aim was to compare the analgesic efficiency and safety of STAP block versus PVB for postoperative analgesia in LC. Patients and methods This randomized double-blind study was done on 90 patients, of both sexes, from 18 to 65 years old, with American Society of Anesthesiologists I and II, and scheduled for elective LC. Patients were randomized into three equal groups (n=30): group I received general anesthesia (GA) only, group II received GA and preoperative bilateral ultrasound (US)-guided STAP block, and group III received GA and preoperative bilateral US-guided PVB at T7. Results Heart rate, mean arterial blood pressure, and visual analog scale during rest and during cough showed insignificant differences at 30 min, 12, 18, and 24 h after recovery but were significantly lower at 2, 4, and 6 h in STAP and PVB groups compared with the GA group. Meanwhile, there were insignificant differences between STAP and PVB groups during the whole postoperative period. Moreover, the first request of pethidine was significantly longer and the amount of intraoperative fentanyl and postoperative pethidine were significantly lower in STAP and PVB groups than in the GA group. Conclusion Bilateral US-guided STAP block and bilateral US-guided PVB are effective and safe analgesic techniques for LC, but pneumothorax should be considered while performing PVB.