Comparison of thoracic epidural analgesia versus transversus abdominis plane block for post-operative analgesia in laparoscopic cholecystectomies

Abstract

Background: A variety of regional analgesic techniques have found their use in laparoscopic surgeries in recent times. Introduced more than 100 years ago, thoracic epidural analgesia (TEA) has evolved from a mere salvage option to a major analgesic technique. On the other hand, the transversus abdominis plane block (TAP) has been shown to be highly effective for pain relief in abdominal surgeries. Aims and Objectives: The aim of our study was to compare the efficacy of TEA with TAP block for analgesia in patients undergoing laparoscopic cholecystectomies. Materials and Methods: This was a prospective, randomized study that comprised 90 American Society of Anesthesiologists 1 and 2 patients posted for laparoscopic cholecystectomies who were randomly divided into three groups: Group C – patients received systemic analgesia with diclofenac 75 mg; Group TE – patients received TEA with 8 mL 0.2% of ropivacaine, and Group TA – patients received subcostal TAP block with 2 mg/kg of 0.2% of ropivacaine. Duration of analgesia, Visual Analog Scale scores, and post-operative nausea and vomiting (PONV) were noted. One-way analysis of variance test was employed for comparing continuous variables, and the Chi-square test for categorical variables. Results: TAP block provided comparable analgesia to TEA. There were more episodes of hypotension in the TEA group. There were no neurological complications in any patient. Conclusion: TAP block can be a suitable alternative to TEA in providing adequate post-operative analgesia in laparoscopic cholecystectomies with fewer episodes of hypotension and PONV.