Comparison of subcostal transversus abdominis block with intraperitoneal instillation of bupivacaine and dexmedetomidine for pain relief after laparoscopic cholecystectomy, randomized double blinded controlled study

BACKGROUND: This study compared the analgesic effectiveness of ultrasound-guided subcostal transversus abdominis plane (STAP) block with intraperitoneal instillation of bupivacaine and dexmedetomidine after LC. METHODS: This prospective, randomized, double-blind trial involved 60 ASA I-II patients undergoing elective LC. At random, the patients were divided into two groups of thirty each. Group 1 was given STAP block with bupivacaine and dexmedetomidine along with intraperitoneal normal saline. Bupivacaine, dexmedetomidine was administered intraperitoneally to Group 2 along with STAP with normal saline. The Numerical Rating Scale (NRS) was used to measure postoperative pain at rest, while coughing, and for shoulder tip discomfort as a primary outcome. Patient satisfaction, sedation rating, and time to first analgesic demand were also assessed as a secondary outcome. RESULTS: At rest and while coughing, Group 1's NRS ratings were considerably lower at all times (p < 0.001). Group 1 experienced considerably less shoulder tip discomfort 24 h after surgery (p = 0.032). Group 1 had a longer time to first analgesic demand (16.5 vs. 11.7 h, p = 0.003). By the end of the research, 12 patients in Group 1 needed postoperative analgesia (46.2% vs. 96.4%, p < 0.001). Group 1 had increased patient satisfaction (p < 0.001). CONCLUSION: STAP block offers better postoperative analgesia than intraperitoneal instillation. TRIAL REGISTRATION: This prospective interventional double-blinded clinical trial was done at Assiut University Hospitals, Assiut, Egypt, From June, 2021 to May, 2024. The study protocol was approved by the Institutional Review Board of the Faculty of Medicine, Assiut University (IRB approval number: 17200580) and registered with ClinicalTrials.gov (ID: NCT04715165).