A Comparison Of Preemptive Transversus Abdominis Plane Block With 0.25% Bupivacaine And 0.25% Bupivacaine With 20mcg Fentanyl For Post Operative Analgesia In Laparoscopic Appendicectomy - A One Year Hospital Based Randomised Controlled Trial

Abstract

BACKGROUND: In recent years laparoscopic appendicectomy is performed more often than open appendicectomy to reduce postoperative pain, reduced duration of hospital stay, early ambulation and discharge.However laparoscopic surgery is not completely pain free. Several modalities have been tried to treat post operative pain following laparoscopic appendicectomy. Transversus abdominis plane block has been found to be a safe and effective tool to provide postoperative analgesia in a various laparoscopic surgeries. OBJECTIVE: To compare the efficacy of preemptive Transversus abdominis plane block with 0.25% bupivacaine and 0.25% bupivacaine with fentanyl for duration of postoperative analgesia in patients undergoing laparoscopic appendicectomy. METHODOLOGY: The present study was conducted at , KLE'S Dr.Prabhakar Kore Hospital and Medical Research Centre, Nehru nagar, Belagavi 590010, on 60 adult patients undergoing elective laparoscopic appendicectomy under General Anaesthesia between January 2016 to December 2016.Patients were divided into 2 groups, Group 1 and Group 2 by computer generated randomisation table. After induction of general anaesthesia Group 1 patients received TAP block with 15ml of 0.25% bupivacaine bilaterally and Group 2 patients received received TAP block with 15ml of 0.25% bupivacaine + 10 mcg of fentanyl bilaterally.Laparoscopic appendicectomy was done according to standard protocol. In the post operative period patients were assessed for post operative pain at 0, 1,2,3,4,5,6,8,10,12,14,16,18,20,22,24 hours using VAS pain scale. If VAS>3 rescue analgesia in the form of Inj Tramadol 2mg/kg IV was given. Time of first rescue analgesia was noted. RESULTS: The two groups were comparable with respect to age, mean weight, ASA status and gender distribution. The mean VAS scores were comparable (less than 3) in both the groups at different time intervals post operatively (p > 0.05).14 patients in group 1 and 7 patients in group 2 recorded VAS score > 3 and required rescue analgesic in the first 24 hours. This difference was statistically significant (p=0.029). The time for requirement of first rescue analgesic was 11.43±4.26 hrs in group 1 and 14.00±1.63 hrs in group 2. Even though the time for first rescue analgesic is longer in group 2, it was not statistically significant (p=0.142). CONCLUSION: Pre-emptive Transversus abdominis plane block with 0.25% bupivacaine or with addition of fentanyl is equally effective in providing postoperative pain relief in patients undergoing elective laparoscopic appendicectomy