Role of Transversus Abdominis Plane (TAP) Block in Day Case Laparoscopic Cholecystectomy (DCLC) - A Prospective Study

Background: Despite being accepted as a standard day case procedure, day case rates for laparoscopic cholecystectomy (LC) remain low. Post-operative pain, nausea and vomiting continue to be important obstacles to early discharge. Present study was undertaken to assess the role of transversus abdominis plane (TAP) block as an analgesic adjunct in improving procedure related outcomes for patients undergoing day case laparoscopic cholecystectomy (DCLC). Methods: Patients undergoing day case DCLC were prospectively randomised to TAP and no TAP block groups after informed consenting. Patients in both the groups also received port site infiltration with Marcaine. Primary outcome measure was post-operative pain. Secondary outcome measures included post-operative nausea/vomiting scores, sedation scores, length of post-operative hospital stay, complication rates, re-admission rates and overall patient satisfaction scores. Results: A total of 53 patients undergoing DCLC were randomised into TAP block (26) and no TAP block (27) groups. Both the groups were well matched for age, sex, ASA (American society of anaesthesiologists) grade and BMI (Body mass index). No significant differences were noted in the post-operative pain scores when measured at 2h (p-0.810), 4h (p-0.993), at discharge (p-0.539) and first post-operative day (p-0.491). Average post-operative hospital stay was 5.86h (4-8h) in the TAP group and 6.38h (5-22h) in the no TAP group (p-0.482). Post-operative nausea and sedation scores assessed at similar intervals did not reveal any significant difference between the two groups. Complication rates (3 patients in each group) and re-admission rates (none in each group) were similar for both the groups. Overall 42 patients (21 in each group) described the experience as highly satisfying with 9 patients reporting as satisfying (TAP-5, No TAP-4). Conclusion: The study failed to prove any benefit from TAP block in patients undergoing elective DCLC.