The efficacy of ultrasound-guided oblique subcostal transversus abdominis plane block in patients undergoing open cholecystectomy

Abstract

Background: Ultrasound-guided oblique subcostal transversus abdominis plane (TAP) blockade has been described recently as providing a wider analgesic blockade than the posterior approach, with the possibility of being suitable for surgery both superior and inferior to the umbilicus. The objective of this study was to report the authors’ experience of intraoperative oblique subcostal TAP blockade during open cholecystectomy. Case report: This is a case series of 10 patients who had bilateral oblique subcostal TAP blockade for elective laparoscopic cholecystectomy which was subsequently converted to open cholecystectomy. Intraoperative haemodynamic parameters (pulse rate, systolic and diastolic blood pressure and mean arterial blood pressure) were recorded every five minutes. A rescue bolus of intravenous fentanyl (0.5 μg/kg) was given when any of the above-mentioned parameters were raised more than 15% from the baseline. The postoperative visual analogue score (VAS) was recorded in the recovery room. Intraoperative administration of rescue fentanyl bolus was minimal with a mean postoperative VAS of 2.1 ± 1.60. No complications were noted related to TAP blockade. Conclusion: Ultrasound-guided oblique subcostal TAP blockade can be effective as intraoperative analgesia in abdominal surgery. Randomised controlled studies comparing TAP blockade with other modes of analgesia are needed to determine its efficacy for abdominal surgery.

Keywords: oblique subcostal TAP block, open cholecystectomy, anterior abdominal wall, thoracolumbar intercostal nerves, intraoperative analgesia