Introduction: Laparoscopic Cholecystectomy is presently a commonly performed surgical procedure. It is needed in both the young and the old; healthy as well as the severely co-morbid. During the surgery, pain is generated at the port site and also from the viscera. Bilateral Subcostal (Upper Quadrant) Transversus Abdominis Plain Block can block the pain from the parietal port sites. This study is to assess the efficiency of Bilateral Subcostal Transversus Abdominis Plane Block as a mode of multi-modal analgesia in the General Anaesthesia administered for Laparoscopic Cholecystectomy.

Material and Methods: One hundred patients of ASA 1 or 2 categories in the age group 20 to 60 years from both sex posted for elective Laparoscopic Cholecystectomy was included in the study. Fifty patients each was randomly assigned to two groups ‘A’ and ‘B’. Group A was the control group and did not receive any blocks. The surgery was done solely under General Anaesthesia. In the group ‘B’, Bilateral Subcostal TAP block with 30 ml of 0.25% Ropivacaine was administered from the Block Room. General Anaesthesia in a standardised protocol for the study was administered by a different Anaesthetist who was blinded about the blocks. The extra amount of Fentanyl required per hour to maintain adequate anaesthesia was noted in every patient. Minimum concentration of Sevoflurane demanded by individual patients is also noted. Systolic BP value range of ‘Control BP to an additional 15mm of Hg’ is targeted as adequate anaesthetic depth in this study.

Post Operative Analgesia also had a standard protocol for all the patients. The additional dose Inj. Tramadol to control the pain in the 8 post operative hours is also noted.

Results: The study demonstrated a statistically significant decrease in the intra operative inhalational anaesthetic and narcotic analgesic demand, in the Group B in which Bilateral Subcostal TAP Block was administered. The decrease in the 8 hour post operative analgesic demand in the Group B was found to be statistically significant.

Conclusion: After a bilateral Subcostal TAP block, there is a decrease in the intra operative anaesthetic demand for a Laparoscopic Cholecystectomy. The regional analgesia extends to immediate 8 post operative hours, and reduces the analgesic demand. This may not make a marked difference in the outcome in ASA 1 or 2 patients. But in ASA 3 or 4 patients with poor cardiac or other system reserve, a higher narcotic analgesic or inhalational anaesthetic requirement may cause decompensation.  A low anaesthetic demand after a Bilateral Subcostal TAP block may be beneficial in these patients.

Keywords-Laparoscopic Cholecystectomy, Subcostal TAP Block, Multimodal Analgesia, Sevoflurane, Ropivacaine, Fentanyl, Tramadol.