Comparison of Post-Operative Analgesic Efficacy of Bupivacaine and Ropivacaine using Ultra Sound Guided Oblique Subcostal Transverse Abdominis Plane Block in Open Cholecystectomy under General Anaesthesia

Indications for cholecystectomy, either open or laparoscopic, are usually related to symptomatic gallstones or complications related to gallstones. However, some situations still require a traditional open cholecystectomy. Depending on the clinical situation, the procedure can either begin as an open operation or be converted to an open procedure from a laparoscopic one. Open cholecystectomy should also be considered in patients with cirrhosis and bleeding disorders, as well as pregnant patients. Most open cholecystectomies result from conversion of a laparoscopic procedure, often because of bleeding complications or unclear anatomy. Conversion rates for laparoscopic cholecystectomy vary widely, with a reported range of 1-30%. Transverse abdominis plane can be approached through three methods. Most common method is approaching from lateral abdominal wall through lumbar triangle of petit, but blocking through this approach is useful for surgeries below the umbilicus. Subcostal approach gives analgesia around the umbilicus Whereas “Obliue Subcostal Transverse abdominis plane” (OSTAP) approach gives pain relief to both supra and infra umblical region. So we conducted a study in patients undergoing cholecystectomy (either directly planned for open cholecystectomy or open cholecystectomy converted from laparoscopic cholecystectomy) by comparing the analgesic efficacy of providing post operative pain relief. These patients are randomized and 30 patients grouped to Group A receiving Inj.Bupivacaine 0.25% and 30 patients grouped to Group B receiving Inj.Ropivacine 0.25%. After giving general anaesthesia, under strict aseptic precaution using ultrasound guidance injectate of either of the drug injected bilaterally by visualizing the continuous Ultra-sonography. Intraoperative hemodynamics and postoperative hemodynamics were noted till the patient complains of pain. Patient is said to have pain if patient have VAS score of >3. And rescue analgesia given. The mean duration of analgesia was longer in Inj.Bupivacaine group (486 ± 32.31 min) than Inj.Ropivacine group (404 ± 57.82 min). Both produces significant reduction in opiod usage for alleviationg postoperative pain. Both the group was maintained well with good intraoperative and postoperative hemodynamics when mean HR, SBP, DBP and MAP are monitored. Hence, Ultrasound guided Oblique subcostal transverse abdominis block plays important role in multimodal analgesia. When administered along with non-opiods like Inj.Paracetamol it redudes both parietal and visceral pain. In addition all the side effects of opiod usage like PONV, Sedation, Respiratory depression can be minimized