Page 286 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology Preperitoneal infiltration after laparoscopic cholecystectomy

required fewer opioids, had delayed onset of rescue analgesia, and reported lower
pain scores at critical post-operative intervals.

Keywords: Transversus abdominis plane block; Preperitoneal space; Cholecystectomy;
Analgesia

1. Introduction analgesia. In addition, the potential risk of inadvertent
intraperitoneal injection or inconsistent drug spread may
Laparoscopic cholecystectomy is a commonly performed limit its effectiveness. 6,7
procedure, typically associated with a short post-operative
hospital stay. Although laparoscopic cholecystectomy Both TAP block and preperitoneal infiltration are
1
operations result in less post-operative pain than open associated with minimal complications. TAP block has been
cholecystectomy operations, severe and moderate pain reported to have a favorable safety profile, with rare but
are the most common concerns, particularly during the potential risks including inadvertent needle injury to adjacent
first 24 h. A critical objective for early hospital discharge structures such as the liver or bowel. In addition, improper
is implementing appropriate pain management. In administration may result in incomplete analgesia or block
2
general, multimodal analgesic techniques, such as failure. Preperitoneal infiltration, a simpler technique,
intravenous patient-controlled analgesia and thoracic carries a lower risk of technical complications but may be less
epidural analgesia, are implemented to mitigate pain. A effective in managing pain at later post-operative stages. 8
3
regional nerve blockade method known as the transversus This study compares the analgesic efficacy of
abdominis plane (TAP) block, which has recently acquired preperitoneal infiltration with bupivacaine and
popularity, is now a frequently used multimodal approach dexamethasone and the TAP block in patients undergoing
element in post-operative pain management. 4
laparoscopic cholecystectomy. This comparison is based
The TAP block is a regional anesthesia technique that primarily on post-operative pain scores (Visual Analog
involves injecting local anesthetics into the TAP, located Scale [VAS]) and the time for first request for rescue
between the transversus abdominis and internal oblique analgesia, which are critical metrics for evaluating pain
muscles. This technique has gained popularity due to its management strategies.
effectiveness in reducing post-operative pain and opioid
consumption, particularly when ultrasound guidance is 2. Methodology
used to enhance precision. Studies have demonstrated This randomized, prospective, double-blinded study was
that TAP block significantly prolongs the duration of performed at the Department of Anesthesia and General
analgesia, delaying the first request for rescue analgesia and Surgery of Al-Zahraa University Hospital and Minia
improving overall patient comfort. However, its primary University Hospital, Egypt. This study was approved by
limitation is its inability to provide visceral pain relief, the Institutional Review Board and the Ethical Committee
as it primarily targets somatic pain from the abdominal of the Faculty of Medicine for Girls, Al-Azhar University
wall. In addition, its efficacy is highly operator-dependent, (Approval Number 1784/2023), and additionally by the
requiring technical expertise and ultrasound guidance for Institutional Review Board of Minia University Hospital,
optimal results. 5
according to the WMA Declaration of Helsinki. It was
Preperitoneal infiltration involves the administration approved by the Ethical Committee of Al-Azhar Faculty
of local anesthetics into the preperitoneal space, effectively of Medicine. The study was conducted for 6 months from
targeting nociceptive pathways to reduce post-operative February 2023 to August 2023. The trial was filed at the
pain. This technique offers several advantages, including Pan African Clinical Trial Registry (pactr.samrc.ac.za)
ease of administration under direct laparoscopic database (PACTR202504865598437).
visualization and reduced dependence on specialized
equipment like ultrasound. Furthermore, preperitoneal The participants were informed of the study’s objectives
infiltration can minimize opioid requirements, thereby and instruments. This investigation was conducted with
the approval of the institutional review board of the Faculty
reducing the incidence of opioid-related side effects of Medicine for Girls Al-Azhar University (1784/2023).
such as post-operative nausea and vomiting (PONV)
and sedation. However, its analgesic duration is shorter The study was voluntary, and each participant had to
than the TAP block, often necessitating earlier rescue provide informed written consent before enrollment. Each

Volume 9 Issue 3 (2025) 278 doi: 10.36922/EJMO025180164