Page 288 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology Preperitoneal infiltration after laparoscopic cholecystectomy

surgical approach. The intra-abdominal pressure was guidance, the involvement of experienced specialists
kept at 12 mm Hg for all cases. Before skin incision, the and standardized procedural steps helped ensure
procedure was performed in the operating room using a consistency. We acknowledge that differing guidance
fully aseptic technique. methods (ultrasound vs. laparoscopic) may affect the
reproducibility and accuracy of anesthetic spread, and we
For the TAP block group, a unilateral TAP block was
performed on the surgery site utilizing 18 mL of 0.25% have added this as a potential limitation in the discussion
bupivacaine and 8 mg of dexamethasone (total volume of section.
20 mL) through a midaxillary approach under ultrasound 2.5. Protocol for post-operative analgesia
guidance. The probe was positioned transversely between
the costal margin and the iliac crest. The 22-G echogenic Additional analgesia was administered when patients
spinal needle, which was 8 cm long, was advanced in-plane. reported a VAS score of ≥4, indicating moderate to severe
After the needle point reached the plane, the correct pain. The first-line rescue analgesic used was intravenous
placement was confirmed by instilling 2 mL of anesthetic paracetamol (1 g) administered every 6 h, as needed. If
solution to view the hydrodissection. Subsequently, the pain persisted despite paracetamol, intravenous pethidine
entire drug volume was administered, resulting in the (50 mg) was given as a second-line agent. For each patient,
formation of a meniscus between the planes. To minimize the total dosage and frequency of administration were
operator variability, all TAP blocks were performed by recorded to evaluate cumulative analgesic use.
the same consultant anesthesiologist with over 5 years of 2.6. Outcomes
experience in ultrasound-guided regional anesthesia.
2.6.1. Primary outcomes
Preperitoneal infiltration was performed immediately
after induction of general anesthesia. The procedure was 2.6.1.1. Visual Analog Scale scores
performed under laparoscopic visualization after insertion Pain intensity was measured using the VAS at six post-
of trocars and carbon dioxide gas insufflation. Digital operative time points: 0, 2, 4, 8, 12, and 24 h. Patients rated
pressure was applied to identify the injection site, and a their pain on a scale from 0 (no pain) to 10 (worst pain
blind injection was then performed, advancing the needle imaginable). This provided an objective assessment of pain
inserted until its tip was visible at the peritoneum. The severity over time for comparison between the two groups.
needle was then withdrawn gently for about 0.5 cm, and
the local anesthetic was injected. The surgeon administered 2.6.1.2. Time to first rescue analgesia
18 mL of 8 mg dexamethasone and 0.25% bupivacaine The duration from the end of surgery until the patient’s
(total volume 20 mL) under laparoscopic vision. first request for additional analgesia was recorded. This
measure reflects the analgesic efficacy and duration of pain
To ensure that no intraperitoneal injections were
administered, the injection site within the peritoneal relief provided by the intervention.
cavity was examined, with an internal protrusion, 2.6.1.3. Total analgesic dose
also known as Doyle’s bulge, serving as the definitive The cumulative dose of opioids required within the first
procedural landmark. To minimize operator variability, 24 h postoperatively was documented. Lower opioid
all preperitoneal infiltrations were conducted by the same consumption indicated better pain control and effectiveness
senior laparoscopic surgeon under direct laparoscopic of the analgesic technique.
visualization. The injection site was identified after trocar
insertion and insufflation. 2.6.2. Secondary outcomes
Sevoflurane administration was discontinued at the 2.6.2.1. PONV
conclusion of surgery, and spontaneous breathing resumed. The occurrence of nausea and vomiting was monitored in
The gas flow rate was increased to 7 L/min of oxygen, both groups, as these are common side effects of anesthesia
and the neuromuscular blockade was reversed with a and opioid use. PONV incidences were compared to
standard dose of atropine (0.01 mg/kg) and neostigmine evaluate the influence of the analgesic technique on this
(0.05 mg/kg). The patient was extubated when they were outcome.
able to respond to a verbal request and were able to
breathe spontaneously with a tidal volume of 5–8 mL/kg. 2.6.2.2. Sleep quality
Subsequently, they were transferred to the recovery room.
Post-operative sleep quality was assessed using a subjective
While the TAP block used real-time imaging and the scoring system, where patients rated their sleep on a scale
preperitoneal technique relied on visual laparoscopic from 0 (poor sleep) to 10 (excellent sleep). This score was

Volume 9 Issue 3 (2025) 280 doi: 10.36922/EJMO025180164