Page 292 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology Preperitoneal infiltration after laparoscopic cholecystectomy

significantly less total opioid consumption within the first in providing pain relief to patients who underwent
24 h postoperatively. laparoscopic gynecologic surgery.
The results of our study agree with the findings of El While our findings indicate that the TAP block provided
sharkwy et al. They determined that the TAP block is more longer-lasting analgesia and reduced opioid consumption
15
efficacious in the early post-operative period in terms of compared to preperitoneal infiltration, it is important to
pain scores and analgesia consumption than preperitoneal emphasize that both techniques were clinically effective
infiltration in surgical laparoscopy. Ghisi et al., discovered in managing post-operative pain following laparoscopic
16
that the pain scores at rest and through movement were cholecystectomy.
not lowered by ultrasound-guided TAP block through the Although the differences in VAS scores at 8 and 12 h
first 24 h following laparoscopic hysterectomy, in contrast were statistically significant, the absolute differences were
to the control group that received morphine patient- modest. This suggests that while the TAP block may offer
controlled analgesia as a treatment. This is in stark contrast an advantage in the duration of pain relief, preperitoneal
to the findings of El sharkwy et al. , who demonstrated the infiltration remains a viable and practical alternative,
15
superiority of the TAP block over preperitoneal infiltration particularly when ultrasound resources or expertise are
during the early post-operative period.
limited. These findings support the inclusion of either
17
In a retrospective cohort study by Rivard et al., the technique within a multimodal analgesia strategy, tailored
intraperitoneal bupivacaine administration was associated to the clinical setting, provider experience, and patient-
with reduced post-operative narcotic use and lower specific factors.
patient-reported pain scores in minimally invasive surgery,
such as cancer staging and hysterectomy. With respect to 4.1. Strengths
post-operative complications, no significant difference in The study’s randomized, double-blinded design enhances
PONV was indicated between the preperitoneal group and the reliability and validity of the findings by reducing
the TAP block group. selection and observer biases. Using objective measures,
Badawy compared the intraperitoneal local analgesia such as the VAS for pain assessment and quantification of
18
instillation before the trocars’ removal in laparoscopic opioid consumption, adds rigor to the evaluation of the
hysterectomy cases to the control group. Pain scores were analgesic techniques. Furthermore, the direct comparison
significantly decreased within the first 24 h after surgery between the TAP block and preperitoneal infiltration offers
when an intraperitoneal local anesthetic was administered. a practical perspective on optimizing pain management
This was demonstrated by the reduction in opioid strategies. The study also controlled key procedural
consumption and post-operative analgesia. In addition, variables, such as surgical and anesthetic protocols,
there was a reduction in the incidence of PONV. ensuring that observed differences were attributable to
the analgesic methods rather than external factors. These
None of the complications associated with the methodological strengths provide a robust foundation for
TAP block was encountered during our investigation. the study’s conclusions.
Furthermore, the TAP block has not been associated with
any complications in the preponderance of all other studies. 4.2. Limitations
The primary benefit of the TAP block is its safety profile, Despite its strengths, the study has notable limitations.
although researchers have documented the incidence of A notable limitation of this study is its relatively small
liver and colon injury. 19 sample size, which may reduce the generalizability of the
In contrast, wound infiltration utilization by local findings and the statistical power to detect smaller but
anesthetics through laparoscopic surgery to mitigate clinically meaningful differences. Although the observed
post-operative pain has been documented since the trends favor the TAP block in terms of analgesic duration
early 1990s. Dec and Andruszkiewicz were the first to and opioid-sparing effect, these results should be interpreted
20
disclose the use of wound infiltration by local anesthetics with caution. The study focuses exclusively on laparoscopic
for minimally invasive cholecystectomies in the general cholecystectomy, and its applicability to other surgical
surgery literature in 2016. A meta-analysis of 30 studies procedures remains uncertain. The study examined only
featuring laparoscopic cholecystectomies revealed a short-term outcomes within the first 24 h, omitting the
reduction in the quantity of analgesics administered potential for long-term complications, chronic pain, or
postoperatively and a decrease in post-operative pain extended recovery metrics. The homogeneity of the study
scores. Yoshiyama et al., found that the posterior TAP population, with limited diversity in demographics or
21
block was more efficient than the lateral TAP block comorbidities, further narrows the scope of the conclusions.

Volume 9 Issue 3 (2025) 284 doi: 10.36922/EJMO025180164