The Effect of Postoperative Analgesia on the Day-Case Rate of Laparoscopic Cholecystectomy: A Randomised Pilot Study of the Laparoscopic-assisted Right Subcostal Transversus Abdominis Plane Block plus Local Anaesthetic Wounds Infiltration versus Local Anaesthetic Wounds Infiltration only

The transversus abdominis plane (TAP) block and local anaesthetic infiltration of port-sites (LAI) provide adequate analgesia after laparoscopic cholecystectomy (LC). Little is known if the two techniques affect the day-case (DC) rate of LC. We tested the appropriateness of the research design in view of a larger randomised controlled trial (RCT) - laparoscopic assisted right subcostal TAP block plus local anaesthetic wounds infiltration (STALA) vs LAI. Sixty patients having DC LC were randomised into STALA and LAI. Participants received bupivacaine 0.5% 30 ml. Pain scores were evaluated with the Visual Analogue Scale (VAS) score, at 1-hour post-surgery and at discharge. Need of post-operative intravenous (IV) opioids, DC rate and Quality of Recovery-15 questionnaires, were compared between groups and were considered as measures of efficacy of the interventions and follow-up in a definitive trial. Twenty-nine participants were randomised to STALA, 31 to LAI. Subjects in LAI group were all women (p = 0.0007) and younger (43.8 vs 37.7 years, p = 0.023). Median VAS scores were 0 vs 1 at 1 hour (p = 0.60), 0 vs 1.5 at discharge (p = 0.55). The need of IV opioids was 15/29 (51.7%) vs 13/31 (41.9%; p = 0.60). The DC rate was 93.1% vs 93.5% (p = 0.39). Fifty (83.3%) participants responded the questionnaires. The laparoscopically guided right subcostal TAP block provided no additional benefit to LAI on pain control after LC and DC rate. Despite the appropriate design, our findings do not support a larger RCT.