Post-operative Analgesic Efficacy Of Ultrasound Guided Bilateral Continuous Subcostal Transversus Abdominis Plane Block Compared With Thoracic Epidural Analgesia After Open Radical Gastrectomy

Objective: To evaluate the postoperative analgesic efficacy of USG guided continuous subcostal TAP block with TEA in a patient undergoing open gastrectomy and to investigate the clinical effect of continuous subcostal transverse abdominis muscle plane block as a new analgesia technique.Methods: 60 patients undergoing open gastrectomy were randomized into two groups(TAP & EA).Group TAP underwent USG guided subcostal TAP block with loading dose 0.375% Ropivacaine 1.5mg/kg/side 20 ml,intraoperatively received 0.375% Ropivacaine 0.1ml/kg/side every 1 hr 30 mins and PCA commenced with 0.15% Ropivacaine 0.1ml/kg/side upto 48 hrs postoperatively.Group EA underwent thoracic epidural catheterization at T8-T9 vertebral space received loading dose 0.375% Ropivacaine 10 ml,intraoperatively received0.375% Ropivacaine 5ml every 1 hr 30 mins and PCEA commenced with 0.15%Ropivacaine background infusion and PCA bolus 3ml/hr upto 48 hrspostoperatively.The primary outcome was VAS scores at rest,on coughing,rescue analgesics used at OT/PACU and ward.Secondary outcome was hemodynamic fluctuations,use of Ephedrine,patient satisfaction,occurrence of adverse reactions and postoperative recovery.Result: In the end Group TAP had 29 patients(1 had catheter dislodgement while transferring patient to PACU)and Group EA had 30 patients.There was significant differences in VAS scores on coughing at 4 and 8 hours(P =0.035,P =0.010respectively)postoperatively.However,VAS scores at rest was not statistically significant.There was no significant differences in use of rescue analgesics.There was significant difference in SBP and DBP of TAP group and EA group during T1(P =0.003 and P =0.001)respectively with ephedrine consumption higher in EA group(P =0.009).There was no significant difference in PONV and patient satisfaction score.However,lower limb numbness and weakness with other adverse effects were found more in EA group.Conclusion: Subcostal TAP block may be effective alternative to epidural analgesia for providing postoperative static analgesia with minimal hemodynamic fluctuations but lag behind during dynamic analgesia after open gastrectomy.