COMPARISON OF EFFECTIVENESS OF PRE-EMPTIVE AND POST-OPERATIVE COMPARISON OF EFFECTIVENESS OF PRE-EMPTIVE AND POST-OPERATIVE TAP BLOCK FOR POST-OPERATIVE ANALGESIA IN PATIENTS UNDTAP BLOCK FOR POST-OPERATIVE ANALGESIA IN PATIENTS UNDERGOING CHOLECYSTECTOMY

Abstract

Objective: To compare the post-operative analgesic efficacy of pre-emptive versus post-operative administered TAP block in patients undergoing cholecystectomy.

Study Design and Duration of Study: Randomized controlled trial. Department of Anesthesia, Fauji Foundation Hospital, Rawalpindi, from Dec-2025 to Feb-2026.

Method: A total of 80 patients aged 18–60 years scheduled for elective laparoscopic cholecystectomy were included and randomly allocated to two equal groups (n=40 each). Patients in Group pre-em received TAP block before the surgical incision, just after the induction of general anesthesia, while patients in Group post-op received this block after completion of surgery just before extubation.  Assessment of the post-operative pain was done using the Visual Analog Scale (VAS). The primary outcome was set as the time to require first rescue analgesia and the number of rescue analgesia doses (IV Diclofenac sodium 75 mg) administered within the first 24 hours (when VAS ≥4).   Secondary outcomes included the pain scores at 6 and 12 hours post-operatively. These outcomes were compared by applying independent t-test considering p≤0.05 as significant.

Results: The results of primary outcomes showed that the time to first rescue analgesia was longer (5.95±0.75 hours vs 4.88±1.51 hours; p<0.001) and the number of rescue analgesia doses was lower in Group post-op compared to Group pre-em (2.13±0.72 vs 2.83±0.90; p<0.001). Similarly, the pain scores were significantly lower at 6 hours and 12 hours in Group post-op than Group pre-em (4.18±1.55 vs 5.35±1.17; p<0.001 and 3.08±1.19 vs 3.73±0.93; p=0.01, respectively).

Conclusion: Post-operative block is more effective than the pre-emptive TAP block in providing postoperative analgesia in patients undergoing laparoscopic cholecystectomy.