Abstract

Background and aim: The postoperative pain in obese patients undergoing laparoscopic cholecystectomy (LC) is challenging due to combination of reduced functional residual capacity, increased oxygen consumption, and higher sensitivity to the respiratory depressant effects of opioids. The primary objective of the study was to compare total consumption of rescue analgesics over 24 hours in obese patients receiving external oblique intercostal fascial plane block (EOIPB) and port-site local anaesthetic (LA) infiltration and the secondary objectives were to compare the total duration of effective analgesia, postoperative pain intensity and the postoperative quality of recovery.

Hypothesis: We hypothesised that EOIPB is superior to port site infiltration for postoperative pain management in patients undergoing LC. The primary outcome was total rescue analgesic consumption in the first 24 hours postoperatively, with secondary outcomes including time to first analgesic request, pain scores, quality of recovery, and opioid-related side effects.

Methods: This prospective randomized controlled study was conducted in 60 adult obese patients randomly allocated to receive port-site LA infiltration in Group L and EOIPB in Group E with 20 ml of 0.25% bupivacaine. Total consumption of rescue analgesics over 24 hours, postoperative pain using the numerical rating scale (NRS) and the quality of recovery (QoR) at first 24 hours after surgery were measured.

Results: Group E had significantly lower total rescue analgesic consumption within the first 24 hours compared to Group L (p = 0.009). The median NRS score was significantly higher in Group L compared to Group E at 0,2,4,6, 8, 12 and 24 hours after surgery. Postoperative quality of recovery was superior in Group E compared to Group L (p = 0.0015).

Conclusion: External oblique intercostal fascial plane block compared to port site LA infiltration results in superior pain relief for a longer duration after LC in obese patients.