Comparison of Transversus Abdominis Plane (TAP) Block with Intraperitoneal Mist Instillation Using 0.5% Isobaric Ropivacaine in Elective Laparoscopic Surgeries for Postoperative Pain Management
Ankur Sharma, Sudhir Sachdeva, Namita Gupta, Vijay Mathur, Arpit Rai
Author(s)5Resident, Department of Anaesthesiology, Critical Care & Pain Management, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India.
Abstract
Background: Postoperative pain after laparoscopic surgery has both somatic and visceral components. Ultrasound-guided transverses abdominis plane (TAP) block primarily provides somatic analgesia, whereas intraperitoneal mist instillation may improve visceral pain control through uniform peritoneal drug distribution. This study compared the analgesic efficacy of intraperitoneal mist instillation of 0.5% ropivacaine with ultrasound-guided TAP block. Material and Methods: In this prospective, randomized, double-blind study, 134 ASA I–II patients undergoing elective laparoscopic surgery were equally allocated to Group T (bilateral ultrasound-guided TAP block with 0.5% ropivacaine) or Group N (intraperitoneal mist instillation of 0.5% ropivacaine using the Aerogen Pro® device). Postoperative pain scores, rescue analgesic requirement, recovery profile, patient satisfaction, haemodynamic parameters, and adverse effects were evaluated. Results: Baseline characteristics were comparable between groups. Group N had significantly lower early postoperative static and dynamic numerical rating scale pain scores, longer time to first rescue analgesia (10.22±1.85 vs. 7.63±1.35 h; P<0.001), lower 24-hour tramadol consumption (70.90±24.85 vs. 84.33±29.14 mg; P=0.008), and fewer rescue analgesic doses (P=0.014). Recovery was faster, with earlier oral intake, ambulation, and unassisted walking (all P<0.001). Shoulder pain was significantly less frequent (14.9% vs. 53.7%; P<0.001), and patient satisfaction was higher (P<0.001). Safety profiles and adverse effects were comparable. Conclusion: Intraperitoneal mist instillation of 0.5% ropivacaine provided superior postoperative analgesia, reduced opioid requirement, accelerated recovery, and decreased shoulder pain compared with TAP block, while maintaining a comparable safety profile.
Keywords: Laparoscopic surgery; intraperitoneal mist instillation; ropivacaine; transversusabdominis plane block; postoperative analgesia.