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Excellent postoperative analgesia with the addition of hyaluronidase to lignocaine for subcostal TAP block used in conjunction with systemic analgesia for laparoscopic cholecystectomy
  1. Mark Zachary Johnson,
  2. Therese C O'Connor
  1. Department of Anaesthetics, Sligo Regional Hospital, Sligo, Ireland
  1. Correspondence to Dr Mark Zachary Johnson, markzjohnson{at}


Subcostal transversus abdominis plane (TAP) blocks provide good postoperative analgesia for laparoscopic cholecystectomies. We hypothesised that adding hyaluronidase may improve the efficacy of this technique by increasing spread of the local anaesthetic (LA). In this case, we performed a bilateral ultrasound-guided subcostal TAP block using lignocaine (40 mL 1%) with hyaluronidase (75 IU/mL) for postoperative analgesia following elective laparoscopic cholecystectomy. It was used in combination with intraoperative morphine, diclofenac and paracetamol. Regular paracetamol was administered postoperatively. We monitored serial serum lignocaine levels and recorded the patient's visual analogue scale (VAS) pain scores postoperatively. We found that the patient experienced excellent analgesia throughout the postoperative period and that the serum lignocaine levels did not exceed the therapeutic range.

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