Nerve Blocks vs Local Injections for Post-op Pain Prevention in Laparoscopic Cholecystectomy in Children

In this study, patients ages 8 through 17 years scheduled for elective laparoscopic cholecystectomy will be invited to participate. Those having da Vinci cholecystectomy procedures will also be eligible. The da Vinci System is a minimally invasive option utilizing robotic technology. Once randomized, the patient will undergo either ultrasound guided bilateral TAP blocks or LWI at the beginning of the surgical procedure. Prospective data regarding pain scores, use of opioid medication, and nausea and vomiting episodes will be collected for both groups. Due to the nature of the study, it will not be possible to blind the investigators to the randomly selected method of injecting local anesthesia; however the personnel involved in the post-anesthetic and post-operative assessment will be blinded to the intervention, as well as the subjects themselves.

Inclusion criteria

• 8-17 yrs of age at date of enrollment.
• Elective laparoscopic or da Vinci cholecystectomy scheduled for any diagnostic reason.

Exclusion criteria

• Chronic pain or chronic use of narcotic or other prescription pain medications.
• Use of pain medication within 24 hours before surgery
• Prior major abdominal surgery
• Evidence of acute inflammation
• Patients with acute cholecystitis
• Bleeding / coagulation disorder
• Seizure disorder
• Renal dysfunction
• Infection at injection sites for TAP block or trocar placement
• Contraindication to LWI or TAP block procedure, as determined by surgeon or anesthesiologist performing the procedure (including, but not limited to, previous incision distorting anatomy or inability to visualize anatomical planes)
• Any known allergy to medications used in this study
• Patient unable to verbalize pain score or independently assess pain level
• Unstable patient in need of emergent intervention at surgeon discretion
• Patients who are known to be pregnant
• Patients who are currently prisoners
• Children in custody of the state
• Subjects will a BMI >/= 50
• Investigator discretion for any other reason