Efficacy of unilateral laparoscopic-guided abdominal wall block compared to local infiltration in postoperative analgesia following laparoscopic cholecystectomy: a single-center randomized controlled trial

Abstract

Introduction: Effective postoperative analgesia is crucial for recovery after laparoscopic cholecystectomy (LC). Although local anaesthetic infiltration (LAI) is commonly used, transversus abdominis plane (TAP) block may offer improved outcomes.
Aim: To evaluate the efficacy and safety of unilateral laparoscopy-assisted TAP (L-TAP) block, and their combination (L-TAP block+LAI), for postoperative pain management after LC.
Materials and methods: In this prospective, randomised clinical trial, patients undergoing LC were allocated into 4 equal-sized groups: L-TAP, LAI, L-TAP+LAI, and control, and were blinded to group assignment. The primary outcome was pain intensity measured using the Numerical Rating Scale (NRS) at 2, 6, and 24 hours postoperatively. The pain intensity at the umbilical, subcostal, and substernal wounds, the number of patients needing analgesics, and local complications assessed postoperatively were secondary outcomes.
Results: Forty patients were randomised to each group and analysed. The L-TAP group had lower NRS scores at 2, 6, and 24 hours postoperatively than the LAI group (P=0.003, P=0.015, and P=0.046, respectively). Similarly, subcostal pain was lower in the L-TAP group than in the LAI group (P=0.008, P=0.01, and P<0.001, respectively). No major complications were noted. The ecchymosis occurred most frequently in the LAI group (P=0.03).
Conclusions: Laparoscopic-guided unilateral TAP block is a safe and effective method for postoperative analgesia in LC. It provides superior pain control and fewer wound-related
complications than LAI, supporting its use as a practical intraoperative alternative to trocar-site infiltration.