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

Introduction: Effective postoperative analgesia is crucial for recovery after laparoscopic cholecystectomy (LC). Although local anesthetic infiltration (LAI) is commonly used, transversus abdominis plane (TAP) block may offer improved outcomes. Aim: We aimed to evaluate the efficacy and safety of unilateral laparoscopic-assisted TAP (L-TAP) block, LAI, and their combination (L-TAP+LAI) for postoperative pain management after LC. Materials and methods: In this prospective, randomized clinical trial, 160 eligible 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. Secondary outcomes comprised pain intensity at the umbilical, subcostal, and substernal wounds, the number of patients requiring analgesics, and local complications assessed postoperatively. Results: Each group comprised 40 patients. The L-TAP group had lower NRS scores at 2, 6, and 24 hours postoperatively than the LAI group (P = 0.003, P = 0.02, and P = 0.046, respectively). Similarly, subcostal pain was lower in the L-TAP than in the LAI cohort (P = 0.008, P = 0.01, and P <⁠0.001, respectively). No major complications were observed. 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.