Background Postoperative pain remains a major concern in laparoscopic cholecystectomy. Transversus abdominis plane (TAP) and rectus sheath (RS) blocks are effective regional anesthesia techniques for pain control, but the optimal administration method is unclear. This study aimed to compare the efficacy of laparoscopic versus ultrasound‐guided subcostal TAP and RS blocks in this procedure. Methods This prospective, double‐blinded, noninferiority randomized controlled trial included 99 patients who underwent elective laparoscopic cholecystectomy. Patients were randomly allocated to receive either ultrasound‐guided or laparoscopic subcostal TAP and RS blocks with 0.2% ropivacaine. The primary outcome was postoperative opioid consumption. The secondary outcomes included pain scores measured by Numeric Rating Scale (NRS) at predefined time points—preoperatively and at 0, 2, 6, 12, and 24 h postoperatively—as well as block time and intraoperative hemodynamic parameters. Results Morphine consumption was statistically noninferior between the laparoscopic and ultrasound‐guided groups (mean difference −0.996 mg, p = 0.25). NRS pain scores followed similar trends in both groups, with only one time point (12 h postoperatively) showing a small statistically significant difference favoring the laparoscopic group ( p = 0.0454), which may have limited clinical relevance. The block time was significantly shorter in the laparoscopic group (mean 5.90 vs. 10.15 min, p < 0.05). Intraoperative hemodynamic parameters were not significantly different between the groups. Conclusion Compared with ultrasound‐guided blocks, laparoscopic subcostal TAP and RS blocks provide noninferior analgesia with faster block times in laparoscopic cholecystectomy. These findings suggest that laparoscopic blocks are safe and effective alternatives for multimodal pain management in laparoscopic cholecystectomy, particularly in settings with limited access to ultrasound equipment or trained anesthesia providers. Trial Registration: Iranian Registry of Clinical Trials identifier: IRCT20170515033986N5
Shakeri et al. (Thu,) studied this question.