Abstract Introduction: Ultrasound-guided subcostal transversus abdominis plane (USG-subcostal TAP) block is commonly used for post-operative analgesia in laparoscopic sleeve gastrectomy (LSG). Laparoscopic-guided subcostal TAP (L-subcostal TAP) offers a practical alternative, especially in resource-limited settings. However, comparative evidence in the LSG population is limited. Patients and Methods: This prospective, randomised trial included 50 patients undergoing LSG, assigned to either L-subcostal TAP or USG-subcostal TAP groups. Pain scores at rest and during movement (Numeric Rating Scale), rescue analgesic requirements, antiemetic use and patient satisfaction (Quality Improvement in Post-operative Pain Survey) were assessed at post-operative 30 min, 1, 2, 6, 12 and 24 h. Results: Pain scores were similar across the groups during the first 12 h. At 24 h, USG-subcostal TAP was associated with significantly lower pain scores at rest and during movement ( P < 0.05). Additional analgesics were required in four patients in the L-subcostal TAP group, while none were needed in the USG group ( P = 0.037). Satisfaction levels were high in both the groups, and no complications occurred. A negative correlation was found between satisfaction and the need for rescue analgesia. Conclusion: Both USG-subcostal and L-subcostal TAP blocks provide effective early post-operative analgesia in LSG. While USG-subcostal TAP had a longer duration of effect, L-subcostal TAP offers practical advantages including ease of use, shorter application time and no requirement for specialised equipment. In settings with limited access to ultrasound or trained personnel, L-subcostal TAP can be considered a safe and effective alternative within multimodal analgesia strategies.
Seyit et al. (Fri,) studied this question.