Ultrasound-guided versus laparoscopic-assisted subcostal transversus abdominis plane block for postoperative analgesia after laparoscopic cholecystectomy: A prospective randomized trial

Objective: To compare the analgesic efficacy of ultrasound-guided and laparoscopic-assisted subcostal transversus abdominis plane (TAP) block after laparoscopic cholecystectomy.Methods: In this prospective, randomized, double-blind trial, 60 adults undergoing elective laparoscopic cholecystectomy received either ultrasound-guided (US-TAP, n = 30) or laparoscopic-assisted (L-TAP, n = 30) subcostal TAP block under standardized general anesthesia and multimodal analgesia. The primary outcome was pain intensity on the Numeric Rating Scale (NRS) across the first 24 postoperative hours; comparisons at individual time points were exploratory. Secondary outcomes were analgesic consumption, time to first rescue analgesia, rescue opioid requirement, postoperative nausea and vomiting (PONV), time to ambulation, length of stay, and complications.Results: Baseline characteristics were comparable; pain scores declined over time in both groups. NRS scores were lower with US-TAP at 1 hour (2.50 ± 1.72 vs 4.03 ± 1.56; difference 1.53, 95% CI 0.68 to 2.38; p = 0.001) and 6 hours (1.83 ± 1.44 vs 2.70 ± 1.47; difference 0.87, 95% CI 0.12 to 1.62; p = 0.015), with no differences at the other six time points. No differences were found in time to first analgesic request, rescue analgesic or opioid requirements, PONV, ambulation, hospital stay, complications, or the overall 24-hour reduction in NRS.Conclusion: Ultrasound guidance was associated with lower early postoperative pain scores, but these differences fell below commonly cited thresholds for clinically important change and were not accompanied by differences in analgesic requirements or recovery outcomes. Without a no-block control group and not being designed to test equivalence, this trial compares the two techniques rather than establishing the efficacy of either.Trial Registration: The study was registered at ClinicalTrials.gov (ID: NCT07352189). Registration was retrospective.