Ultrasound-guided versus transversus abdominis plane (TAP) block versus No TAP block in laparoscopic cholecystectomy; a randomized double-blind controlled trial

Postoperative pain following laparoscopic cholecystectomy remains a clinically significant concern despite the minimally invasive nature of the procedure. Inadequately controlled pain can delay ambulation, increase opioid consumption, and negatively impact postoperative recovery. Regional analgesic techniques such as the transversus abdominis plane (TAP) block have been shown to improve postoperative pain control and reduce opioid requirements. Among these, ultrasound-guided subcostal TAP block offers accurate local anesthetic deposition and enhanced analgesic efficacy. However, limited data exist comparing ultrasound-guided TAP block with no TAP block in laparoscopic cholecystectomy, particularly in resource-limited tertiary care settings. Aim: To evaluate the analgesic efficacy of ultrasound-guided subcostal TAP block compared with no TAP block in adult patients undergoing elective laparoscopic cholecystectomy. Methods: This randomized, double-blind, controlled trial was conducted over nine months (March 2025 to December 2025) at the Department of Anaesthesiology and General Surgery, Government Medical College Doda. A total of 100 adult patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomized into two groups. Group USTAP (n = 50) received ultrasound-guided subcostal TAP block using 0.25% ropivacaine, while Group Control (n = 50) received no TAP block. General anesthesia was standardized for all patients using fentanyl, propofol, atracurium, and maintenance with oxygen–nitrous oxide and isoflurane. The primary outcome was postoperative pain assessed using the Visual Analog Scale (VAS) at 1, 4, 8, 12, and 24 hours. Secondary outcomes included total opioid consumption in the first 24 hours, time to first rescue analgesic requirement, incidence of postoperative nausea and vomiting, hemodynamic stability, and length of hospital stay. Results: Patients in the ultrasound-guided TAP block group had significantly lower postoperative VAS pain scores at all assessed time points compared to the control group (p < 0.001). Total 24-hour opioid consumption was markedly reduced in the USTAP group, and the time to first rescue analgesic request was significantly prolonged. The incidence of postoperative nausea and vomiting was also lower in patients receiving TAP block. Hemodynamic parameters remained stable in both groups, and no block-related complications were observed. Length of hospital stay was shorter in the USTAP group compared to controls. Conclusion: Ultrasound-guided subcostal TAP block provides effective postoperative analgesia following laparoscopic cholecystectomy, significantly reducing pain scores and opioid consumption while improving overall recovery outcomes. Incorporation of ultrasound-guided TAP block as part of a multimodal analgesia protocol can enhance postoperative pain management and patient satisfaction without increasing complications.