Efficacy of Laparoscopic-Guided Transversus Abdominis Plane Block versus Standard Analgesia for Postoperative Pain Control in Laparoscopic Cholecystectomy

Ghazanfar  Zulfiqar; Muhammad Imran  Anwar; Zaigham  Jameel; Saqlain  Ghazanfar; Muzammil  Khan; Talha  Tariq

doi:10.54112/bcsrj.v6i5.1750

Authors

Ghazanfar Zulfiqar Department of General Surgery and Surgical Oncology, Sheikh Zayed Hospital, Lahore, Pakistan
Muhammad Imran Anwar Department of General Surgery and Surgical Oncology, Sheikh Zayed Hospital, Lahore, Pakistan
Zaigham Jameel Department of General Surgery and Surgical Oncology, Sheikh Zayed Hospital, Lahore, Pakistan
Saqlain Ghazanfar Department of General Surgery and Surgical Oncology, Sheikh Zayed Hospital, Lahore, Pakistan
Muzammil Khan Department of General Surgery and Surgical Oncology, Sheikh Zayed Hospital, Lahore, Pakistan
Talha Tariq Department of General Surgery and Surgical Oncology, Sheikh Zayed Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i5.1750

Keywords:

Analgesia, Cholecystectomy, Laparoscopic, Pain Management, Postoperative Pain, TAP Block, Tramadol

Abstract

The management of postoperative pain following laparoscopic cholecystectomy remains a clinical challenge. While systemic analgesics are routinely used, they may be associated with suboptimal relief and adverse effects. The laparoscopic-guided Transversus Abdominis Plane (TAP) block has emerged as a promising regional technique for effective postoperative analgesia. Objectives: To compare the efficacy of laparoscopic-guided TAP block versus standard systemic analgesia for postoperative pain control in patients undergoing laparoscopic cholecystectomy. Methodology: A prospective, randomized controlled trial conducted at the Department of Surgery Sheikh Zayed Hospital, Lahore, from March 2023 se April 2024. A total of 140 patients undergoing elective laparoscopic cholecystectomy were randomly divided into two equal groups: TAP block group (n=70) and standard analgesia group (n=70). The TAP block was administered under direct laparoscopic guidance at the end of surgery. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2, 4, 8, 12, and 24 hours. Secondary outcomes included time to first analgesic request, total 24-hour tramadol consumption, frequency of rescue analgesia, and patient satisfaction. Results: VAS scores were significantly lower at all intervals in the TAP group (p < 0.001). The mean time to first analgesic request was longer (6.8 ± 2.5 vs 3.2 ± 1.7 hours), and tramadol consumption was lower (84.2 ± 21.4 mg vs 137.5 ± 30.8 mg) in the TAP group (p < 0.001). Patient satisfaction was also significantly higher (p < 0.001). Conclusion: Laparoscopic-guided TAP block provides superior postoperative analgesia, delays the need for rescue analgesics, reduces opioid use, and improves patient satisfaction compared to standard analgesia.

Downloads

Download data is not yet available.

References

Gutt C, Schläfer S, Lammert F. The treatment of gallstone disease. Deutsches Ärzteblatt International. 2020;117(9):148.

Shabanzadeh DM, Christensen DW, Ewertsen C, Friis-Andersen H, Helgstrand F, Nannestad Jørgensen L, et al. National clinical practice guidelines for the treatment of symptomatic gallstone disease: 2021 recommendations from the Danish Surgical Society. Scandinavian Journal of Surgery. 2022;111(3):11-30.

Kehlet H. Postoperative pain, analgesia, and recovery—bedfellows that cannot be ignored. Pain. 2018;159:S11-S6.

Cianci P, Tartaglia N, Fersini A. Pain control after laparoscopic cholecystectomy. A prospective study. Annali Italiani di Chirurgia. 2020;91(6):611-6.

Nachiyunde B, Lam L. The efficacy of different modes of analgesia in postoperative pain management and early mobilization in postoperative cardiac surgical patients: A systematic review. Annals of cardiac anaesthesia. 2018;21(4):363-70.

Zhao-Fleming H, Hand A, Zhang K, Polak R, Northcut A, Jacob D, et al. Effect of non-steroidal anti-inflammatory drugs on post-surgical complications against the backdrop of the opioid crisis. Burns & trauma. 2018;6.

Mitra S, Carlyle D, Kodumudi G, Kodumudi V, Vadivelu N. New advances in acute postoperative pain management. Current pain and headache reports. 2018;22:1-11.

Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA surgery. 2017;152(7):691-7.

Tsai H-C, Yoshida T, Chuang T-Y, Yang S-F, Chang C-C, Yao H-Y, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. BioMed research international. 2017;2017(1):8284363.

Mallan D, Sharan S, Saxena S, Singh TK, Faisal. Anesthetic techniques: focus on transversus abdominis plane (TAP) blocks. Local and regional anesthesia. 2019:81-8.

Iaquinandi F, Mongelli F, Christoforidis D, Cianfarani A, Pini R, Saporito A, et al. Laparoscopic vs. ultrasound-guided transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis of randomized trials. Surgical Endoscopy. 2024;38(3):1119-30.

Mongelli F, Marengo M, Bertoni MV, Volontè F, Ledingham NS, Garofalo F. Laparoscopic-assisted transversus abdominis plane (TAP) block versus port-site infiltration with local anesthetics in bariatric surgery: a double-blind randomized controlled trial. Obesity Surgery. 2023;33(11):3383-90.

Tihan D, Totoz T, Tokocin M, Ercan G, Calikoglu TK, Vartanoglu T, et al. Efficacy of laparoscopic transversus abdominis plane block for elective laparoscopic cholecystectomy in elderly patients. Bosnian journal of basic medical sciences. 2016;16(2):139.

Shabanzadeh DM. The symptomatic outcomes of cholecystectomy for gallstones. Journal of Clinical Medicine. 2023;12(5):1897.

Latenstein CS, Hannink G, van der Bilt JD, Donkervoort SC, Eijsbouts QA, Heisterkamp J, et al. A clinical decision tool for selection of patients with symptomatic cholelithiasis for cholecystectomy based on reduction of pain and a pain-free state following surgery. JAMA surgery. 2021;156(10):e213706-e.

Rajanbabu A, Puthenveettil N, Appukuttan A, Asok A. Efficacy of laparoscopic-guided transversus abdominis plane block for patients undergoing robotic-assisted gynaecologic surgery: A randomised control trial. Indian Journal of Anaesthesia. 2019;63(10):841-6.

Khoja HR, Kunchagi DK, Joshi PK, Om P. Efficacy of laparoscopic guided transversus abdominis plane block in post operative analgesia requirement in elective laparoscopic cholecystectomy. International Surgery Journal. 2021;8(3):925-9.

Hasnain F, Saeed M, Shah SQA, Qureshi S, Riaz MM, Shareef MH. Efficacy of Erector Spinae Block Versus Transversus Abdominis Plane Block in Post Operative Pain Control After Laparoscopic Cholecystectomy. Pakistan Armed Forces Medical Journal. 2025;75(2):277.

Ismail S, Mistry AA, Siddiqui AS, Aziz A, Zuberi NF. The analgesic efficacy of ultrasound-guided transversus abdominis plane block vs. local anesthetic infiltration technique in major gynecologic surgery: A randomized controlled trial. Journal of Anaesthesiology Clinical Pharmacology. 2023.

Chauhdry M, Lateef M, Tariq H, Iftikhar H, Amjad F, Masood K, et al. Efficacy of Transversus Abdominal Plane (TAP) block vs. Diclofenac Suppository for Management of Post-Operative Pain in Patients Undergoing Laparoscopic Cholecystectomy. Indus Journal of Bioscience Research. 2025;3(4):460-4.

Hassan N, Ahmed I, Murtaza H, Malik AA, Shahid S, Mahmood S. Tranversus Abdominis Plane Block in Laparoscopic Surgery: Transversus Abdominis Plane Block in Laparoscopic Surgery. Pakistan Journal of Health Sciences. 2022:193-7.