JMIR Publications

ABSTRACT

Background:

The laparoscopic-guided subcostal transversus abdominis plane (TAP) block has been introduced as a surgeon-performed alternative for postoperative analgesia following laparoscopic cholecystectomy (LC). This approach allows direct visual confirmation of local anesthetic distribution without reliance on ultrasound guidance. However, evidence regarding its efficacy in patients with complicated gallstone disease remains limited.

Objective:

To evaluate the clinical outcomes and perioperative factors associated with postoperative opioid requirement following laparoscopic-guided subcostal TAP block.

Methods:

A prospective observational study was conducted between November 2023 and October 2024 at Srinakharinwirot University Hospital, Thailand. Adult patients (18–80 years) undergoing LC for uncomplicated or complicated gallstone disease received a laparoscopic-guided subcostal TAP block with 0.25% bupivacaine. Postoperative pain intensity was assessed using the Visual Analogue Scale (VAS) at 2, 4, 6, 8, 12, and 24 hours. Morphine administration within 24 hours was recorded. Perioperative variables were analyzed using univariate and exploratory multivariable logistic regression. The study was approved by the Institutional Ethics Committee (SWUEC-004/2566F), and the trial was registered with the Thai Clinical Trials Registry (TCTR20250314002).

Results:

Forty-two patients were included in the analysis. Half of the patients did not require postoperative opioids, whereas the remaining patients received a mean cumulative morphine dose of 3.86 ± 1.39 mg. Pain scores were significantly lower at 2, 4, and 12 hours postoperatively in the morphine-free group (p < 0.05). Higher ASA classification independently predicted postoperative morphine requirement (OR = 6.51; 95% CI, 1.37–30.96; p = 0.018). No major complications or local anesthetic toxicity were observed.

Conclusions:

The laparoscopic-guided subcostal TAP block provides effective early postoperative analgesia and a clinically meaningful opioid-sparing effect after LC, including in patients with gallstone-related complications. A higher ASA class was associated with increased opioid requirement, emphasizing the need for individualized, risk-adapted analgesic strategies within comprehensive perioperative care. These findings support the feasibility and potential integration of surgeon-performed TAP block into Enhanced Recovery After Surgery (ERAS) protocols to optimize multimodal analgesia and enhance postoperative recovery. Clinical Trial: Trial registration: Thai Clinical Trials Registry (TCTR20250314002).