Abstract

Context: Pain following laparoscopic cholecystectomy can adversely affect postoperative recovery and increase the need for analgesic medication. The transversus abdominis plane (TAP) block is a well-established regional anaesthetic technique for postoperative pain control. Performing the block under laparoscopic guidance offers a practical alternative to the conventional ultrasound-guided approach. Aim: To assess the effectiveness of a laparoscopically guided bilateral oblique subcostal TAP block using 0.2% Ropivacaine in reducing postoperative pain in patients undergoing elective laparoscopic cholecystectomy. Settings and Design: A prospective, double-blind, randomized controlled trial conducted at a tertiary care teaching hospital between July 2023 and March 2024. Methods and Materials: Fifty patients aged 20–60 years who underwent elective laparoscopic cholecystectomy were randomly allocated into two equal groups (25 participants in each group). Patients in the intervention group received a laparoscopy guided bilateral oblique subcostal TAP block with 20 mL of 0.2% ropivacaine on each side, whereas those in the control group were managed with standard intravenous analgesia. Postoperative pain intensity was evaluated using the Visual Analogue Scale (VAS) at 6 hours, 12 hours, and at the time of discharge. The requirement for rescue analgesia was also documented. Statistical Analysis: Data analysis was performed using IBM SPSS version 26.0. Continuous variables were analysed using the independent t-test or the Mann–Whitney U test, while categorical variables were compared using the Chi- square test or Fisher’s exact test, as appropriate. A p-value <0.05 was considered statistically significant. Results: Patients who received the TAP block had significantly lower postoperative VAS scores at 6 hours (4.6 vs. 5.8; p=0.007), 12 hours (2.9 vs. 4.0; p=0.001), and at discharge (1.6 vs. 2.6; p=0.001) compared with the control group. Additionally, 72% of patients in the TAP block group did not require any rescue analgesia. Conclusion: Laparoscopy-guided bilateral oblique subcostal TAP block using ropivacaine is a safe, feasible, and effective adjunct for postoperative pain management following elective laparoscopic cholecystectomy.

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