Surgery · 3 h ago
TAP Block Strategies Reduce Early Pain After Laparoscopic Cholecystectomy
A single-center, open-label randomized trial compared three pain-management strategies in 180 patients undergoing elective laparoscopic cholecystectomy. TAP-block strategies were associated with less early pain and lower rescue tramadol use than standard-pressure pneumoperitoneum with port-site infiltration; low-pressure pneumoperitoneum plus TAP block showed some additional benefits.
- Randomized trial enrolled 180 elective cholecystectomy patients.
- TAP groups required less rescue tramadol than port-site infiltration.
- L-TAP showed lower pain than S-TAP at selected 6-hour assessments.
- Multiple comparisons and differing block protocols limit interpretation.
This prospective, open-label, three-arm randomized trial enrolled 180 patients undergoing elective laparoscopic cholecystectomy for gallstones at a tertiary center between October 2022 and June 2024. Sixty patients per group received low-pressure pneumoperitoneum with laparoscopic-guided transversus abdominis plane (TAP) block (L-TAP), standard-pressure pneumoperitoneum with TAP block (S-TAP), or standard-pressure pneumoperitoneum with port-site infiltration (S-PS). Pain was assessed at multiple timepoints and in several positions; no single timepoint-position comparison was designated as the standalone primary endpoint.
Both TAP groups had lower pain scores than S-PS at several early assessments. At 6 hours, L-TAP had lower pain scores than S-TAP while coughing and lying (p=0.009 for each). Shoulder-tip pain occurred in 3.3% of L-TAP patients versus 20.0% with S-PS (p=0.008). Rescue tramadol was required by 8.3% with L-TAP, 13.3% with S-TAP, and 41.7% with S-PS (p<0.001). Day-1 discharge rates were 96.7%, 95.0%, and 86.7%, respectively.
The findings suggest potential benefits of TAP-based strategies for early postoperative pain and rescue analgesic use. Interpretation is limited by the open-label, single-center design and multiple outcome comparisons. Differences in local anesthetic dose, volume, and timing also prevent attributing L-TAP’s apparent additional benefit to low pressure or the block alone.
In practice
For patients undergoing elective laparoscopic cholecystectomy, this single-center randomized trial suggests that TAP-block strategies may reduce early postoperative pain and rescue tramadol use compared with standard-pressure pneumoperitoneum plus port-site infiltration. L-TAP showed additional benefit over S-TAP on selected pain assessments, but the trial did not designate a single timepoint-position endpoint, and multiple comparisons warrant caution. Differences in anesthetic dose, volume, and timing also make it difficult to identify which components account for the observed effects; the findings alone do not establish a preferred standard approach.
AI-generated clinical interpretation · Not editor-reviewed
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Surgical Endoscopy: Laparoscopic-guided transversus abdominis plane block with low-pressure versus standard-pressure pneumoperitoneum versus port site infiltration with standard-pressure pneumoperitoneum for postoperative pain management in laparoscopic cholecystectomy: randomized controlled trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.