Laparoscopic-assisted transversus abdominus plane block versus intraperitoneal irrigation of local anesthetic for patients undergoing laparoscopic cholecystectomy: a prospective, multicentre, single-blinded, randomised controlled trial

BACKGROUND: The PROSPECT guidelines provide GRADE A recommendations for paracetamol, non-steroidal anti-inflammatories, and port site infiltration (PSI) with local anaesthetic following laparoscopic cholecystectomy. Despite varying practice, the optimal method of delivering additional local anesthetic is unclear. AIM: To perform a randomised clinical trial (RCT) evaluating the value of laparoscopic-delivered transversus abdominal plane block (L-TAP) compared to intraperitoneal infiltration (IP) in addition to PSI in patients undergoing laparoscopic cholecystectomy. METHODS: A multicentre RCT was performed during a 7-month recruitment period (March-October 2025) across 6 hospitals. Patients were randomised on a 1:1 basis to L-TAP or IP. The primary outcome was postoperative visual analogue scores (VAS). Descriptive statistics and regression analyses were performed. RESULTS: 147 patients were recruited, of whom, 135 underwent final analysis. Of these, 49.6% were allocated to IP (67/135) and 50.1% to L-TAP (68/135). A non-significant difference was observed in baseline clinical information between groups (P > 0.050). A significant reduction in mean VAS was observed in favour of L-TAP at 6-h (IP: 3.3 (standard deviation (SD): 0.3) vs. L-TAP: 2.3 (SD: 0.3), P = 0.014) and 24-h (IP: 3.1 (SD: 0.4) vs. L-TAP: 1.6 (SD: 0.4), P = 0.008), with a trend towards significance at 12-h (IP: 3.5 (SD: 0.4) vs. L-TAP: 2.5 (SD: 0.4), P = 0.063). Moreover, regression analysis demonstrated a significant reduction in VAS following TAP (beta-coefficient: -0.681, standard error: 0.281, P = 0.015), however, a non-significant difference in 'breakthrough' opioid and morphine equivalent consumption was noted between groups (P > 0.050). There was a non-significant difference in surgical data, postoperative outcomes, and quality of life metrics between groups (P > 0.050). CONCLUSION: This study demonstrates the superiority of L-TAP compared to IP in reducing postoperative pain, as measured VAS scores, in patients undergoing laparoscopic cholecystectomy.