AB096. SOH26AB_0167. Laparoscopic-assisted transversus abdominus plane block versus intraperitoneal irrigation of local anaesthetic 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. We aimed to perform a randomised controlled trial (RCT) evaluating the value of laparoscopic-delivered transversus abdominus 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 six hospitals. Patients were randomised on a 1:1 basis to L-TAP or IP. The primary outcome was postoperative Visual Analogue Scale (VAS) scores. Descriptive statistics and regression analyses were performed. Results: A total of 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>0.05). A significant reduction in VAS was observed in favour of L-TAP at 6 hours (P=0.01) and 24 hours (P=0.008), with a trend towards significance at 12 hours (P=0.06). 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>0.05). There was a non-significant difference in surgical data, postoperative outcomes, and quality of life metrics between groups (P>0.05). Conclusions: This study demonstrates the superiority of L-TAP compared to IP in reducing postoperative pain, as measured by VAS scores, in patients undergoing laparoscopic cholecystectomy.