The Effect of Unilateral Subcostal Transversus Abdominis Plane Block Applied as Single or Multiple Injections on Pain in Laparoscopic Cholecystectomy

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• Picked for Anesthesiology and Pain Medicine (top studies of the week, 4 October 2026): RCT TAP block single vs multiple injections

Abstract

BACKGROUND: Effective postoperative pain management in cases of laparoscopic cholecystectomy is essential for recovery and patient satisfaction. The subcostal transversus abdominis plane (TAP) block is a regional analgesic technique used for upper-abdominal pain. While the single-injection TAP has shown benefits in reducing perioperative opioid consumption, the comparative efficacy of the multi-injection version of this block remains insufficiently studied. OBJECTIVES: This study aimed to compare the analgesic efficacy of unilateral single-injection versus multi-injection subcostal TAP blocks in patients undergoing laparoscopic cholecystectomy. STUDY DESIGN: A prospective, randomized, single-center, parallel-group clinical trial. SETTING: A tertiary referral center where patients underwent elective laparoscopic cholecystectomy. METHODS: Ninety adult patients (ASA I-III) scheduled for laparoscopic cholecystectomy were randomized into 3 groups: Group S received a single-injection unilateral subcostal TAP block, Group T received a multi-injection unilateral subcostal TAP block, and Group C received no block. Blocks were performed under ultrasound guidance with standardized anesthetic management. The primary endpoint was 24-hour tramadol consumption. Secondary endpoints included postoperative pain scores on the Visual Analog Scale (VAS), intraoperative remifentanil use, postoperative nausea and vomiting (PONV), rescue analgesic requirement, and patient satisfaction. Pain and adverse effects were assessed at 30 minutes and at one, 3, 6, and 24 hours after the procedure. Statistical comparisons were made using analysis of variance (ANOVA), Bonferroni correction, and logistic regression. RESULTS: Eighty-nine patients completed the trial. Both TAP groups demonstrated significantly reduced intraoperative remifentanil consumption compared with controls. At 24 hours, tramadol use was lowest in the multi-injection group, which also showed significantly lower VAS scores at one, 6, and 24 hours than did the single-injection and control groups (P < 0.05). Rescue analgesic requirements were markedly reduced in the multi-injection group, in which PONV incidence was also lowest (92% without PONV vs. 64% in the single-injection group and 52% in the control group; P = 0.007). Patient satisfaction was significantly higher in the multi-injection group, with a greater proportion reporting "very satisfied" (P < 0.001). No major complications were reported. LIMITATIONS: The study's single-center design limited external generalizability. Dermatomal mapping of block spread was not performed, and long-term outcomes beyond 24 hours were not evaluated. CONCLUSIONS: Both single- and multi-injection subcostal TAP blocks provided effective perioperative analgesia in laparoscopic cholecystectomy. The multi-injection technique demonstrated superior efficacy in pain control, opioid consumption reduction, and patient satisfaction. This type of TAP block may therefore be considered a valuable component of multimodal analgesia protocols for upper-abdominal surgery.

Abstract as published, via PubMed.