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
In brief
TAP blocks cut rescue tramadol use from 42% to 8% after gallbladder surgery
In 180 patients having laparoscopic gallbladder removal, both TAP block groups needed less rescue tramadol than patients given painkiller injections at the incision sites: 8% to 13% versus 42%. The low-pressure TAP group also had less shoulder pain than the incision-injection group, but multiple pain comparisons and differences in block technique limit conclusions about which component drove benefit.
- Journal
- Surgical endoscopy (Q1)
- Published
- 16 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Puneeth Thalasta, Anita Dhar, Sunil Chumber, Rajinder Parshad, Jyotsna Punj, Kamal Kataria, et al.
- PMID
- 42886247
- DOI
- 10.1007/s00464-026-13510-0
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 18 October 2026): Laparoscopic‑guided TAP block vs pressure strategies for pain
Abstract
BACKGROUND: Postoperative pain remains a significant challenge following laparoscopic cholecystectomy, influencing recovery, opioid consumption, and hospital stay. Laparoscopic-guided transversus abdominis plane (TAP) block and low-pressure pneumoperitoneum have independently demonstrated analgesic benefits. This study compared three predefined perioperative analgesic strategies: low-pressure pneumoperitoneum with laparoscopic-guided TAP block (L-TAP), standard-pressure pneumoperitoneum with TAP block (S-TAP), and standard-pressure pneumoperitoneum with port-site infiltration (S-PS). METHODS: A prospective, open-label, three-arm randomized controlled trial was conducted at a tertiary care center (October 2022-June 2024). One hundred and eighty patients undergoing elective laparoscopic cholecystectomy for cholelithiasis were randomized equally (n = 60 each). The principal outcome was postoperative pain assessed using the Visual Analogue Scale (VAS) at 1 h, 6 h, 24 h, 7 days, and 30 days in four positions: lying, turning, coughing, and standing; standing was not assessed at 1 h. No single timepoint-position combination was designated as a standalone primary endpoint, and comparisons were interpreted as multiple outcomes. Standard analgesia comprised intravenous paracetamol 1 g QID. Rescue analgesia with intravenous tramadol 50 mg was administered when VAS ≥ 4. Secondary outcomes included shoulder-tip pain, PONV, early mobility, morphine consumption, surgical difficulty, conversion rate, and hospital stay. RESULTS: Both TAP groups demonstrated lower VAS pain scores than S-PS at several early time points. L-TAP showed significantly lower pain scores than S-TAP during coughing and lying at 6 h (p = 0.009 for both). Shoulder-tip pain was lower in L-TAP than S-PS (3.3% vs 20.0%; p = 0.008). Rescue tramadol requirement was lower in L-TAP and S-TAP than S-PS (8.3% and 13.3% vs 41.7%; p < 0.001). Day-1 discharge rates were 96.7%, 95.0%, and 86.7%, respectively. CONCLUSION: TAP-based strategies were associated with lower early postoperative pain and reduced rescue analgesic requirements than S-PS. L-TAP suggested additional analgesic benefit over S-TAP, although differences in local anesthetic dose, volume, and timing limit attribution to individual components.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.