Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block versus Intravenous Analgesia for Postoperative Pain Control Following Laparoscopic Abdominal Surgery: A Randomized Controlled Trial

Abstract

Background: Adequate postoperative pain management following laparoscopic abdominal surgery remains a significant clinical challenge. Ultrasound-guided transversus abdominis plane (TAP) block has emerged as a promising regional anesthetic technique; however, robust comparative evidence against conventional intravenous (IV) analgesia in a homogeneous surgical cohort is lacking. The objective was to compare the analgesic efficacy, opioid consumption, and recovery outcomes of bilateral ultrasound-guided TAP block versus standard IV analgesia in patients undergoing elective laparoscopic cholecystectomy.

Methods: In this prospective, randomized, double-blind, parallel-group controlled trial, 120 ASA I-II patients were randomized equally to receive either bilateral TAP block with 20 mL of 0.25% bupivacaine per side (TAP group, n = 60) or IV morphine-based patient-controlled analgesia (IV group, n = 60) after laparoscopic cholecystectomy. The primary outcome was visual analogue scale (VAS) pain score at rest and on movement at 2, 6, 12, and 24 hours postoperatively. Secondary outcomes included total morphine consumption at 24 hours, time to first analgesic request, incidence of postoperative nausea and vomiting (PONV), sedation scores, and time to hospital discharge.

Results: The TAP group demonstrated significantly lower VAS scores at all assessed time points compared to the IV group (p < 0.001 at 2, 6, and 12 hours; p = 0.003 at 24 hours). Mean 24-hour morphine consumption was markedly reduced in the TAP group (4.2 ± 1.8 mg vs. 12.7 ± 3.4 mg; p <0.001). Time to first analgesic request was significantly prolonged in the TAP group (342 ± 67 min vs. 48 ± 22 min; p < 0.001). PONV incidence was lower in the TAP group (15.0% vs. 38.3%; p = 0.005). No significant differences in sedation scores were observed. Time to discharge was shorter in the TAP group (22.4 ± 4.1 h vs. 27.8 ± 5.3 h; p <0.001).

Conclusions: Ultrasound-guided bilateral TAP block provides superior postoperative analgesia, significantly reduces opioid consumption, lowers PONV incidence, and facilitates earlier hospital discharge compared to IV morphine-based analgesia in patients undergoing laparoscopic cholecystectomy. TAP block should be considered a routine component of multimodal analgesia in this patient population.