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Background <p>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.</p> Aim <p>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.</p> Methods <p>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.</p> Results <p>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 (<i>P</i> &gt; 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), <i>P</i> = 0.014) and 24-h (IP: 3.1 (SD: 0.4) vs. L-TAP: 1.6 (SD: 0.4), <i>P</i> = 0.008), with a trend towards significance at 12-h (IP: 3.5 (SD: 0.4) vs. L-TAP: 2.5 (SD: 0.4), <i>P</i> = 0.063). Moreover, regression analysis demonstrated a significant reduction in VAS following TAP (beta-coefficient: -0.681, standard error: 0.281, <i>P</i> = 0.015), however, a non-significant difference in ‘breakthrough’ opioid and morphine equivalent consumption was noted between groups (<i>P</i> &gt; 0.050). There was a non-significant difference in surgical data, postoperative outcomes, and quality of life metrics between groups (<i>P</i> &gt; 0.050).</p> Conclusion <p>This study demonstrates the superiority of L-TAP compared to IP in reducing postoperative pain, as measured VAS scores, in patients undergoing laparoscopic cholecystectomy.</p>

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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

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  • 发表日期：

    2026年3月10日

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  • Matthew G. Davey,
  • David E. Kearney,
  • Sherif El-Masry,
  • Arnold D. K. Hill,
  • Supyae Yadanar,
  • Emma Forde,
  • Claire Keohane,
  • Hussein Suliman,
  • Arvin Perthani,
  • Aisha Osman Alseikh Alzain,
  • Mohammed Elfaki,
  • Maheen Rana,
  • Emilie McCormack,
  • Yasmine Roden,
  • Wael Shabo,
  • Mohammed Amir,
  • Ammar Ahmed,
  • Mohammed Salama,
  • Babur Sami,
  • Aine O’Neill,
  • Waqar,
  • Aziz Hamad,
  • Ayah Musa,
  • Brendan Moran,
  • Oliver Barrett,
  • Abdel Nasr,
  • Chaudhri Shahbaz,
  • Eleanor Faul,
  • Masaoud Bashir,
  • Obai Elzamzami,
  • Haresh Kumar,
  • Ibrahim Ahmed,
  • Lucy Burns,
  • Muhammad Zeshan,
  • Caroline Drumm,
  • Niamh Smyth,
  • Ciara Hunt,
  • Kaotharat Balogun,
  • Eoghan Kennedy,
  • Mohammed Alazzawi,
  • Sumaira Zulfiqar,
  • Naveed Abbas,
  • Vikram Tewaitia,
  • Himanshu Yadav,
  • James Byrne,
  • Paula Loughlin,
  • J. Michael,
  • Allen,
  • Mayilone Arumugasamy,
  • Achille Mastrosimone,
  • David Beddy,
  • Amira Amir,
  • Yumna Asif,
  • Nicola McShane,
  • Domhnall O’Connor,
  • Fiachra McHugh,
  • Muhammad Assam Sarwar,
  • Gordan Daly,
  • Jake McDonnell,
  • Noel E. Donlon,
  • Eanna J. Ryan,
  • Colm Neary,
  • Angus Lloyd,
  • Jennifer McGarry,
  • William Duggan,
  • John P. Burke,
  • Niamh McCawley,
  • Mohammed Aafik,
  • Brenda Murphy,
  • Colm Power,
  • Jarlath C. Bolger,
  • William B. Robb,
  • Ian S. Reynolds,
  • Abeeda Butt,
  • Darren Porter,
  • Trudi Roche,
  • Sorcha O’Grady,
  • Jan Sorensen

摘要

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.