Right unilateral versus bilateral ultrasound-guided subcostal transversus abdominis plane block for post-operative analgesia after laparoscopic cholecystectomy: A prospective observational cohort study
Abstract
Background: Ultrasound-guided subcostal transversus abdominis plane (TAP) block is an established component of multimodal analgesia after laparoscopic cholecystectomy (LC). Given that principal trocar sites and dissection are predominantly right sided, a unilateral (UT) right subcostal TAP block may provide adequate analgesia with reduced local anesthetic use, though comparative evidence remains limited. Aims and Objectives: This study compared post-operative analgesic outcomes between right UT and bilateral (BT) subcostal TAP blocks in adults undergoing elective LC. Primary outcomes were post- operative Numerical Rating Scale (NRS) pain scores at rest and during coughing, and time to first rescue analgesia. Secondary outcomes included 24-h tramadol consumption, second rescue analgesia, post-operative nausea and vomiting, shoulder pain, patient satisfaction, and block-related complications. Materials and Methods: In this prospective, non-randomized observational cohort, 100 adults (American Society of Anesthesiologists I–II) undergoing elective LC under general anesthesia received either right (UT group, n=50) or (BT group, n=50) subcostal TAP blocks with ropivacaine 0.2% (20 mL per side in BT, 20 mL right sided in UT). Results: Baseline characteristics were comparable. NRS pain scores decreased over 24 h without significant between-group differences. Time to first rescue analgesia was longer in BT (585±104 vs. 520±96 min; P=0.002), and 24-h tramadol consumption was lower (114±38 vs. 132±42 mg; P=0.026). Patient satisfaction was higher in BT (4.5±0.6 vs. 4.2±0.7; P=0.031). Other secondary outcomes were similar. No block-related complications occurred. Conclusion: Both UT and BT subcostal TAP blocks provided comparable pain scores. BT blockade prolonged analgesia, reduced tramadol use, and improved patient satisfaction.