Right Unilateral versus Bilateral Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy under General Anesthesia: A Randomized Controlled Trial.

BACKGROUND AND AIM: Laparoscopic cholecystectomy necessitates focused analgesia on the right abdominal wall region to address the somatic component of postoperative pain. Ultrasound-guided preemptive subcostal transversus abdominis plane (TAP) block blocks the anterior branches of thoracic spinal nerves (T6-T9). This study aimed to assess whether a right unilateral subcostal TAP block provides a similar duration of operative site analgesia compared to a bilateral subcostal TAP block during laparoscopic cholecystectomy.

METHODOLOGY: A prospective randomized controlled trial was conducted on 50 patients (25 in each group) aged 18-60 years undergoing elective laparoscopic cholecystectomy under general anesthesia. Group A received an ultrasound-guided right unilateral subcostal TAP block with 20 mL of 0.25% bupivacaine, whereas Group B received bilateral subcostal TAP blocks using the same local anesthetic dose on each side. Duration of analgesia, analgesic consumption, and block administration time were assessed over 24 h postoperatively using the Visual Analog Scale.

RESULTS

No significant difference was observed in the duration of analgesia between Group A (411.4 ± 24.0 min) and Group B (410.8 ± 24.3 min), with P = 0.93. The time required to administer the block was significantly shorter in the unilateral group (5.68 ± 0.57 min) compared to the bilateral group (11.70 ± 1.24 min), P < 0.001. Total 24-h analgesic consumption was comparable between the groups (Group A: 1.42 ± 0.48 doses vs. Group B: 1.64 ± 0.49 doses, P = 0.063).

CONCLUSION

Right unilateral subcostal TAP block provides similar duration of postoperative analgesia when compared with bilateral subcostal TAP block, with the additional benefits of lower local anesthetic dosage and shorter block procedure time.