Surgeon-Delivered Bupivacaine Achieves Analgesic Efficacy Comparable to ESP and TAP Blocks in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Background and Objectives: Effective pain management is essential for optimizing recovery after laparoscopic cholecystectomy (LC). Ultrasound-guided erector spinae plane (ESP) and transversus abdominis plane (TAP) blocks are validated techniques, but may be limited by equipment requirements and technical complexity. This study aimed to evaluate whether surgeon-delivered local anesthetic infiltration provides comparable analgesic efficacy. Materials and Methods: This prospective, randomized, controlled, single-center trial enrolled 172 patients undergoing elective LC between November 2020 and June 2022. Patients were randomized into four groups: Group A—surgeon-delivered port-site and intraperitoneal bupivacaine infiltration; Group B—ESP block; Group C—TAP block; and Group D—control. Primary outcomes were postoperative pain assessed by Visual Analog Scale (VAS) scores at 1, 3, 6, 12, and 24 h, and Behavioral Pain Scale (BPS) scores at 1 and 3 h. Secondary outcomes included 24 h tramadol consumption, patient satisfaction, additional rescue analgesia requirement, and procedure duration. Results: All intervention groups (A–C) demonstrated significantly lower VAS and BPS scores compared to controls (VAS at 24 h: 1.8 ± 0.9 vs. 2.8 ± 1.3, p < 0.001). Tramadol use was also reduced (≈82 mg vs. 97 mg, p < 0.001), with fewer opioid-related adverse effects. No significant differences were observed among Groups A–C. Patient satisfaction was higher in the intervention groups, and no major complications were reported. Conclusions: Surgeon-delivered local infiltration achieved analgesic efficacy equivalent to ESP and TAP blocks. Considering its simplicity, safety, and minimal resource demands, this method may represent a practical alternative for enhanced recovery pathways following LC.