Comparison Between the Analgesic Effect of Ultrasound-Guided Thoracoabdominal Nerves Block and Erector Spinae Plane Block for Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Background: Laparoscopic cholecystectomy (LC), though minimally invasive, is often associated with notable postoperative pain. Truncal blocks such as the Erector Spinae Plane Block (ESPB) and the Thoracoabdominal Nerves Block through the Perichondrial Approach (TAPA) have been introduced as effective components of multimodal analgesia. This study compared the analgesic efficacy of ESPB and TAPA in patients undergoing LC. Methods: A randomized, controlled, double-blinded trial was conducted at the AFCM, Cairo, Egypt, in 2023. Ninety-three patients scheduled for elective LC were assigned to three groups: ESPB (n=31), TAPA (n=31), and a control group receiving general anesthesia with opioids only (n=31). The primary outcome was 24-hour postoperative morphine consumption. Secondary outcomes included time to first analgesic request, intraoperative fentanyl use, postoperative Numerical Rating Scale (NRS) pain scores, and side effects. Results: The time to first analgesic request was significantly longer in the ESPB (7.61 ± 1.26 h) and TAPA (6.39 ± 1.76 h) groups than in the control group (4.97 ± 0.84 h, p<0.001). Both blocks significantly reduced 24-hour morphine use (ESPB: 6.19 ± 1.94 mg; TAPA: 7.32 ± 1.8 mg) and intraoperative fentanyl (ESPB: 9.55 ± 4.49 µg; TAPA: 11.84 ± 5.18 µg) compared with control (9.87 ± 2.28 mg; 25.94 ± 9.2 µg; p<0.001). ESPB showed lower NRS scores than TAPA and control at most time points. Conclusion: Both ESPB and TAPA blocks effectively reduce pain and opioid use after LC, with ESPB providing superior, longer-lasting analgesia. Keywords: Laparoscopic cholecystectomy, Erector Spinae Plane Block, TAPA, postoperative pain, regional anesthesia.