Laparoscopic-assisted Transversus Abdominis Plane Block versus Conventional Periportal Infiltration for Postoperative Pain Management after Elective Laparoscopic Cholecystectomy: A Prospective Interventional Study

Introduction: Managing postoperative pain is critically important for recovery following Laparoscopic Cholecystectomy (LC). While conventional periportal infiltration with local anaesthetics is commonly used, the laparoscopic-assisted Transversus Abdominis Plane (TAP) block is gaining attention for its potential to provide superior analgesia and reduce opioid requirements. Aim: To compare the efficacy of laparoscopic-assisted TAP block versus conventional periportal infiltration in reducing postoperative pain, opioid requirement, and hospital stay in patients undergoing elective LC. Materials and Methods: The present prospective interventional study was conducted on patients scheduled for elective LC in the Department of General Surgery at SRM Medical College Hospital and Research Centre (SRM MCHRC), Tamil Nadu, India, from September 2024 to February 2025. The subjects were randomly divided into two groups: Group A (n=40) underwent laparoscopic-assisted TAP block, while Group B (n=40) underwent conventional periportal infiltration (control group). Postoperative pain was assessed using the Wong Baker FACES Pain Rating Scale (WBFPS) at 3, 6, and 12 hours after surgery. Rescue analgesia requirement, total opioid consumption within the first 24 hours after surgery, and Length of Hospital Stay (LHS) were recorded. Independent t-tests were used to compare continuous variables between the two groups, with p<0.05 considered statistically significant. Results: The mean age of participants in Groups A and B was 43.5±14.5 years and 41.3±13.0 years, respectively. Group A comprised 22 females (55%) and 18 males (45%), while Group B included 20 females (50%) and 20 males (50%). Patients in the TAP block group demonstrated significantly lower pain scores at 3, 6, and 12 hours postoperatively compared to the control group (p<0.05). The time to first rescue analgesia was significantly prolonged in Group A (7.7±1.7 hours) compared to Group B (2±0.8 hours, p<0.001). Consequently, patients in the TAP block group required lower doses of opioid analgesics within the first 24 hours. The mean LHS was significantly shorter in Group A (2.0±0.7 days) compared to Group B (3.7±1.2 days, p=<0.001). Conclusion: The laparoscopic-assisted TAP block is markedly superior to periportal infiltration in managing postoperative pain following LC. It provides more effective pain control, reduces opioid consumption, and shortens hospital stay, making it an important component of multimodal analgesia.