Efficacy and safety of laparoscopic-guided transversus abdominis plane block versus port-site local anesthetic infiltration in laparoscopic cholecystectomy

Background: Postoperative pain following laparoscopic cholecystectomy remains a major clinical concern, and the optimal method of local anesthetic delivery is unresolved. This systematic review and meta-analysis evaluated the efficacy and safety of laparoscopic-guided transversus abdominis plane (LTAP) block versus port-site local anesthetic infiltration for reducing pain, opioid use, and improving recovery in patients undergoing LC. Methods: This review was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and was prospectively registered on the International Prospective Register of Systematic Reviews (CRD420261344930). PubMed, Embase, and the Cochrane Library were searched from inception to March 2026, without language restriction, for randomized controlled trials (RCTs) comparing LTAP block with standard port-site local anesthetic infiltration in adults undergoing LC. Eligible studies were RCTs reporting at least 1 clinically relevant outcome (postoperative pain, operative time, shoulder pain, rescue analgesia, hospital stay, or discharge within 24 hours); observational studies, non-randomized designs, and reviews were excluded. Risk of bias was assessed independently by 2 reviewers using the Cochrane Risk of Bias 2.0 tool. Data were pooled using a random-effects model (Mantel-Haenszel method with DerSimonian-Laird estimation) in Review Manager version 5.4.1, with heterogeneity quantified using the I-squared statistic (heterogeneity measure). Results: Eight RCTs comprising 711 patients were included (LTAP unilateral in 2 studies, bilateral in 6). LTAP significantly reduced visual analogue scale pain scores at 1, 3, 6, and 24 hours compared with port-site infiltration, although heterogeneity was substantial for some outcomes and was reduced following sensitivity analyses. No significant differences were found between groups in operative time, shoulder pain, rescue analgesia, postoperative nausea and vomiting, or discharge within 24 hours, with a modest reduction in hospital stay favoring LTAP. Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was high for pain at 1 and 3 hours, moderate for most secondary outcomes, and low for pain at 6 and 12 hours. Trial sequential analysis confirmed the reliability of the benefit for early pain relief and hospital stay, while several outcomes remained inconclusive. Conclusion: LTAP block provides superior early postoperative analgesia compared with port-site local anesthetic infiltration after laparoscopic cholecystectomy, with a modest reduction in hospital stay, although evidence for several secondary outcomes remains limited by heterogeneity and inconclusive trial sequential analysis.