Document resource
Background and Aims Laparoscopic cholecystectomy often results in moderate to severe postoperative pain. While systemic opioids remain a mainstay for pain management, their association with multiple side effects underscores the need for effective regional anesthesia alternatives. This study aimed to compare the effectiveness of the Transversus Abdominis Plane (TAP) block and the Erector Spinae Plane (ESP) block in relieving postoperative pain in patients undergoing laparoscopic cholecystectomy.Methods In this single-blind, parallel-group trial, 60 ASA I-II patients undergoing elective laparoscopic cholecystectomy were randomized to receive either bilateral ESP blocks (T12-L1 level, n=30) or subcostal TAP blocks (n=30), both administered pre-incision with 20 mL 0.375% ropivacaine per side under ultrasound guidance (Esaote L4–15 probe). The primary outcome was dynamic Visual Analog Scale (VAS) pain score at 12 hours postoperatively. Secondary outcomes included: 24-hour opioid consumption, time to first rescue analgesia, ambulation, bowel function recovery, length of hospital stay, adverse effects.Results The study showed that the ESP block provided lower dynamic VAS scores at H2, H4, H8 and H24 with significant differences compared to the TAP block. More patients achieved adequate analgesia (VAS <4) at H12 with the ESP block (66.7% vs. 36.7%; p = 0.022). Regarding analgesic consumption, patients in the ESP group required a significantly lower cumulative dose of tramadol (median 100 [IQR 100–150]mg vs 200 [IQR 150–200]mg, p<0.001), with a longer delay before the first opioid use (p=0.033). The ESP block allowed earlier ambulation (p=0.018) and quicker return of bowel function (p<0.001). Both techniques showed similar incidences of postoperative nausea and vomiting with comparable tolerability.Conclusions The ESP block appears to provide better pain control and improved postoperative recovery compared to the TAP block. However, additional studies are required to validate these findings and support its clinical implementation.