Efficacy and safety of laparoscopic-guided transversus abdominis plane block versus port-site local anesthetic infiltration in laparoscopic cholecystectomy: A systematic review, meta-analysis, and trial sequential analysis.

TL;DR

This meta-analysis of 8 RCTs (711 patients) found that laparoscopic-guided transversus abdominis plane (LTAP) block provides superior pain control at 1, 3, 6, and 24 hours post-cholecystectomy compared to port-site local anesthetic infiltration, with modest reductions in hospital stay but no differences in operative time, shoulder pain, or discharge within 24 hours.

Key findings

• LTAP block significantly reduced postoperative pain scores at 1, 3, 6, and 24 hours compared to port-site infiltration across 8 RCTs (711 patients)
• High certainty evidence for pain reduction at 1 and 3 hours; moderate certainty for secondary outcomes; trial sequential analysis supported early pain relief benefits
• No significant differences found between LTAP and port-site infiltration for operative time, shoulder pain, rescue analgesia, postoperative nausea/vomiting, or same-day discharge
• LTAP block offered modest reduction in hospital stay duration compared to port-site infiltration

Why this matters at the bedside

For patients undergoing laparoscopic cholecystectomy, LTAP block appears more effective than port-site infiltration for early postoperative pain management, though secondary outcome benefits remain limited. Choice between techniques should consider technical feasibility, patient factors, and that both approaches support reasonable recovery profiles.