This prospective randomized controlled trial aims to evaluate whether the timing of ultrasound-guided subcostal transversus abdominis plane (TAP) block combined with rectus sheath block (RSB) affects postoperative pain in patients undergoing laparoscopic cholecystectomy.
Participants will be randomly assigned to receive the combined regional blocks either before surgical incision or after completion of surgery. The primary outcome is postoperative pain intensity measured using a numerical rating scale. Secondary outcomes include opioid consumption, incidence of postoperative nausea and vomiting, and other recovery parameters.
The results of this study may help optimize the timing of abdominal wall blocks to improve postoperative analgesia and recovery following laparoscopic cholecystectomy.
Elective laparoscopic cholecystectomy
Adults aged 18 to 80 years
Ability to understand the study procedures and provide informed consent
American Society of Anesthesiologists (ASA) physical status I-III
Presence of significant pain unrelated to the target disease that may interfere with pain assessment
Known allergy or contraindication to study medications (ropivacaine, acetaminophen, nefopam, or pethidine)
Planned single-port laparoscopic cholecystectomy
American Society of Anesthesiologists (ASA) physical status IV or higher
Parallel
Ultrasound-guided subcostal TAP block combined with rectus sheath block
Procedure/SurgeryUltrasound-guided right subcostal transversus abdominis plane (TAP) block combined with bilateral rectus sheath block (RSB) is performed under sterile conditions using local anesthetic for postoperative analgesia.
Maximum postoperative pain intensity within 24 hours
The highest postoperative pain intensity measured using an 11-point numeric rating scale (NRS; 0 = no pain, 10 = worst pain imaginable) during the first 24 hours after surgery, assessed at 1, 6, 12, and 24 hours postoperatively.
Maximum postoperative pain intensity during post-anesthesia care unit stay
The highest postoperative pain intensity measured using an 11-point numeric rating scale (NRS; 0 = no pain, 10 = worst pain imaginable) during the recovery period.
Cumulative rescue opioid consumption within 24 hours
Total amount of rescue opioid administered between 1 and 24 hours after surgery.
Incidence of postoperative nausea and vomiting
Occurrence of nausea or vomiting during the postoperative period.
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