Clinical Feasibility and Outcomes of Surgeon-Performed Laparoscopic-Guided Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy: Prospective Observational Study.

Background: Laparoscopic-guided subcostal transversus abdominis plane (TAP) block has been introduced as a surgeon-performed approach to postoperative analgesia in laparoscopic cholecystectomy (LC), allowing direct visual confirmation of local anesthetic delivery without ultrasound guidance. However, evidence regarding its clinical outcomes, particularly in patients with complicated gallstone disease, remains limited. Objective: This study aimed to evaluate postoperative analgesic outcomes and identify factors associated with opioid requirement following laparoscopic-guided subcostal TAP block. Methods: A prospective observational study was conducted between November 2023 and October 2024 at Srinakharinwirot University Hospital, Thailand. Patients (aged 18-80 years) undergoing LC for uncomplicated or complicated gallstone disease received a laparoscopic-guided subcostal TAP block with 0.25% bupivacaine. Postoperative pain was assessed using the Visual Analog Scale at 2, 4, 6, 8, 12, and 24 hours. Morphine administration within the first 24 hours was recorded. Associations between perioperative variables and opioid requirement were analyzed using univariate and exploratory multivariable logistic regression. Results: A total of 42 patients were included in the analysis. Of these, 21 (50%) did not require postoperative opioids, while the remaining patients (n=21, 50%) received a mean cumulative morphine dose of 3.86 (SD 1.39) mg within 24 hours. Pain scores were lower during the early postoperative period (2, 4, and 12 h) in patients who did not require opioids. Higher American Society of Anesthesiologists classification was independently associated with postoperative morphine requirement (odds ratio 6.51, 95% CI 1.37-30.96; P=.01). No major complications or local anesthetic toxicity were observed. Conclusions: In this prospective observational cohort, laparoscopic-guided subcostal TAP block may be associated with favorable early postoperative analgesic profiles and relatively low opioid requirements after LC, including in patients with gallstone-related complications. Higher American Society of Anesthesiologists classification may be associated with increased opioid demand, highlighting the importance of individualized, risk-adapted analgesic strategies. Although limited by the absence of a control group and modest sample size, these findings support the clinical feasibility of surgeon-performed TAP block for consideration within multimodal analgesia approaches in enhanced recovery after surgery-oriented perioperative care.