Timing of Subcostal TAPB Combined With Rectus Sheath Block for Postoperative Pain After Laparoscopic Cholecystectomy

Effect of Timing of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block Combined With Rectus Sheath Block on Postoperative Pain in Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial

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.

Study Overview

• Status: Recruiting
• Conditions: Postoperative Pain; Laparoscopic Cholecystectomy
• Intervention / Treatment: Procedure: Ultrasound-guided subcostal TAP block combined with rectus sheath block

Detailed Description

Postoperative pain after laparoscopic cholecystectomy remains a significant clinical concern despite the minimally invasive nature of the procedure. Ultrasound-guided abdominal wall blocks, including subcostal transversus abdominis plane (TAP) block and rectus sheath block (RSB), are widely used to reduce postoperative pain and opioid requirements. However, the optimal timing of block administration relative to surgical incision remains unclear.

This prospective, single-center, randomized controlled trial will compare the analgesic efficacy of pre-incisional versus post-operative administration of combined ultrasound-guided subcostal TAP block and RSB in adult patients undergoing elective laparoscopic cholecystectomy under general anesthesia.

Participants will be randomized in a 1:1 ratio using block randomization with randomly permuted block sizes. Standardized general anesthesia and postoperative analgesia protocols will be applied to all participants.

The primary outcome will be postoperative pain intensity measured using a numerical rating scale at predefined time points after surgery. Secondary outcomes will include cumulative opioid consumption, incidence of postoperative nausea and vomiting, rescue analgesic requirements, and recovery profiles.

The findings of this study are expected to provide evidence for optimizing the timing of abdominal wall block administration to improve postoperative analgesia and patient recovery after laparoscopic cholecystectomy.

• Study Type: Interventional
• Enrollment (Estimated): 96
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Hye-yeon Cho, MD; Phone Number: +82-2-970-8705; Email: anesthesia_chy@eulji.ac.kr
• Study Contact Backup: Name: Soojeong Kang, MD; Phone Number: +82-2-970-8705; Email: 20260034@eulji.ac.kr

Study Locations

• South Korea
  • Seoul, South Korea, 01830
    • Recruiting
    • Nowon Eulji University Hospital
    • Contact: Hye-yeon Cho, MD; Phone Number: +82-2-970-8705; Email: anesthesia_chy@eulji.ac.kr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• 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

Exclusion Criteria:

• 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
• Infection of the abdominal wall or skin at the injection site, or anatomical abnormalities of the abdominal wall
• Major neurological, psychiatric, or systemic diseases that may affect pain perception, treatment response, or study evaluation
• Requirement for postoperative mechanical ventilation
• Pregnancy or breastfeeding
• Considered unsuitable for the study by the investigator
• Refusal to participate or inability to provide informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Pre-incisional Block Group; Participants receive ultrasound-guided subcostal transversus abdominis plane (TAP) block combined with rectus sheath block (RSB) after induction of general anesthesia and before surgical incision.	Procedure: Ultrasound-guided subcostal TAP block combined with rectus sheath block; Ultrasound-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.
Experimental: Postoperative Block Group; Participants receive ultrasound-guided subcostal transversus abdominis plane (TAP) block combined with rectus sheath block (RSB) after completion of surgery and before emergence from anesthesia.	Procedure: Ultrasound-guided subcostal TAP block combined with rectus sheath block; Ultrasound-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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	Within 24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	During the post-anesthesia care unit stay
Cumulative rescue opioid consumption within 24 hours	Total amount of rescue opioid administered between 1 and 24 hours after surgery.	Within 24 hours after surgery
Incidence of postoperative nausea and vomiting	Occurrence of nausea or vomiting during the postoperative period.	Within 24 hours after surgery

Collaborators and Investigators

• Sponsor: Eulji University Hospital
• Investigators: Principal Investigator: Hye-yeon Cho, Nowon Eulji University Hospital, Eulji University College of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): February 23, 2026
• Primary Completion (Estimated): January 15, 2027
• Study Completion (Estimated): January 15, 2027

Study Registration Dates

• First Submitted: February 22, 2026
• First Submitted That Met QC Criteria: February 25, 2026
• First Posted (Actual): February 27, 2026

Study Record Updates

• Last Update Posted (Actual): February 27, 2026
• Last Update Submitted That Met QC Criteria: February 25, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Postoperative pain; Laparoscopic Cholecystectomy; Transversus Abdominis Plane Block; Rectus Sheath Block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative
• Other Study ID Numbers: 2026-01-026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No