Comparison of Erector Spinae Plane and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Prospective, Randomised, Double-Blinded, Comparative Study

Background: Laparoscopic cholecystectomy (LC) has become the standard procedure for gallbladder removal, but is associated with significant postoperative pain. This study aims to compare the analgesic efficacy of ultrasound-guided erector spinae plane (ESP) and subcostal transversus abdominis plane (TAP) block in patients undergoing elective LC.
Methods: Forty ASA I/II patients, aged 18 – 60 years, were randomised to receive ESP (group E, n=20) or TAP (group T, n=20) block after standard general anaesthesia induction. The primary outcome was time to first rescue analgesia in the postoperative period. Secondary outcomes included total postoperative analgesic consumption, perioperative haemodynamics, stress response markers, random blood sugar (RBS), total leucocyte count (TLC), C-reactive protein (CRP), and serum cortisol.
Results: Group E had significantly prolonged time to first rescue analgesia [654 (SD: 58.20) (95% CI: 626.76, 681.24) min vs. 482.40 (SD: 60.00) (95%CI: 454.26, 510.54) min, p< 0.001], lower NRS scores (at 6, 12 and 24-h intervals, p< 0.05) and higher patient satisfaction scores [5.80 (SD:0.63) (95%CI: 5.505, 6.095) vs. 4.10 (SD: 1.48) (95%CI: 3.407, 4.793), p < 0.001] compared to group T. CRP and serum cortisol levels were also significantly lower in Group E (p<0.05). Intraoperative haemodynamics and total postoperative analgesic requirement remained comparable between the groups.
Conclusion: ESP block provides prolonged analgesia and higher patient satisfaction compared to the subcostal TAP block in patients undergoing LC, along with a favourable effect on surgical stress response.