Clinical Outcomes of Surgeon-Performed Laparoscopic-Guided Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy: An Observational Study

Background: Laparoscopic-guided subcostal transversus abdominis plane (TAP) block has been introduced as a surgeon-performed alternative for postoperative analgesia in laparoscopic cholecystectomy (LC). This technique provides direct visual confirmation of anesthetic delivery without the need for ultrasound guidance. Evidence in patients with complicated gallstone disease remains limited. This study evaluated the clinical outcomes and factors associated with postoperative 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. Adult patients (18–80 years) undergoing LC for uncomplicated or complicated gallstone disease received a laparoscopic-guided subcostal TAP block with 0.25% bupivacaine. Pain was assessed using the Visual Analogue Scale (VAS) at 2, 4, 6, 8, 12, and 24 hours postoperatively. Morphine administration within 24 hours was recorded. Perioperative variables were analyzed using univariate and exploratory multivariable logistic regression. Results: Forty-two patients were analyzed; half of patients did not require postoperative opioids, while the remainder received a mean cumulative morphine dose of 3.86 ± 1.39 mg. Pain scores were significantly lower at 2, 4, and 12 hours in the morphine-free group (p < 0.05). Higher ASA classification independently predicted morphine requirement (OR = 6.51; 95% CI, 1.37–30.96; p = 0.018). No major complications or local anesthetic toxicity were observed. Conclusion: Laparoscopic-guided subcostal TAP block appears to provide effective early postoperative analgesia and a meaningful opioid-sparing benefit after LC, including in patients with gallstone-related complications. Higher ASA class was associated with greater opioid demand, underscoring the importance of individualized, risk-adapted analgesic strategies. These findings support the feasibility and potential integration of surgeon-performed TAP block into ERAS pathways to enhance multimodal analgesia and postoperative recovery.