4-Point TAP Block vs. Combined RSB-OSTAP Block for Recovery After Laparoscopic Cholecystectomy

Comparison of 4-Point Transversus Abdominis Plane Block and Combined Bilateral Rectus Sheath-Oblique Subcostal TAP Block on Quality of Recovery After Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Laparoscopic cholecystectomy is a common keyhole surgery to remove the gallbladder. Although the cuts are small, patients can still have significant pain and nausea after the operation, which may delay recovery and discharge. To improve comfort, doctors often use ultrasound-guided abdominal nerve blocks as part of multimodal pain management.

In this single-center, randomized controlled trial, adult patients scheduled for elective laparoscopic cholecystectomy will receive standard general anesthesia and be randomly assigned to one of two routinely used block techniques at the end of surgery: (1) a 4-point transversus abdominis plane (TAP) block, or (2) a combined bilateral rectus sheath block plus oblique subcostal TAP block. Both techniques are performed under ultrasound guidance while the patient is still asleep.

The main aim of the study is to compare the quality of recovery on the first day after surgery between the two groups, using a short questionnaire (QoR-15). Secondary aims are to compare pain scores, the need for additional pain medicine, and the frequency of postoperative nausea and vomiting between the groups during the first 24 hours. All other aspects of anesthesia and surgical care will follow standard hospital practice. Participation is not expected to add significant risk beyond that of routine anesthesia and surgery, as both block techniques are already commonly used in clinical practice.

Inclusion Criteria:

Adults aged 18-65 years

ASA physical status I-II

Scheduled for elective laparoscopic cholecystectomy

Ability to understand the study and provide written informed consent

Exclusion Criteria:

Allergy or hypersensitivity to local anesthetics or study medications

Coagulopathy, anticoagulant therapy, or local infection at block site

Severe pulmonary disease (severe COPD, uncontrolled asthma, respiratory failure)

NYHA class III-IV heart failure

History of thoracic or abdominal surgery affecting block area

Chronic pain syndrome or regular opioid/analgesic use

Morbid obesity (BMI > 35 kg/m²)

Pregnancy or breastfeeding

Cognitive impairment preventing cooperation

Conversion to open cholecystectomy

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