A total of 90 patients, aged 18 to 65 years, with American Society of Anesthesiologists
(ASA) physical status I-III, scheduled for laparoscopic cholecystectomy, will be enrolled
in this study. Exclusion criteria encompasse a history of allergy to local anesthetics,
chronic analgesic use, psychiatric disorders, renal or hepatic dysfunction, coagulopathy,
a body mass index (BMI) > 40 kg/m², and pregnancy. Patients in Group S receive a
subcostal TAP block with a single injection, patients in Group T receive a subcostal TAP
block with multiple injections, and patients in Group C will not receive any form of
block.
Standard monitoring protocols will be implemented upon arrival in the operating theatre
and heart rate (HR), mean arterial pressure (MAP), and peripheral oxygen saturation
(SpO2) will be recorded during operation. Anesthesia will be induced using propofol (2
mg/kg) and fentanyl (1 μg/kg) and muscle relaxation is achieved with rocuronium (0.5
mg/kg). and maintained using sevoflurane in a 50:50 air/oxygen mixture at a flow rate of
1 L/min. Intraoperative analgesia will be provided through a remifentanil infusion at a
rate of 0-0.2 μg/kg/min.
Prior to the initiation of surgery, the subcostal TAP block will be administered in
Groups S and T under sterile conditions using ultrasound guidance. A single injection of
20 mL of 0.25% bupivacaine will be administered above the transversus abdominis muscle
adjacent to the linea semilunaris to the left sides of the patients in Group S. The
patients in Group T will be given three distinct injections to their left sides: 10 mL of
0.25% bupivacaine above the transversus abdominis muscle adjacent to the linea
semilunaris, 5 mL of 0.25% bupivacaine between the transversus abdominis and internal
oblique muscles in the subcostal region above the midclavicular line and 5 mL of 0.25%
bupivacaine between the transversus abdominis and internal oblique muscles in the
subcostal region above the anterior axillary line.
Laparoscopic cholecystectomy will be performed using four trocar placements on the right
side of the abdomen. Postoperative analgesia was managed with a patient-controlled
analgesia (PCA) device containing tramadol.
Postoperative remifentanil concumption will be estimated at the end of the operation.
Assessments will be conducted at 30th minute, 1st, 3rd, 6st and 24th hours
postoperatively, with parameters including pain, nausea, and total PCA consumption. Pain
intensity will be measured using the Visual Analogue Scale (VAS; 0 = no pain, 10 = worst
imaginable pain). Postoperative nausea and vomiting (PONV) will be evaluated using a
verbal descriptive scale (VDS) (0: No PONV, 1: Mild PONV, 2: Moderate PONV, 3: Severe
PONV) [10]. Patient satisfaction will beevaluated at discharge using a five-point Likert
scale (1 = strongly unsatisfied, 5 = strongly satisfied). Complications, including
infection, bleeding, and subcutaneous emphysema will be documented.