Pamukkale University compares three regional analgesic strategies after laparoscopic cholecystectomy
Pamukkale University has completed a retrospective cohort study examining whether two ultrasound-guided fascial plane blocks can outperform simple port-site infiltration for pain control after laparoscopic cholecystectomy. The record centers on M-TAPA, EOIP block, and local anesthetic infiltration — three approaches that target postoperative abdominal wall pain through different anatomic routes.
The question is clinically familiar and still unresolved at the bedside. Laparoscopic gallbladder removal usually reduces surgical trauma compared with open surgery, yet the procedure still leaves patients with shoulder, port-site, and visceral pain that can delay early ambulation and increase reliance on opioids. A block that meaningfully blunts that pain in the first several postoperative hours can influence recovery in a way that is immediately visible to anesthesia teams and surgeons.
This single-center analysis drew on routine care delivered between January and April 2025 at Pamukkale University Hospital in Türkiye. Investigators identified 135 patients who had been allocated during routine clinical care, then applied retrospective eligibility criteria and ended with 90 adults for analysis, 30 in each arm. The cohort was restricted to patients 18 years or older with American Society of Anesthesiologists physical status I-II, all of whom underwent elective laparoscopic cholecystectomy under general anesthesia.
Three techniques, three different anatomic targets
The study compared a bilateral ultrasound-guided modified thoracoabdominal nerve block through the perichondrial approach with a bilateral ultrasound-guided external oblique intercostal plane block and with local anesthetic infiltration around the four laparoscopic port sites. Each of the two fascial plane techniques used 20 mL of 0.25% bupivacaine on each side, for a total of 40 mL. Local infiltration used 20 mL of 0.50% bupivacaine in total, with about 5 mL injected at each port site.
The anatomy matters here. M-TAPA is designed to deliver local anesthetic into the fascial plane between the transversus abdominis muscle and the costochondral structure, with the intent of reaching the thoracoabdominal nerves that carry somatic pain from the upper abdominal wall. EOIP block places anesthetic between the external oblique and intercostal muscles near the sixth and seventh ribs, a different route to suppressing chest wall and upper abdominal wall nociception. Local infiltration is simpler and faster, but its effect is confined to the immediate incision sites and may not extend as reliably to deeper somatic pain pathways.
Pain scores were the primary readout, not long-term recovery
The primary endpoint was pain intensity during movement two hours after surgery, measured with a visual analog scale. Secondary measures included VAS scores at 15 minutes and at 4, 8, 16, and 24 hours, the need for rescue opioid analgesia, and opioid-related adverse events. All patients also received standardized general anesthesia and routine perioperative analgesic treatment, which helps reduce treatment noise but does not erase the differences between the regional techniques.
The record does not include posted outcomes, so no comparative efficacy claims can be made from the study entry alone. Even without results, the design reveals what the investigators considered clinically important: early dynamic pain, rescue opioid use, and opioid toxicity. Those endpoints map directly to common post-laparoscopic care decisions, especially when teams are trying to reduce nausea, sedation, respiratory depression, and delayed discharge.
A retrospective design also imposes a hard ceiling on what the data can prove. The study explicitly treats its findings as observational associations rather than causal effects, and the groups were not identical in total local anesthetic dose. In practical terms, that means any later comparison between M-TAPA, EOIP, and infiltration must be read as a real-world signal from routine care, not as a definitive head-to-head efficacy trial.
The cohort was narrow by design, which improves internal consistency but limits reach
Eligibility criteria selected a relatively healthy surgical population. Patients with major organ failure, significant cardiovascular instability, BMI of 35 kg/m² or higher, neurologic or psychiatric disorders that could impair communication, or use of antidepressant medications such as SSRIs, SNRIs, MAOIs, tricyclic antidepressants, or mirtazapine were excluded. Patients who required additional procedures or anesthesia other than general anesthesia were also excluded, as were those with incomplete records.
This kind of restriction strengthens postoperative pain measurement. Patients who can reliably report pain on a visual analog scale are essential when the primary endpoint is subjective discomfort during movement. At the same time, the study population becomes less representative of the broader cholecystectomy population, especially patients with obesity, complex comorbidity, or more difficult perioperative pain trajectories. A block that performs well in ASA I-II adults may not behave the same way in older, sicker, or technically more challenging cases.
Why these blocks remain attractive to anesthesiologists
Fascial plane blocks have gained traction because they attempt to reduce opioid exposure without relying on systemic sedatives or repeated rescue dosing. After laparoscopic cholecystectomy, the pain burden often comes from the abdominal wall rather than from a large incision, which makes targeted regional anesthesia biologically plausible. If a block can interrupt nociceptive traffic before central sensitization gains momentum, the patient may experience less movement-evoked pain during the first postoperative hours, when coughing, turning, and mobilization are most uncomfortable.
The interest in M-TAPA and EOIP reflects that logic. Both approaches use ultrasound guidance, both can be performed bilaterally, and both aim at nerves supplying the upper abdominal wall. Their practical appeal lies in the possibility of extending analgesia beyond port-site infiltration while staying within a familiar regional anesthesia workflow.
The study also exposes a familiar operational tradeoff. More extensive regional techniques can demand more expertise, more equipment, and more time at the end of surgery, while simple infiltration is easy to deliver and hard to ignore in busy operating rooms. Whether the added complexity is justified depends on how much incremental analgesia and opioid sparing the technique can actually deliver.
What this record adds before the results even appear
Even without posted outcome data, the trial record makes clear that postoperative analgesia after laparoscopic cholecystectomy remains an active comparison among competing regional techniques rather than a settled standard. The investigators chose a clinically relevant endpoint at two hours, repeated pain assessments through 24 hours, and tracked rescue opioid requirements and adverse events, which means the eventual dataset was built to answer a real-world anesthesia question rather than a purely technical one.
The most important limitation is embedded in the design itself: retrospective allocation, unequal total local anesthetic exposure across groups, and a single-center sample of only 90 patients. Those features constrain how far any later conclusion can travel. If one of the two fascial plane blocks proves superior, the next question will not be whether the effect exists in a narrow cohort of healthy adults at one Turkish center; it will be whether that effect holds when the technique is used across different teams, different patients, and different postoperative pathways.
The record is complete, but the clinical argument is not. No results were posted, so the comparative value of M-TAPA, EOIP block, and local infiltration remains unreported in the registry entry itself, leaving the operative team with a well-framed question and no published answer from this dataset yet.