Vildan KÖLÜKÇÜ, Ahmet Tuğrul ŞAHİN, Mehtap GÜRLER BALTA, Ali GENÇ, Bülent KOCA
İstanbul Medical Journal - 2026;27(1):44-49
Introduction: In biliary operations, laparoscopic techniques have largely replaced traditional methods; cholecystectomy is among the most common. Despite being minimally invasive, this procedure still poses a notable challenge in managing postoperative pain. This study aims to examine the impact of administering the transversus abdominis plane (TAP) block either before or after surgery on pain levels and hemodynamic responses in patients undergoing laparoscopic cholecystectomy. Methods: A total of 75 cases were retrospectively reviewed, all of whom had undergone a laparoscopic cholecystectomy and received a bilateral TAP block under ultrasound guidance. Participants were divided into two cohorts: the TAP block was administered to Group 1 before surgery and to Group 2 after surgery. Evaluated variables included demographic data, numerical pain scales, hemodynamic indicators, patient-controlled analgesia (PCA) device utilization, opioid requirements, and postoperative symptoms. Results: Group 1 consisted of 35 patients. American Society of Anesthesiologists grading, body mass index, surgery length, and demographic characteristics such as age and sex were statistically similar in both patient groups. Intraoperative hemodynamic parameters were also similar (p>0.05). The amount of remifentanil administered during surgery was considerably greater in those assigned to Group 2 (p=0.001). Pain intensity assessed at 0 and 1 hours after surgery was markedly lower in Group 1 than in Group 2 (p<0.05). No statistically significant difference in PCA usage was found between the groups (p>0.05). Nevertheless, patients in Group 2 required considerably more opioid analgesics in addition to PCA at postoperative hours 0 and 1 (p=0.036 and p=0.040, respectively). Furthermore, nausea occurred more frequently in Group 2 at the second postoperative hour (p=0.040). Conclusion: This study demonstrates that preoperative TAP block administration during laparoscopic cholecystectomy reduces intraoperative opioid requirements, lowers early postoperative pain scores, and decreases the need for additional postoperative opioid analgesia compared with postoperative TAP block administration.
