{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:07:13Z","timestamp":1792238833469,"version":"4.4.0"},"reference-count":23,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Perioper Med"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Laparoscopic-guided subcostal transversus abdominis plane (TAP) block has been introduced as a surgeon-performed approach to postoperative analgesia in laparoscopic cholecystectomy (LC), allowing direct visual confirmation of local anesthetic delivery without ultrasound guidance. However, evidence regarding its clinical outcomes, particularly in patients with complicated gallstone disease, remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to evaluate postoperative analgesic outcomes and identify factors associated with opioid requirement following laparoscopic-guided subcostal TAP block.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A prospective observational study was conducted between November 2023 and October 2024 at Srinakharinwirot University Hospital, Thailand. Patients (aged 18\u201080 years) undergoing LC for uncomplicated or complicated gallstone disease received a laparoscopic-guided subcostal TAP block with 0.25% bupivacaine. Postoperative pain was assessed using the Visual Analog Scale at 2, 4, 6, 8, 12, and 24 hours. Morphine administration within the first 24 hours was recorded. Associations between perioperative variables and opioid requirement were analyzed using univariate and exploratory multivariable logistic regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 42 patients were included in the analysis. Of these, 21 (50%) did not require postoperative opioids, while the remaining patients (n=21, 50%) received a mean cumulative morphine dose of 3.86 (SD 1.39) mg within 24 hours. Pain scores were lower during the early postoperative period (2, 4, and 12 h) in patients who did not require opioids. Higher American Society of Anesthesiologists classification was independently associated with postoperative morphine requirement (odds ratio 6.51, 95% CI 1.37\u201030.96;\n P<\/jats:italic>\n =.01). No major complications or local anesthetic toxicity were observed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this prospective observational cohort, laparoscopic-guided subcostal TAP block may be associated with favorable early postoperative analgesic profiles and relatively low opioid requirements after LC, including in patients with gallstone-related complications. Higher American Society of Anesthesiologists classification may be associated with increased opioid demand, highlighting the importance of individualized, risk-adapted analgesic strategies. Although limited by the absence of a control group and modest sample size, these findings support the clinical feasibility of surgeon-performed TAP block for consideration within multimodal analgesia approaches in enhanced recovery after surgery\u2013oriented perioperative care.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/87622","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T06:20:07Z","timestamp":1772000407000},"page":"e87622-e87622","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Feasibility and Outcomes of Surgeon-Performed Laparoscopic-Guided Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy: Prospective Observational Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9350-5991","authenticated-orcid":false,"given":"Sarun","family":"Mahasupachai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4607-983X","authenticated-orcid":false,"given":"Thawatchai","family":"Tullavardhana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"R1","volume":"22","author":"Tullavardhana","journal-title":"J Med Health Sci"},{"issue":"9","key":"R2","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1016\/j.ijsu.2013.05.039","article-title":"Does a transversus abdominis plane (TAP) local anaesthetic block improve pain control in patients undergoing laparoscopic cholecystectomy? A best evidence topic","volume":"11","author":"Keir","journal-title":"Int J Surg"},{"key":"R3","unstructured":"Law LS Lo EA Gan TJ et al. Preoperative antiemetic and analgesic management. In: Gan TJ Thacker JK Miller TE , editors. Enhanced Recovery for Major Abdominopelvic Surgery. Professional Communications Inc; 2016:105-120."},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1001\/jamasurg.2016.4952","article-title":"Enhanced recovery after surgery: a review","volume":"152","author":"Ljungqvist","journal-title":"JAMA Surg"},{"issue":"Suppl 1","key":"R5","doi-asserted-by":"publisher","first-page":"S40","DOI":"10.4103\/joacp.JOACP_51_18","article-title":"Multimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings","volume":"35","author":"Kaye","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"4","key":"R6","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1177\/0310057X0703500417","article-title":"Ultrasound-guided transversus abdominis plane (TAP) block","volume":"35","author":"Hebbard","journal-title":"Anaesth Intensive Care"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2021.700318","article-title":"A meta-analysis of randomized controlled trials concerning the efficacy of transversus abdominis plane block for pain control after laparoscopic cholecystectomy","volume":"8","author":"Wang","journal-title":"Front Surg"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/j.jamcollsurg.2015.03.030","article-title":"Efficacy of a laparoscopically delivered transversus abdominis plane block technique during elective laparoscopic cholecystectomy: a prospective, double-blind randomized trial","volume":"221","author":"Elamin","journal-title":"J Am Coll Surg"},{"issue":"12","key":"R9","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.4103\/ija.IJA_528_20","article-title":"Comparison of laparoscopy-guided with ultrasound-guided subcostal transversus abdominis plane block in laparoscopic cholecystectomy - a prospective, randomised study","volume":"64","author":"Venkatraman","journal-title":"Indian J Anaesth"},{"issue":"23","key":"R10","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11236896","article-title":"Transversus abdominis plane block as a strategy for effective pain management in patients with pain during laparoscopic cholecystectomy: a systematic review","volume":"11","author":"Alsharari","journal-title":"J Clin Med"},{"issue":"2","key":"R11","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1055\/s-0038-1676477","article-title":"Pain Management in Enhanced Recovery after Surgery (ERAS) protocols","volume":"32","author":"Simpson","journal-title":"Clin Colon Rectal Surg"},{"issue":"6","key":"R12","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1007\/s40122-024-00647-w","article-title":"Efficacy and safety of different preemptive analgesia measures in pain management after laparoscopic cholecystectomy: a systematic review and network meta-analysis of randomized controlled trials","volume":"13","author":"Cao","journal-title":"Pain Ther"},{"issue":"4","key":"R13","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1016\/j.bja.2018.06.023","article-title":"Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update","volume":"121","author":"Barazanchi","journal-title":"Br J Anaesth"},{"issue":"3","key":"R14","doi-asserted-by":"publisher","first-page":"382","DOI":"10.3344\/kjp.23114","article-title":"Comparison of modified thoracoabdominal nerve block through perichondral approach and subcostal transversus abdominis plane block for pain management in laparoscopic cholecystectomy: a randomized-controlled trial","volume":"36","author":"Cho","journal-title":"Korean J Pain"},{"issue":"3","key":"R15","doi-asserted-by":"publisher","first-page":"339","DOI":"10.4103\/0970-9185.98331","article-title":"Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Comparison with conventional port-site infiltration","volume":"28","author":"Tolchard","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/2668215","article-title":"Is Right Unilateral Transversus Abdominis Plane (TAP) block successful in postoperative analgesia in laparoscopic cholecystectomy?","volume":"2022","author":"Ozciftci","journal-title":"Int J Clin Pract"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2022.106639","article-title":"Ultrasound-guided versus laparoscopic-guided subcostal transversus abdominis plane (TAP) block versus No TAP block in laparoscopic cholecystectomy; 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