Efficacy of external and rectus abdominus plane (EXORA) block versus subcostal transversus abdominus plane(TAP) block in laaroscopic cholecystectomy surgeries

The methodology for this prospective, randomized, double-blinded, comparative study will commence with patient enrollment at a tertiary care hospital in Western Maharashtra, where adult patients scheduled for elective laparoscopic cholecystectomy under general anesthesia will be screened for eligibility based on inclusion and exclusion criteria. Eligible patients, aged 18–65 years with ASA physical status I or II and BMI < 35 kg/m², will provide written informed consent following a detailed explanation of the study. Patients will be allocated to one of two groups—Group A (EXORA block) or Group B (subcostal TAP block)—using block randomization with allocation concealment ensured via sealed opaque envelopes.

Prior to surgery, bilateral blocks will be administered under ultrasound guidance by an experienced anaesthesiologist using a high-frequency linear probe (6–13 MHz). For the EXORA block group, 15 mL of 0.25% bupivacaine (total 30 mL per side) will be injected into the fascial plane between the external oblique and rectus abdominis muscles, targeting the T6–T9 anterior cutaneous branches of the thoracoabdominal nerves. For the subcostal TAP block group, the same volume and concentration of bupivacaine will be deposited between the internal oblique and transversus abdominis muscles, targeting the T6–T12 thoracic intercostal nerves.

A standardized general anesthesia protocol will be followed, using propofol (2–3 mg/kg), fentanyl (2 µg/kg), and rocuronium (0.6–1 mg/kg) for induction, and sevoflurane (1–2%) for maintenance, with surgery performed via a standard four-port laparoscopic cholecystectomy technique.

Postoperatively, patients will receive intravenous paracetamol (1 g every 6 hours) as the first-line analgesic, with intravenous tramadol (50 mg) as rescue analgesia for VAS scores exceeding 4. Pain intensity at rest and during movement (coughing or sitting up) will be assessed using the Visual Analogue Scale (VAS, 0–10) at 30 minutes, 2, 4, 6, 12, and 24 hours post-surgery by blinded outcome assessors. Secondary outcomes, including time to first rescue analgesic request, total tramadol consumption (converted to morphine equivalents), block-related complications (e.g., haematoma,

vomiting), patient satisfaction (via a 5-point Likert scale), and block performance time, will be recorded in a structured proforma. Sensory blockade will be evaluated post-block using a pinprick test to confirm dermatomal coverage.