Laparoscopic CholecystectomyPhase 1NCT06714279
Laparoscopic-Assisted Transversus Abdominus Plane Block Versus Intraperitoneal Irrigation of Local Anesthetic for Patients Undergoing Laparoscopic Cholecystectomy
A Phase 1 study testing Tap Block - Bupivacaine and Intraperitoneal infiltration to liver in people with Laparoscopic Cholecystectomy and TAP Block, run by Royal College of Surgeons, Ireland at 1 site in Ireland.
Trial summary
This study is being performed to investigate whether the administration of local anaesthetic into the muscles in the abdomen or onto squirting the local anaesthetic onto the liver following keyhole gallbladder surgery is more beneficial in reducing pain post-operatively. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Laparoscopic Cholecystectomy, TAP Block, Local Anesthetic
- What is being tested?
- Tap Block - Bupivacaine and Intraperitoneal infiltration to liver
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 144 participants
- Where
- 1 siteIreland
- Study dates
- 12 Mar 2025to Jun 2026
- Phase
- Phase 1
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Adult patients aged 18 years or older will be considered for recruitment into this study if they are indicated to undergo elective laparoscopic cholecystectomy
Who cannot join
- Patients failing to meet the above inclusion criteria.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Ireland1 site, 1 recruiting
- Recruiting
Beaumont Hospital
Dublin
Matthew Davey SpR, MB BCh BAO MCh MRCSI PhD, 018032000, matthewdavey21@rcsi.ie
Arnold Hill Chair of Surgery, MCh FRCSI
About this study
Official title: Laparoscopic-Assisted Transversus Abdominus Plane Block Versus Intraperitoneal Irrigation of Local Anesthetic for Patients Undergoing Laparoscopic Cholecystectomy - A Prospective, Randomised Clinical Trial
This study is being performed to investigate whether the administration of local anaesthetic into the muscles in the abdomen or onto squirting the local anaesthetic onto the liver following keyhole gallbladder surgery is more beneficial in reducing pain post-operatively.
Keyhole gallbladder surgery is typically performed under general anaesthesia (or while the patient is 'fully asleep'), however doctors use other pain relief types to reduce pain after the operation. One of these options is local anaesthetic, which involves the injection of an medication into or onto the part of the body which has been operated on. The reason for doing this is to reduce the pain felt by the patient in the part if the body where the operation occurred. The best way of using these medications remain unclear.
Read more
The local anaesthetic being used in the study is fully approved for use in Ireland and the drug itself is not being tested. In other words, the drug is not an experimental drug. Local anaesthetic drugs are given in different ways in patients who have just had the keyhole surgery on their gall bladder (this is the surgery that you are about to have).
Therefore, the aim of this study is to compare two ways of giving patients these local anaesthetic medications following key-hole gallbladder surgery. These include (1) injecting the medication into the skin at the surgical wounds and squirting it onto the liver (where the gallbladder has been removed from), or (2) injecting the medication into the skin at the surgical wounds and into the muscles in the abdomen (known formally as a transversus abdominus plane block).
Read the detailed description
Laparoscopic cholecystectomy remains the cornerstone in treating benign diseases of the gallbladder and biliary tree, with approximately 5,000 of these procedures being performed annually in the Republic of Ireland. While significant complications, including bile leak, common bile duct injury (CBDI), and converting to an open incision, are typically discussed in detail when counselling patients in the preoperative setting, post-operative pain in the first 24-hours after surgery remains the main barrier of early discharge following the procedure. To counteract this issue, multimodal analgesic strategies have practically been adopted to minimise post-operative pain following laparoscopic cholecystectomy, as outlined by the Procedure Specific Post-Operative Pain Management (PROSPECT) in their review and recommendations. More specifically, the PROSPECT guidelines provide GRADE A recommendations in support of both standard paracetamol and non-steroidal anti-inflammatory (or cyclooxygenase-2 specific inhibitors), combined with surgical site local anaesthetic infiltration in patients in the peri-operative setting 'as the first line for routine use'.
Despite these recommendations, there remains ambiguity in the surgical literature surrounding to the optimal strategy for the infiltration of local anaesthetic; previous data has coherently demonstrated the superiority of surgical site wound infiltration, intraperitoneal infiltration and intra-abdominal wall blocks with local anaesthetic agents in reducing post-operative pain relative to placebo. In particular, data from a previous randomised clinical trial (RCT) has indicated that infiltrating the gallbladder fossa with local anaesthetic is more effective in reducing post-operative pain than local wound infiltration, however these results were subsequently refuted in a sequential RCT, leaving ambiguity as to the effect of this technique in reducing post-operative pain. Furthermore, recent RCTs have demonstrated that infiltration of local anaesthetic into either transversus abdominus plane (TAP) or the rectus sheath intraoperatively reduced post-operative pain compared to infiltration into the wound alone, directly reducing the post-operative morphine requirement. While ultrasound-guided transversus abdominus plane (US-TAP) are now commonly utilised in the perioperative setting following laparoscopic cholecystectomy, the suitability of a laparoscopic-guided approach (L-TAP) has been less well established within the surgical literature.
Given the contrasting results of these previous studies, there remains no consensus as to the validity of using L-TAP or intraperitoneal infiltration of local anaesthetic to the liver bed as contemporary modes of delivering local anaesthetic following laparoscopic cholecystectomy. Accordingly, the aim of this study was to perform a prospective, randomised study evaluating the benefit of L-TAP or intraperitoneal infiltration in patients indicated to undergo laparoscopic cholecystectomy. This study is a parallel two-arm study which will evaluate outcomes following local anesthetic infiltration (1) directly into the laparoscopic port sites combined with intraperitoneal infiltration, and (2) directly into the laparoscopic port sites combined with laparoscopic infiltration via TAP block.
- Conditions
- Laparoscopic Cholecystectomy, TAP Block, Local Anesthetic
- Being tested
- Tap Block - Bupivacaine, Intraperitoneal infiltration to liver
- Keywords
- Laparoscopic cholecystectomy, TAP block, Transversus abdominus plane block, Local anesthetic
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Tap Block - BupivacaineDrug
The medicinal product for both groups is the same - Bupivacaine. The mode of administration is what this study is reviewing: Control group (Intraperitoneal infiltration to liver) and Study Group - Laparoscopic Transversus Abdominis Plane Block (LTap Block)
Intraperitoneal infiltration to liverDrug
The medicinal product for both groups is the same - Bupivacaine. The mode of administration is what this study is reviewing: Control group (Intraperitoneal infiltration to liver) and Study Group - Laparoscopic Transversus Abdominis Plane Block (LTap Block)
| Study group | Role | What they receive |
|---|---|---|
| Study Group - Tap Block | Other | Study Group: Study group: Laparoscopic Transversus Abdominis Plane in four points: above the umbilicus on the left side; dose calculation 2.5mg per body weight.
After the cholecystectomy is done and just before withdrawing port and deflating the abdomen, the operating surgeon will advance a needle into the abdominal wall to the level of the preperitoneal space. Once the needle tip is seen, it is withdrawn slowly and gently about 0.5cm above/superficial to the transversus abdominis (TA) muscle. The surgeon then infiltrates the local anaesthetic into the plane, and the right plane is confirmed by visualising a uniform protrusion downwards of the TA muscle fibres (Doyle's bulge). Seeing a preperitoneal or muscle blister laparoscopically indicates that the infiltration is deeper to this plane, and the needle should be withdrawn more superficially. Receives: Drug: Tap Block - Bupivacaine |
| Control Group - Intraperitoneal Local Anesthetic onto Liver | Placebo comparator | Administration of local anesthetic to the liver using, dose calculation 2.5mg per body weight. Receives: Drug: Intraperitoneal infiltration to liver |
What is being measured
The primary outcome is the main question the study is designed to answer.
Post operative pain measured via Visual Anaolgue Scores
The primary objective for the study is to quantify and analyse differences in the post-operative resting and shoulder tip pain as measured using VAS at 1-hour, 3-hours, 6-hours, 12-hours and 24-hours following laparoscopic cholecystectomy. Thereafter, the further opioid analgesic requirements for each patient will be recorded for the duration of their inpatient stay and also the total sum of opioids prescribed for these patients on discharge (measured using morphine equivalents).
Measured: 1-hour, 3-hours, 6-hours, 12-hours and 24-hours
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Dec 2024
- Study start12 Mar 2025
- Primary completionJun 2026 (estimated)
- Study completionJun 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Laparoscopic CholecystectomyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 144 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Royal College of Surgeons, Ireland
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Matthew Davey, Royal College of Surgeons, Ireland
- Investigators
- Arnold DK Hill, MB MCh FRCS, Principal investigator, RCSI
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06714279
- Sponsor's protocol ID
- 24.71
- Status last verified
- Aug 2025
- First submitted
- 23 Nov 2024
- Last updated
- 14 Aug 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 14 Aug 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Laparoscopic-Assisted Transversus Abdominus Plane Block Versus Intraperitoneal Irrigation of Local Anesthetic for Patients Undergoing Laparoscopic Cholecystectomy - A Prospective, Randomised Clinical Trial
- ClinicalTrials.gov ID
- NCT06714279
- Acronym / sponsor ID
- 24.71
- Conditions
- Laparoscopic Cholecystectomy, TAP Block, Local Anesthetic
- Keywords
- Laparoscopic cholecystectomy, TAP block, Transversus abdominus plane block, Local anesthetic
- Phase
- Phase 1
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 144 participants (estimated)
- Lead sponsor
- Royal College of Surgeons, IrelandUniversity, hospital or other
- Study start
- 12 Mar 2025 (actual)
- Primary completion
- Jun 2026 (estimated)
- Study completion
- Jun 2026 (estimated)
- First posted
- 3 Dec 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study is being performed to investigate whether the administration of local anaesthetic into the muscles in the abdomen or onto squirting the local anaesthetic onto the liver following keyhole gallbladder surgery is more beneficial in reducing pain post-operatively.
Keyhole gallbladder surgery is typically performed under general anaesthesia (or while the patient is 'fully asleep'), however doctors use other pain relief types to reduce pain after the operation. One of these options is local anaesthetic, which involves the injection of an medication into or onto the part of the body which has been operated on. The reason for doing this is to reduce the pain felt by the patient in the part if the body where the operation occurred. The best way of using these medications remain unclear.
The local anaesthetic being used in the study is fully approved for use in Ireland and the drug itself is not being tested. In other words, the drug is not an experimental drug. Local anaesthetic drugs are given in different ways in patients who have just had the keyhole surgery on their gall bladder (this is the surgery that you are about to have).
Therefore, the aim of this study is to compare two ways of giving patients these local anaesthetic medications following key-hole gallbladder surgery. These include (1) injecting the medication into the skin at the surgical wounds and squirting it onto the liver (where the gallbladder has been removed from), or (2) injecting the medication into the skin at the surgical wounds and into the muscles in the abdomen (known formally as a transversus abdominus plane block).
Detailed description
Laparoscopic cholecystectomy remains the cornerstone in treating benign diseases of the gallbladder and biliary tree, with approximately 5,000 of these procedures being performed annually in the Republic of Ireland. While significant complications, including bile leak, common bile duct injury (CBDI), and converting to an open incision, are typically discussed in detail when counselling patients in the preoperative setting, post-operative pain in the first 24-hours after surgery remains the main barrier of early discharge following the procedure. To counteract this issue, multimodal analgesic strategies have practically been adopted to minimise post-operative pain following laparoscopic cholecystectomy, as outlined by the Procedure Specific Post-Operative Pain Management (PROSPECT) in their review and recommendations. More specifically, the PROSPECT guidelines provide GRADE A recommendations in support of both standard paracetamol and non-steroidal anti-inflammatory (or cyclooxygenase-2 specific inhibitors), combined with surgical site local anaesthetic infiltration in patients in the peri-operative setting 'as the first line for routine use'.
Despite these recommendations, there remains ambiguity in the surgical literature surrounding to the optimal strategy for the infiltration of local anaesthetic; previous data has coherently demonstrated the superiority of surgical site wound infiltration, intraperitoneal infiltration and intra-abdominal wall blocks with local anaesthetic agents in reducing post-operative pain relative to placebo. In particular, data from a previous randomised clinical trial (RCT) has indicated that infiltrating the gallbladder fossa with local anaesthetic is more effective in reducing post-operative pain than local wound infiltration, however these results were subsequently refuted in a sequential RCT, leaving ambiguity as to the effect of this technique in reducing post-operative pain. Furthermore, recent RCTs have demonstrated that infiltration of local anaesthetic into either transversus abdominus plane (TAP) or the rectus sheath intraoperatively reduced post-operative pain compared to infiltration into the wound alone, directly reducing the post-operative morphine requirement. While ultrasound-guided transversus abdominus plane (US-TAP) are now commonly utilised in the perioperative setting following laparoscopic cholecystectomy, the suitability of a laparoscopic-guided approach (L-TAP) has been less well established within the surgical literature.
Given the contrasting results of these previous studies, there remains no consensus as to the validity of using L-TAP or intraperitoneal infiltration of local anaesthetic to the liver bed as contemporary modes of delivering local anaesthetic following laparoscopic cholecystectomy. Accordingly, the aim of this study was to perform a prospective, randomised study evaluating the benefit of L-TAP or intraperitoneal infiltration in patients indicated to undergo laparoscopic cholecystectomy. This study is a parallel two-arm study which will evaluate outcomes following local anesthetic infiltration (1) directly into the laparoscopic port sites combined with intraperitoneal infiltration, and (2) directly into the laparoscopic port sites combined with laparoscopic infiltration via TAP block.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Study Group - Tap Block | Other | Drug: Tap Block - BupivacaineStudy Group: Study group: Laparoscopic Transversus Abdominis Plane in four points: above the umbilicus on the left side; dose calculation 2.5mg per body weight. After the cholecystectomy is done and just before withdrawing port and deflating the abdomen, the operating surgeon will advance a needle into the abdominal wall to the level of the preperitoneal space. Once the needle tip is seen, it is withdrawn slowly and gently about 0.5cm above/superficial to the transversus abdominis (TA) muscle. The surgeon then infiltrates the local anaesthetic into the plane, and the right plane is confirmed by visualising a uniform protrusion downwards of the TA muscle fibres (Doyle's bulge). Seeing a preperitoneal or muscle blister laparoscopically indicates that the infiltration is deeper to this plane, and the needle should be withdrawn more superficially. |
| Control Group - Intraperitoneal Local Anesthetic onto Liver | Placebo comparator | Drug: Intraperitoneal infiltration to liverAdministration of local anesthetic to the liver using, dose calculation 2.5mg per body weight. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- Adult patients aged 18 years or older will be considered for recruitment into this study if they are indicated to undergo elective laparoscopic cholecystectomy
Key exclusion criteria (1 listed)
- Patients failing to meet the above inclusion criteria.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Tap Block - BupivacaineThe medicinal product for both groups is the same - Bupivacaine. The mode of administration is what this study is reviewing: Control group (Intraperitoneal infiltration to liver) and Study Group - Laparoscopic Transversus Abdominis Plane Block (LTap Block) | Drug | Study Group - Tap Block |
| Intraperitoneal infiltration to liverThe medicinal product for both groups is the same - Bupivacaine. The mode of administration is what this study is reviewing: Control group (Intraperitoneal infiltration to liver) and Study Group - Laparoscopic Transversus Abdominis Plane Block (LTap Block) | Drug | Control Group - Intraperitoneal Local Anesthetic onto Liver |
Primary outcome
Post operative pain measured via Visual Anaolgue Scores
Time frame: 1-hour, 3-hours, 6-hours, 12-hours and 24-hours
The primary objective for the study is to quantify and analyse differences in the post-operative resting and shoulder tip pain as measured using VAS at 1-hour, 3-hours, 6-hours, 12-hours and 24-hours following laparoscopic cholecystectomy. Thereafter, the further opioid analgesic requirements for each patient will be recorded for the duration of their inpatient stay and also the total sum of opioids prescribed for these patients on discharge (measured using morphine equivalents).
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Aug 2025.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Arnold DK Hill, MB MCh FRCS principal investigator
RCSI
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1 study testing Tap Block - Bupivacaine and Intraperitoneal infiltration to liver in people with Laparoscopic Cholecystectomy and TAP Block, run by Royal College of Surgeons, Ireland at 1 site in Ireland.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 14 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Ireland. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Matthew G Davey, MB BCh BAO MCh MRCSI PhD (+353180320000, matthewdavey21@rcsi.ie), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Post operative pain measured via Visual Anaolgue Scores (time frame: 1-hour, 3-hours, 6-hours, 12-hours and 24-hours). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Aug 2025.