Analgesic Efficacy of Bupivacaine Infiltration, Erector Spinae Plane Block, and Intrathecal Morphine in Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the standard surgical treatment for gallbladder diseases. Despite being a minimally invasive procedure, postoperative pain is a frequent problem and can negatively affect early mobilization, oral intake, and overall recovery. The pain experienced after this surgery is multifactorial, including somatic pain at trocar sites, visceral pain at the gallbladder bed, and shoulder pain caused by carbon dioxide insufflation. Effective pain management is therefore essential to improve patient comfort, reduce opioid consumption, and shorten hospital stay.

Several methods are available for postoperative analgesia. Local infiltration of the gallbladder bed and trocar sites with bupivacaine provides targeted pain relief at areas of surgical trauma. Erector spinae plane (ESP) block, a recently described ultrasound-guided regional anesthesia technique, offers both somatic and visceral analgesia with a favorable safety profile. Low-dose intrathecal morphine has also been shown to provide strong and prolonged analgesia in abdominal surgery, though its use may be limited by side effects such as nausea, vomiting, and itching.

This single-center, prospective, randomized controlled trial will compare the analgesic efficacy of three techniques:

Group INF (Infiltration): Bupivacaine infiltration at the gallbladder bed and trocar sites.

Group ESP: Bilateral ultrasound-guided ESP block at the T7 level.

Group ITM: Intrathecal morphine administration before induction of anesthesia.

The primary outcome is total opioid consumption within the first 24 hours after surgery.

Secondary outcomes include postoperative pain scores at multiple time points using the Visual Analog Scale (VAS), as well as the incidence of side effects such as nausea, vomiting, pruritus, and respiratory depression.

The results of this study are expected to provide evidence to guide multimodal analgesia strategies in laparoscopic cholecystectomy and to optimize patient recovery and satisfaction.

Inclusion criteria

• Adults aged 18-65 years
• Scheduled for elective laparoscopic cholecystectomy
• American Society of Anesthesiologists (ASA) physical status I-III
• Able to provide written informed consent

Exclusion criteria

• Body mass index (BMI) > 35 kg/m²
• History of coagulopathy or bleeding disorders
• Known allergy or hypersensitivity to opioids or local anesthetics
• Chronic pain or regular analgesic use
• History of neurological or psychiatric disease
• Pregnancy
• Refusal to participate in the study