AbstractAimThe aim of this study was to assess if laparoscopic‐assisted transversus abdominis plane (TAP) block (L‐TAPB) is as efficient as ultrasound‐guided TAP block (U‐TAPB) in postoperative pain control.MethodIn all, 112 patients scheduled for elective laparoscopic colon resection from February 2018 to December 2021 at two Swiss hospitals were included and randomized in a 1:1 ratio before surgery with either L‐TAPB or U‐TAPB. The primary end‐point was the non‐inferiority of the L‐TAPB compared to U‐TAPB with regard to the total opioid consumption within the first 24 h after surgery. Data regarding patients' characteristics, opioid consumption, pain on the visual analogue scale, operative and anaesthesia induction time, complications and length of stay were collected and analysed.ResultsFifty‐five patients were allocated to the L‐TAPB and fifty‐seven to the U‐TAPB. No significant difference was found in the overall dose of opioids within 24 h, and the non‐inferiority of the L‐TAPB was confirmed. There were almost twice as many patients in the L‐TAPB group requesting opioid reserves compared to the U‐TAPB group (54.5% vs. 29.8%, P = 0.008). The anaesthesia induction time was significantly longer in the U‐TAPB group (17 ± 11 min vs. 23 ± 12 min, P = 0.014). For all other variables (pain on the visual analogue scale, opioid consumption, need of epidural analgesia, operating time, postoperative complications and hospital stay) no statistically significant difference between the L‐TAPB and the U‐TAPB groups was noted.ConclusionOur results showed the non‐inferiority of the laparoscopic delivery compared to ultrasound‐guided administration of the TAP block, with the advantage of not affecting anaesthesia times.Study registration number2017‐02017 CE 3294, ClinicalTrials.gov identifier NCT04575233.