Background Transversus abdominis plane block (TAPB) has become a fundamental component of multimodal analgesia for laparoscopic colorectal surgery. Previous meta-analyses comparing laparoscopic-guided TAPB (Lap-TAPB) with ultrasound-guided TAPB (US-TAPB) were constrained by small sample sizes and lacked integration of emerging evidence from recent randomized controlled trials (RCTs). Given the increasing number of studies published since 2023, an updated review is warranted. Objectives To conduct an updated systematic review and meta-analysis comparing Lap-TAPB with US-TAPB in terms of analgesic efficacy and perioperative outcomes in patients undergoing laparoscopic colorectal surgery. Methods PubMed, Embase, and Web of Science were searched, from their inception until November 2025, for studies evaluating Lap-TAPB versus US-TAPB and reporting postoperative analgesic or clinical outcomes following the PRISMA guidelines. The primary outcome was 24-h postoperative opioid consumption, whereas the secondary outcomes included pain scores at 24 h (at rest), postoperative nausea and vomiting (PONV), operative time and complications. Results Five studies involving 585 patients were included in this review. No significant differences were observed in 24-h postoperative opioid consumption with Lap-TAPB (standardized mean difference (SMD) −0.16, 95% confidence interval (CI) = −0.39 to 0.08, p = 0.20), pain scores at rest at 24 h (SMD −0.17, 95% CI = −0.39 to 0.04, p = 0.12), incidence of PONV (odds ratio (OR) = 0.97, 95% CI = 0.36–2.65, p = 0.96), operative time (SMD 0.05, 95% CI = −0.19 to 0.30, p = 0.67), and complications (OR = 1.25, 95% CI = 0.77–2.03, p = 0.37). Conclusion Lap-TAPB did not result in significantly lower 24-h postoperative opioid consumption, pain scores at 24 h (at rest), PONV incidence, operative time and complications compared to US-TAPB. However, it eliminates the need for ultrasound devices while decreasing the logistical complexity of the procedure.
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