Anesth Pain Med.  2022 Jan;17(1):67-74. 10.17085/apm.21030.

Analgesic efficacy of ultrasound-guided transversus abdominis plane block for laparoscopic gynecological surgery: a randomized controlled trial

• Sethi D
• Garg G

• KMID: 2526530
• DOI: http://doi.org/10.17085/apm.21030

Abstract

Background
This study aimed to determine whether ultrasound-guided transversus abdominis plane (TAP) block is more effective in reducing postoperative pain and analgesic consumption than local anesthetic infiltration (LAI) at the port site for elective laparoscopic gynecological surgeries.
Methods
Eighty patients with the American Society of Anesthesiologists status I/II undergoing laparoscopic gynecology surgery were enrolled for this randomized control trial. After general anesthesia was administered, patients in group C received LAI at each port site, and patients in group T received bilateral ultrasound-guided TAP. Postoperative pain was assessed at time intervals of 1/2, 2, 4, 6, 8, and 24 h using the numeric pain scale (NPS). Clinical metrics such as postoperative analgesic diclofenac consumption, need for rescue fentanyl, nausea-vomiting scores, and antiemetic requirements were also recorded.
Results
Seventy-four patients were included in the final analysis. Postoperatively, patients in group T had significantly lower NPS than those in group C (P < 0.05). The highest difference in the postoperative NPS was observed at 2 h (median [1Q, 3Q]; group C = 3 [2, 4]; group T = 1 [0, 2]; P < 0.001). A statistically significant difference was observed in the frequency of diclofenac (75 mg intravenous) requirement between the groups (P = 0.010). No significant difference was observed between the groups in need of rescue fentanyl or antiemetic and the nausea-vomiting scores.
Conclusions
In patients undergoing laparoscopic gynecological surgery, ultrasound-guided TAP block provided greater postoperative analgesic benefits in terms of lower NPS and reduced analgesic requirements than port site LAI.

Keyword

Analgesia; Laparoscopy; Local anesthetic; Transversus abdominis

Figure

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  Fig. 1. Sonographic image showing insertion of sonotap needle with the needle tip reaching the plain between IO and TA muscles. EO: external oblique, IO: internal oblique, TA: transversus abdominis, TAP: transversus abdominis plane.

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  Fig. 2. Sonographic image showing spread of local anesthetic drug in the transversus abdominis plane (TAP) block plane and the separation of the fascial plane between IO and TA muscles. EO: external oblique, IO: internal oblique, TA: transversus abdominis.

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  Fig. 3. CONSORT flow diagram for the study. CONSORT: Consolidated Standards for Reporting of Trials.

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