Effect of transversus abdominis plane block on the quality of recovery in laparoscopic nephrectomy: A prospective double-blinded randomized controlled clinical trial

Abstract

Background: Poorly controlled acute postoperative pain after laparoscopic nephrectomy may adversely affect surgical outcomes and increase morbidity rates. In addition, excessive use of opioids during surgery may slow postoperative endocrine and metabolic responses and cause opioid-related side effects and opioid-induced hyperalgesia. The purpose of this study was to evaluate the effect of ultrasound-guided transversus abdominis plane (TAP) block on the postoperative quality of recovery and intraoperative remifentanil requirement in laparoscopic nephrectomy. Methods: Sixty patients who underwent laparoscopic nephrectomy were randomly divided into 2 groups: TAP and Control groups. After induction of anesthesia and before awakening from anesthesia, the TAP group was administered 40 mL of 0.375% ropivacaine and the Control group was administered 40 mL of normal saline to deliver ultrasound-guided TAP block using 20 mL of each of the above drugs. The main objectives of this study were to evaluate the effect of the TAP block on quality of recovery using the Quality of Recovery 40 (QoR-40) questionnaire and assessments of intraoperative remifentanil requirement. In addition, to evaluate the postoperative analgesic effect of the TAP block, the total usage time for patient-controlled analgesia (PCA) and the number of PCA bolus buttons used in both groups were analyzed. Results: The QoR-40 score, measured when visiting the ward on the third day after surgery, was significantly higher in the TAP group (171.9 ± 23.1) than in the Control group (151.9 ± 28.1) ( P = .006). The intraoperative remifentanil requirement was not significantly different between the groups ( P = .439). In the TAP group, the frequency of bolus dose accumulation at 1, 2, 3, 6, 12, 24, 48, and 72 hours after surgery was low enough to show a significant difference, and the total usage time for PCA was long enough to show a significant difference. Conclusion: In conclusion, we determined that ultrasound-guided TAP block during laparoscopic nephrectomy improves the quality of postoperative recovery and is effective for postoperative pain control but does not affect the amount of remifentanil required for adequate anesthesia during surgery.

Analgesic Strategies for Urologic Videolaparoscopic or Robotic Surgery in the Context of an Enhanced Recovery after Surgery Protocol: A Prospective Study Comparing Erector Spinae Plane Block versus Transversus Abdominis Plane Block

“…However, even if in our study, we demonstrated TAPB to be inferior to ESPB; an analgesic strategy with TAPB achieves great benefits compared to standard analgesic treatments in the first 24-48 h after surgery in terms of pain scores and overall opioid consumption. In fact, TAPB has been described to be effective in analgesic pain control with a reduction in opioid consumption even in urologic surgery with good results in either radical robotic-assisted prostatectomies [20], laparoscopic nephrectomies [21], and percutaneous nephrolithotomy [22].…”

“…Four injection sites were chosen for all pelvic procedures, while for nephrectomies, we opted for three injection sites: two subcostal and one lateral on the intervention side [8]. The latter enabled us to inject concentrations of ropivacaine in the organ extraction area requiring a surgical enlargement of the trocar edge [21] higher than in the two subcostal bilateral sites, aimed at attenuating pain from pneumoperitoneum overdistension. The total volume for each site was always 20 mL as in numerous previous studies and the ropivacaine total dose was determined as the maximal safe dose.…”

A comparison of efficacy of erector spinae plane block versus serratus anterior plane block plus subcostal transversus abdominus plane block for bariatric laparoscopic sleeve gastrectomy surgery: study protocol for a randomised clinical trial.

“…The subcostal TAP block has since been shown to provide postoperative analgesia and reduce open consumption for patients undergoing both open and laparoscopic upper abdominal surgery. 28,29,30 Strengths An undoubted strength of our study is that the regional analgesia technique will be performed by, or under the direct supervision of, the same consultant anaesthesiologist, while the surgery will be performed by the same consultant surgeon, for the duration of the study. Any difference in outcome which may have been contributable to variations in either anaesthetic or surgical approach of different consultants will as such be eliminated.…”