Efficacy of laparoscopic-guided transversus abdominis plane block for patients undergoing robotic-assisted gynaecologic surgery: A randomised control trial

Abstract

Background and Aims:Transverse abdominis plane (TAP) block has been used regularly as part of multimodal analgesia for caesarean sections and other lower abdominal surgeries. Adequate postoperative analgesia provided with regional blocks allows faster postoperative recovery and better patient satisfaction. In our study, we are comparing the analgesic efficacy of laparoscopic-guided TAP block with port infiltration using a local anaesthetic in patients undergoing gynaecologic robotic surgeries.Methods:After obtaining approval from the hospital ethics committee, Central Trial Registry of India (CTRI) clearance and written informed consent from patients, this prospective double-blinded randomised control trial was conducted on patients undergoing robotic-assisted gynaecologic surgery under general anaesthesia. Group B patients received bilateral TAP block under direct laparoscopic vision with 15 ml of 0.1% ropivacaine on each side and Group C patients received routine port site infiltration with 30 ml of 0.1% ropivacaine. Postoperative pain score was measured till 24 hours, need for rescue analgesics, complications associated were noted. Independent two sample 't' test, Mann Whitney u test, Chi-square and Fisher's exact test were used for statistical analysis.Results:Pain score was significantly lower in Group B patients up to 24h (P < 0.001). The use of rescue analgesic was also significantly less in group B compared to Group C (P < 0.001). No adverse events were noted in both groups.Conclusion:Laparoscopic-guided TAP block is effective and superior to port site infiltration in providing postoperative analgesia in patients undergoing robotic-assisted gynaecologic surgery.

Laparoscopically guided transversus abdominis plane block versus local wound analgesia in laparoscopic surgery for peritoneal endometriosis: study protocol for a prospective randomized controlled double-blinded LTAP-trial

“…Thus, there is a need for effective postoperative pain management regimen with minimal side effects allowing ERAS. So far, knowledge on LTAP in gynecologic surgery is sparse and inconsistent [ 12 – 14 ]. However, data from gastrointestinal surgery, mainly from laparoscopic cholecystectomies, have shown promising results after using LTAP in postoperative analgesia [ 7 , 8 , 11 ].…”

“…In another study, a reduction in postoperative pain score measured by visual analog scale was noted even at 1 week after laparoscopic cholecystectomy with LTAP in comparison to local wound analgesia [ 11 ]. LTAP has been suggested to reduce postoperative pain and opioid need in gynecologic and endometriosis laparoscopic surgery, but the results of previously published studies have been inconsistent [ 12 – 14 ]. The purpose of this study is to investigate whether LTAP provides a post-laparoscopic opioid-sparing effect in comparison to local wound analgesia, thus diminishing opioid related side-effects and improving ERAS.…”

Comparison of laparoscopy-guided with ultrasound-guided subcostal transversus abdominis plane block in laparoscopic cholecystectomy – A prospective, randomised study

“…[ 3 12 13 ] LG TAP block has been proven to be effective in providing postoperative pain relief for other laparoscopic surgeries like colorectal surgery,[ 14 ] gynaecological laparoscopy,[ 15 ] and robotic-assisted gynaecologic surgery. [ 16 ]…”

“…They found significantly reduced pain scores and analgesic consumption for 24 h postoperatively. [ 16 ]…”

Neural blocks at the helm of a paradigm shift in enhanced recovery after surgery (ERAS)

“…[ 11 12 ] These blocks are also being currently utilised as a part of multimodal analgesia regimen in various gynaecological, obstetric procedures as well as laparoscopic bariatric surgeries. [ 13 14 15 ]…”