Laparoscopic Posterior Versus Lateral Transversus Abdominis Plane Block in Gynecology

Abstract

Background and Objectives: Transversus abdominis plane (TAP) block is a safe and effective type of regional anesthesia technique used in laparoscopic gynecologic surgery to minimize postoperative pain. Our study aimed to compare the analgesic effects of the posterior versus lateral approaches to laparoscopic-assisted TAP block in minimally invasive gynecologic surgery. Methods: We performed a randomized controlled trial with 82 patients allocated to either posterior (n ϭ 38) or lateral (n ϭ 44) TAP block groups. Laparoscopic-assisted posterior or lateral TAP block was administered using liposomal bupivacaine mixture. All subjects were asked to fill out a questionnaire, which included postoperative pain scores at 6 h, 12 h, 24 h, 48 h, and 72 h, as well as narcotic utilization postoperatively. Both groups were compared for postoperative pain scores, opioid consumption, perioperative, and demographic characteristics. Results: A total of 67 patients were analyzed in our study (n ϭ 33 in posterior arm, n ϭ 34 in lateral arm). Demographic characteristics including race, body mass index, comorbidities, American Society of Anesthesiologists classification, pre-operative diagnosis, complication rates, length of stay, and estimated blood loss were comparable between the two groups. The distribution of different operative procedures was similar between the two groups. There was no statistically significant difference in pain scores at 6 h, 12 h, 24 h, 48 h, and 72 h postoperatively between the two groups. However, patients receiving posterior TAP had a significant reduction in narcotic intake (p ϭ 0.0009). Conclusion: Laparoscopic-assisted TAP block is a safe and effective option for regional analgesia in laparoscopic gynecologic surgery. Posterior TAP block may help to reduce narcotic usage postoperatively.

Response to Letter to the Editor: Laparoscopic Posterior Versus Lateral Transversus Abdominis Plane Block in Gynecology

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We would like to thank Austin et al for their comments regarding our recent manuscript. 1 The authors of the letter raised concern over the use of "Doyle's internal bulge sign" as a visual indicator of correct placement of transversus abdominis plane (TAP) block during laparoscopy. Austin et al described an interesting study performed on 24 patients, who received laparoscopic-assisted TAP block followed by ultrasonographic evaluation.

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