Ultrasound-guided lateral transversus abdominis plane (TAP) block can provide definite analgesia to the anterior abdominal wall. However, whether it is useful in renal surgery involving access through the lateral abdominal wall remains unknown. Therefore, the study was aimed at evaluating the analgesic efficacy of lateral TAP block for retroperitoneoscopic partial or radical nephrectomy.
In this prospective, randomized, double-blind, placebo-controlled trial, eligible patients were randomized into the intervention (T) and control (C) groups. After anesthesia induction, ultrasound-guided lateral TAP block was performed preoperatively with 30 mL of 0.4% ropivacaine and an equivalent amount of normal saline in groups T and C, respectively. The primary outcomes were opioid consumption during surgery and in the first 24 h after surgery. Secondary outcomes were postsurgical pain intensity at immediately awakening from anesthesia, and 0.5, 1, 2, 6, 12, 24 h after surgery, and recovery quality variables including the incidence of postoperative nausea and vomiting (PONV), sleep quality, time to first ambulation, drainage in the first 24 h after surgery, and length of hospital stay.
104 patients were enrolled and randomized: 53 and 51 in groups T and C, respectively. The median intraoperative sufentanil and remifentanil and postoperative sufentanil consumption per kilogram in the first 24 h after surgery was 0.33, 9.02, and 0.57 μg in Group T, respectively; the corresponding values in Group C were 0.30, 9.58, and 0.48 μg, all of which were not significant (p = 0.528, 0.903, and 0.244). Postsurgical pain intensity at all time points was comparable between the groups (all p > 0.05). Intergroup differences in recovery quality variables were not significant (all p > 0.05).
Our findings demonstrated that preoperative lateral TAP could not decrease intraoperative and postoperative opioid consumption and pain intensity in the first 24 h after surgery, nor could it promote postoperative recovery in patients undergoing laparoscopic renal surgery through retroperitoneal access.