Rationale for the use of TAP block technique for perioperative analgesia in laparoscopic cholecystectomy

Abstract

Annotation. Acute postoperative pain is still a common unresolved health-care challenge even in highly developed countries. Insufficient postoperative pain control is associated not only with patients’ sufferings but also with increased incidence of complications (cardiovascular, thromboembolic, infectious, etc.), the development of chronic postoperative pain, delayed ambulation and discharge. Perioperative anesthesia is currently one of the main concerns in abdominal surgery. According to literature data, regional analgesia methods are widely used for anesthesia in perioperative period. Transversus abdominis plane (TAP) block proved to be a reliable regional technique of postoperative multimodal analgesia for anterior abdominal wall pain. Nowadays, ultrasound-guided TAP block techniques are considered to be a gold standard in many surgeries on anterolateral abdominal wall, producing consistent analgesia and having good safety profile. However, the quality of analgesia provided by TAP blocks under ultrasound guidance is different being influenced by the approach used. The choice between the variants of TAP block technique depends on the targeted region and the duration of nerve blockage. To date, the analgesic effect of anterior lateral abdominal wall blocks during laparoscopic cholecystectomy has not been sufficiently studied. The article provides the review of the latest advances in TAP block techniques as well as its standardized nomenclature, and suggests directions for future research. The aim was to analyze and substantiate the possibility of using regional anesthesia methods of the anterior abdominal wall by implementing the TAP-block type in the perioperative period during laparoscopic cholecystectomy. We have analyzed the current information and used the PubMed database. We have also analyzed the advantages of interstitial local anesthetic (TAP block), which primarily provides better control of pain in the anterior abdominal wall, and reduces the need for opiate and non-narcotic analgesics, the prescription of which may cause several side effects. There are many methods of the TAP-block, which to some extent depend on the pain localization in the anterior abdominal wall. For laparoscopic cholecystectomy, the most anatomically and theoretically justified is the oblique subcostal Tap-block. The use of regional techniques in laparoscopic cholecystectomy, namely the TAP-block, strategically fits into the concept of the accelerated recovery ERAS protocol, one of the purposes of which serves adequate control over the post-operative pain and early recovery.