The analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic renal surgery: A randomized controlled study

Abstract

Background 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. Method 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. Results 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). Conclusion 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.

Evaluation of Analgesia Effect after Ultrasound-Guided Laparoscopic Renal Surgery

“…On the one hand, due to the noxious stimulation of tissue cells during the surgical operation, a large amount of inflammatory pain-causing substances are released from the damaged tissue, which triggers inflammatory reactions such as tissue edema. On the other hand, a series of noxious stimuli leads to increased sensitivity of nerve cells, increased response intensity to painful stimuli, and decreased pain threshold [2].…”

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

“…[18] However, the results of a recent study contradict those of previous studies. [19] Moreover, a recent meta-analysis of the analgesic effect of ultrasound-guided TAP block in laparoscopic abdominal surgery showed that TAP block had marginal postoperative analgesic effect. [20] According to the most recently published systematic review and meta-analysis of TAP blocks in urological procedures, although TAP block appears to provide improved analgesia in urological surgery, there is great heterogeneity between the findings of the included studies, and due to significant risk of bias, careful review is recommended.…”