Transversus abdominis plane block under laparoscopic guide versus port‐site local anaesthetic infiltration in laparoscopic excision of endometriosis: a double‐blind randomised placebo‐controlled trial

Abstract

ObjectiveTo compare the efficiency of laparoscopically guided transversus abdominis plane block (LTAP) versus port‐site local anaesthetic infiltration (LAI) in reducing postoperative pain following laparoscopic excision of endometriosis.DesignA prospective, double‐blind randomised controlled trial.SettingA tertiary referral centre for endometriosis and minimally invasive gynaecological surgery.PopulationWomen undergoing laparoscopic excision of endometriosis from December 2015 through July 2016.MethodsParticipants were randomised to receive: port‐site infiltration with bupivacaine and placebo LTAP (LAI group, n = 21); placebo port‐site infiltration and LTAP with bupivacaine (LTAP group, n = 24); placebo port‐site infiltration and placebo LTAP (placebo group, n = 25).Main outcome measuresPost‐operative pain at 2–4, 6–8, 10–12 and 24 hours, analgesic requirements, TAP block‐related complications and opioid‐related adverse effects.ResultsThere were no differences in patient characteristics between the groups. In comparison with placebo, both LTAP and LAI groups had significantly less pain at 2–4, 6–8, and 10–12 hours (median 3, 3, 3.5 versus 3, 6, 4 versus 8, 8, 7 for LTAP, LAI, and placebo, respectively, P < 0.05). Median differences (and 95% confidence intervals) were as follows; LTAP versus placebo −5 (−6 to −4), −4 (−5 to −3), −3 (−4 to −0.5); LAI versus placebo −4 (−5 to −2), −2 (−3 to −0.5), −1 (−4 to −0.5) at 2–4, 6–8 and 10–12 hours, respectively. There were no statistically significant differences between the LTAP and LAI groups.ConclusionsLaparoscopically guided transversus abdominis plane block and LAI both reduce postoperative pain in patients undergoing laparoscopic excision of endometriosis, compared with placebo. We found no differences in effect between LTAP and LAI.Tweetable abstractTAP block and port‐site local infiltration are both effective in reducing postoperative pain in major gynaecological laparoscopic surgery.

Transversus Abdominis Plane Block versus Wound Infiltration with Conventional Local Anesthetics in Adult Patients Underwent Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…The details of the methodological risk of bias assessment are presented in graphic and summary forms (Figures 2 and 3). In summary, 7 RCTs [10,15,17,20,[22][23][24] had a low risk of bias, and 8 RCTs [11-14, 16, 18, 19, 21] had an unclear risk of bias. The main reasons for the 8 RCTs having an unclear risk of bias were due to a failure to mention the following factors: randomization sequence generation, allocation concealment, blinding of participants and personnel, and blinding of outcome assessment.…”

“…BioMed Research International including general surgeries [10][11][12][13][14][15][16], gynecological and obstetric surgeries [17][18][19][20][21][22], urinary surgeries [23], and nephrology surgeries [24].…”

Comparative Study of Postoperative Analgesic Effects of Intraoperative Levobupivacaine Local Infiltration Anesthesia and Transversus Abdominis Plane Block Following Gynecologic Laparoscopy

“…While studies suggest that these two intraoperative anesthetic methods could reduce postsurgical pain in gynecologic laparoscopic surgeries, only two studies from the US and Europe have reported that postsurgical pain outcomes comparing TAP and LA in gynecological laparoscopic surgeries and its effects on postoperative pain remain inconclusive. [ 9 10 ] Therefore, we conducted the first study to compare postoperative analgesic effects of intraoperative levobupivacaine local infiltration anesthesia and TAP block following gynecologic laparoscopy in Japanese population.…”

Laparoscopic Posterior Versus Lateral Transversus Abdominis Plane Block in Gynecology

“… 13 – 14 Furthermore, the efficacy of laparoscopic TAP block was also compared to port-site injections in a number of studies, which showed mixed results, warranting continued investigation. 15 – 17 TAP block-related complications are extremely rare, including transient femoral nerve palsy, anesthetic systemic toxicity, bowel hematoma, and liver laceration. 18 – 19 Prior studies have shown that the majority of TAP block complications resulted from incorrect needle placement and suggested lower complications with direct visualization.…”