Transversus abdominis plane block after ambulatory total laparoscopic hysterectomy: randomized controlled trial

Abstract

Objective: To determine if transversus abdominis plane anesthetic blockage (TAP block) diminishes early postoperative pain scores and facilitates ambulatory management following total laparoscopic hysterectomy.

Design: Randomized triple blind trial.

Setting: Gynecological endoscopy unit at a referral center for laparoscopic surgery.

Population: A total of 197 patients.

Methods: Comparison of a treatment group receiving TAP block with bupivacaine 0.25% and placebo group with comparably placed bilateral injection of sterile saline solution.

Main outcome measures: Pain scores at discharge 24, 48 and 72 h after surgery, opioid requirement after procedure.

Results: Patients who had TAP block had a significant reduction in their pain score at discharge compared with the placebo group (p = 0.017). There were no significant differences in the pain scores between groups at 24 h (95% CI 1.36-0.133, p = 0.237), 48 h (95% CI 0.689-0.465, p = 0.702) and 72 h (95% CI -0.631 to 0.223, p = 0.347). No differences were found between the groups regarding opioid requirements following the procedure (χ(2) = 3.62, p = 0.46).

Conclusion: Although TAP block after a total laparoscopic hysterectomy reduced the pain score at discharge compared with placebo, its role in this setting is debatable due to the possible lack of clinical significance of the small difference found.

Keywords: Transversus abdominis plane block; hysterectomy; laparoscopy; randomized controlled trial; visual analog scale.