Laparoscopic-assisted Transversus Abdominis Plane (TAP) Block in Patient Undergoing Laparoscopic Gynecologic Surgery: Randomized Controlled Trial

Study Objective To compare the analgesic efficacy of laparoscopic-assisted posterior Transversus Abdominis Plane (TAP) block versus lateral TAP block for post-operative pain control in patients undergoing laparoscopic gynecologic surgeries. Design Prospective randomized trial. Setting Patients undergoing laparoscopic/robotic gynecology surgeries. Patients or Participants 80 patients were randomly assigned to laparoscopic-assisted lateral (mid-axillary) TAP block and posterior TAP block. Total sample size of 80 patients with considering 10 % drop out rate, gives 85 % power (two-sided alpha =0. 05) to detect a difference of 0.7 in pain score. Interventions Laparoscopic-assisted TAP block with liposomal Bupivacaine and Bupivacaine HCL 0.5% mixed in ratio of 1:2 in milligram. We randomized patients posterior approach injection was applied in triangle of petit versus in lateral TAP block injection was performed in mid axillary line between iliac crest and lower coastal margin. Opioid consumption and Numeric Pain Rating Score (NPRS 0 to 10) were recorded at 6, 12, 24, 48 and 72 hours post-operatively. Measurements and Main Results patients in the posterior TAP block group was older than the lateral TAP block group (P-Value: 0.03). There was no difference in terms of race, BMI, ASA classification and comorbidities between two groups. Length of surgery was longer in lateral group (P-value: 0.02). There was no difference in terms of type of procedure. Patients in posterior group had less pain score at 6 h, 12h, 24h, 48h and 72 h post-operative, and they significantly used less narcotic during the first 3 days after surgery (p-value:0.009) Conclusion Laparoscopic-assisted TAP block is a new and safe technique for multimodal pain management. Posterior TAP block provides better analgesia than lateral TAP block for laparoscopy gynecologic surgeries. Posterior TAP block significantly reduces the total amount of narcotics used by patients in post-operative course.