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

ObjectiveTo determine if transversus abdominis plane anesthetic blockage (TAP block) diminishes early postoperative pain scores and facilitates ambulatory management following total laparoscopic hysterectomy. DesignRandomized triple blind trial. SettingGynecological endoscopy unit at a referral center for laparoscopic surgery. PopulationA total of 197 patients. MethodsComparison 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 measuresPain scores at discharge 24, 48 and 72h after surgery, opioid requirement after procedure. ResultsPatients 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 24h (95% CI 1.36-0.133, p=0.237), 48h (95% CI 0.689-0.465, p=0.702) and 72h (95% CI -0.631 to 0.223, p=0.347). No differences were found between the groups regarding opioid requirements following the procedure ((2)=3.62, p=0.46). ConclusionAlthough 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.