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

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.