Efficacy of laparoscopic-assisted transversus abdominus plane (LA-TAP) block for minimally invasive gynecologic surgeries (MIGS): A randomized controlled trial.

OBJECTIVE To evaluate the efficacy of laparoscopic-assisted transversus abdominus plane (LA-TAP) block for minimally invasive gynecological surgeries (MIGS).

DESIGN Randomized controlled trial.

SETTING Two hospital sites within a tertiary academic healthcare system.

PARTICIPANTS Eighty participants undergoing MIGS for benign conditions.

INTERVENTIONS Participants were randomized to either a control group that received no block (n = 40) or a LA-TAP group (n = 40) which received a standardized mixture of liposomal and plain bupivacaine. No participants received trocar site local infiltration. Primary outcomes were patient-reported average and worst pain at rest and with activity assessed 24 hours after surgery. Secondary outcomes included: (1) average and worst pain with activity assessed at 48 and 72 hours after surgery, (2) opioids used in the post-anesthesia care unit (PACU) and cumulative use after PACU discharge assessed at each 24-hour block (oral morphine milligram equivalents [OME]), (3) time to PACU discharge (4) nausea or vomiting within the first 24 hours (yes/no), and (5) satisfaction with pain regimen. Pain and satisfaction were scored on a scale of 0 to 10 (10 = highest). Outcome assessor and participants were blinded to group assignment.

RESULTS Final analyses included 34 LA-TAP participants and 30 controls. Worst pain (mean ± SD) at rest within the first 24 hours was lower in the LA-TAP group (4.8 ± 2.7) versus control (6.2 ± 2.3) (p = 0.031). Opioid use in the PACU (mean ± SD) was reduced in the LA-TAP group (13.3 ± 14.1 OME) versus control (22.5 ± 20.1 OME) (p = 0.040). There was no difference in all other pain scores, cumulative opioid use, time to PACU discharge, incidence of nausea or vomiting, or overall satisfaction.

CONCLUSION LA-TAP blocks may reduce early postoperative pain and decrease PACU use of opioids after MIGS.