Transversus abdominis plane block as a component of multimodal anesthesia in laparoscopic nephrectomy

Background. The relevance of the study is due to the need to improve the quality of pain relief in the early postoperative period within the framework of the concept of early recovery after surgical treatment (ERAS). The study and optimization of a multimodal approach to pain management, including transversus abdominis plane blockade (TAP block), is essential to improve surgical outcomes and expedite patient recovery.

Aim. To evaluate the effectiveness and safety of using TAP block for postoperative analgesia during laparoscopic nephrectomy.

Materials and methods. The study involved 44 patients divided into two groups: 20 patients with TAP block (group 1) and 24 patients without block (group 2, control). The primary endpoint was the intensity of pain syndrome according to the visual analog scale, the secondary ones were the need for analgesics, restoration of peristalsis, the presence of nausea and vomiting, and the time of patient activation.

Results. The analysis showed a statistically significant superiority of the TAP-block group in terms of pain syndrome at all time-points of follow-up (1, 3, 6, 12 and 24 hours after surgery). The average time to the first use of analgesics was 42 ± 4 hours in the blockage group versus 19.0 ± 1.9 hours in the control group. The frequency of postoperative nausea and vomiting was significantly lower in the group with TAP block (19.4 % vs. 47.4 %, p = 0.003).

Conclusion. TAP block demonstrated a pronounced analgesic effect in absence of complications. The method made it possible to provide longer-lasting analgesia, reduce the need for additional analgesics and the frequency of postoperative nausea and vomiting compared with the traditional method of anesthesia.

1. Tran D.Q., Bravo D., Leurcharusmee P., Neal J.M. Transversus abdominis plane block: a narrative review. Anesthesiology 2019;131(5):1166–90. DOI: 10.1097/ALN.0000000000002842

2. Tsai H.C., Yoshida T., Chuang T.Y. et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int 2017;2017:8284363. DOI: 10.1155/2017/8284363

3. Iaquinandi F., Mongelli F., Christoforidis D. et al. Laparoscopic vs. ultrasound-guided transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis of randomized trials. Surg Endosc 2024;38(3):1119–30. DOI: 10.1007/s00464-023-10658-x

4. Terranova C., Schiavoni L., Ficarola F. et al. The role of TAP/RS block in minor gynecologic laparoscopic surgery: a randomized clinical trial. Gynecol Obstet Invest 2024;89(2):103–10. DOI: 10.1159/000535835

5. Johns N., OʼNeill S., Ventham N.T. et al. Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: a systematic review and meta-analysis. Colorectal Dis 2012;14(10):e635–42. DOI: 10.1111/j.1463-1318.2012.03104.x

6. Cacciamani G.E., Menestrina N., Pirozzi M. et al. Impact of combination of local anesthetic wounds infiltration and ultrasound transversus abdominal plane block in patients undergoing robot-assisted radical prostatectomy: perioperative results of a double-blind randomized controlled trial. J Endourol 2019;33(4):295–301. DOI: 10.1089/end.2018.0761

7. Aniskevich S., Taner C.B., Perry D.K. et al. Ultrasound-guided transversus abdominis plane blocks for patients undergoing laparoscopic hand-assisted nephrectomy: a randomized, placebo-controlled trial. Local Reg Anesth 2014;7:11–6. DOI: 10.2147/LRA.S61589

8. Ripollés J., Mezquita S.M., Abad A., Calvo J. Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane – a systematic review. Braz J Anesthesiol 2015;65(4):255–80. DOI: 10.1016/j.bjane.2013.10.016

9. Guner C.M., Goz R., Berber I. et al. Ultrasound/laparoscopic camera-guided transversus abdominis plane block for renal transplant donors: a randomized controlled trial. Ann Transplant 2015;20:418–23. DOI: 10.12659/AOT.893926

10. Parikh B.K., Waghmare V.T., Shah V.R. et al. The analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic donor nephrectomy: a randomized controlled study. Saudi J Anaesth 2013;7(1):43–7. DOI: 10.4103/1658-354X.109808