Ultrasound-guided transversus abdominis plane block for control of postoperative pain after laparoscopy-assisted robotic abdominal cancer surgery

Background and objective Transversus abdominis plane (TAP) block is a recently developed method for analgesia that is now widely used in a variety of abdominal surgeries. Robotic laparoscopy is being increasingly adopted for surgical resection of abdominal cancers. We studied the efficacy and safety of TAP block to control pain after robot-assisted laparoscopic abdominal cancer surgery. Methods Totally, 30 patients scheduled for robot-assisted laparoscopic abdominal cancer surgery (hysterectomy, colorectal cancer resection, or cystectomy) received general anesthesia. Before extubation the patients were randomized into two equal groups: group T, in which TAP block was performed by means of an ultrasound-guided subcostal approach, and group C (control group), in which no TAP block was performed or other regional anesthesia was induced. We measured visual analog scale (VAS) both at rest and during episodes of coughing at 1, 2, 6, 12, and 24 h postoperatively. We measured total 24 h morphine consumption, in addition to complications and postoperative nausea and vomiting. Results VAS both at rest and during coughing was lower in the T group at all time intervals until 12 h (P<0.001). At 24 h there was no significant difference in VAS but there was marked difference in the total morphine consumption between the T group (26.0±1.8) and the C group (64.3±4.3). Except for two cases of postoperative nausea and vomiting in each group there were no complications detected. Conclusion Ultrasound-guided TAP block by subcostal approach is an effective and safe method for providing analgesia that markedly reduces morphine consumption after robot-assisted laparoscopic abdominal cancer surgery