The role of transversus abdominis plane blocks in women undergoing total laparoscopic hysterectomy: A retrospective review

Introduction:  The transversus abdominis plane (TAP) local anaesthetic block is beneficial in patients undergoing open pelvic surgery; however, there are no data on its use in women undergoing laparoscopic gynaecologic surgery. Methods:  Successive women undergoing TLH were included in this review. All women had local anaesthetic infiltration at the site of port placement and, in addition, received multimodal post-operative analgesia. Results:  Sixty-one successive cases were included in the study: 20 had a TAP block and 41 were managed without any blocks. The groups were comparable with respect to age, body mass index, Eastern Co-operative Group performance status, type of operation, cancer status, surgical and anaesthetic time. Women with a TAP block had a significantly shorter length of stay (1.45 vs 2.20 days, P = 0.014), lower total peri-operative and post-operative opioid use (12 vs 19 mg in morphine equivalents, P = 0.014; 11 vs 21 mg, P = 0.05) when compared with those without a TAP block. Multivariate analysis identified patient age and a TAP block with a shorter length of stay (P < 0.001 and P = 0.015, respectively). Total opioid use was only significantly correlated with a TAP block (P = 0.005). There were no complications related to a TAP block. Conclusion:  A TAP block in women undergoing TLH results in significantly shorter length of stay and lower opioid use. The retrospective nature of this trial and the absence of data on pain scores and nausea and vomiting are best addressed by a large prospective study.