Transversus Abdominis Plane (TAP) Blocks

Postoperative pain associated with abdominal surgeries impairs physical function, delays recovery, and decreases quality of life. Regional anesthetic techniques such as transversus abdominis plane (TAP) block and erector spinae plane (ESP) block are used to improve patients' postoperative pain experiences. PubMed, CINAHL, Google Scholar, Cochrane Library, and gray literature were searched. Mean difference (MD) and risk ratio were used to estimate continuous and dichotomous variables. Quality of evidence was analyzed using Risk of Bias and GRADE. Sixteen studies involving 934 patients were analyzed. Compared with TAP block, ESP reduced resting (MD, -0.83; 95% confidence interval [CI], -1.02 to -0.64; P < .00001) and dynamic pain intensity (MD, -0.71; 95% CI, -0.93 to -0.50; P < .00001) in the first 24 hours lowered postoperative opioid consumption (MD, -4.52; 95% CI, -5.99 to -3.04; P < .00001) and prolonged the time to first rescue analgesic (MD, 3.18; 95% CI, 2.43 to 3.93; P < .00001). However, ESP was similar to TAP block for intraoperative opioid consumption, and the incidence of nausea or vomiting. Although the ESP block provided statistical superiority over the TAP block for acute pain management, the clinical relevance of the differences was small.

The transversus abdominis plane (TAP) block is widely used to enhance postoperative analgesia after cesarean sections (CS). This study aimed to compare the effect of combining the transversalis fascia plane (TFP) block with the TAP block versus intrathecal morphine (ITM) on postoperative recovery quality assessed using the Obstetric Quality of Recovery-10 (ObsQoR-10T) score. This prospective, randomized clinical trial was conducted at a single university hospital. One hundred patients undergoing elective CS under spinal anesthesia were randomized into two groups. Group ITM received spinal anesthesia comprising 10&#xa0;mg 0.5% hyperbaric bupivacaine, 15&#xa0;&#xb5;g fentanyl, and 100&#xa0;&#xb5;g morphine. Group TAP&#x2009;+&#x2009;TFP received spinal anesthesia with 10&#xa0;mg of 0.5% hyperbaric bupivacaine and 15&#xa0;&#xb5;g of fentanyl, without intrathecal morphine. In the TAP&#x2009;+&#x2009;TFP group only, bilateral TAP and TFP blocks were performed at the end of surgery, whereas no block was administered in the ITM group. Postoperative analgesia was provided using fentanyl-based patient-controlled analgesia (PCA). The primary outcome was the ObsQoR-10T score which was assessed at 24&#xa0;h postoperatively. Secondary outcomes included opioid consumption, pain scores at rest and movement, adverse effects, and patient satisfaction. There was no significant difference between the groups regarding the total ObsQoR-10T scores (91.72&#x2009;&#xb1;&#x2009;6.46 vs. 91.56&#x2009;&#xb1;&#x2009;5.54, p&#x2009;=&#x2009;0.895). The TAP&#x2009;+&#x2009;TFP group had significantly higher fentanyl consumption at 24&#xa0;h compared to the ITM group (187.50&#xa0;&#xb5;g vs. 87.50&#xa0;&#xb5;g, p&#x2009;=&#x2009;0.005). No significant differences were found in pain scores at rest or during movement. The incidence of adverse effects and patient satisfaction rates were comparable between groups. The TAP&#x2009;+&#x2009;TFP block combination yielded a similar overall ObsQoR-10T recovery profile to ITM. Both strategies provided satisfactory analgesia and high maternal satisfaction. ClinicalTrials.gov ID: NCT06944912 retrospectively registered at clinicaltrials, principal investigator: Ali Ahiskalioglu (registration date: April 18, 2025).

Enhanced Recovery After Surgery pathways recommend transversus abdominis plane (TAP) blocks, but their efficacy is controversial and limited by the duration of local anesthetics. Liposomal bupivacaine is commonly used in single-injection TAP blocks to extend analgesia, although its effectiveness remains unclear. Therefore, two coprimary hypotheses were tested: first, that opioid consumption during the initial 24 postoperative hours is higher with saline than plain bupivacaine or liposomal bupivacaine; and second, that opioid consumption between 24 to 48&#x2009;h after surgery is comparable or greater with saline or plain bupivacaine than with liposomal bupivacaine. Patients having major abdominal surgery ( e.g. , colorectal, gynecological, hernia repairs) were enrolled and randomly assigned 1:1:1 to bilateral four-quadrant TAP blocks with liposomal bupivacaine (40&#x2009;ml plain bupivacaine 0.25% with 20&#x2009;ml liposomal bupivacaine and 20&#x2009;ml saline), plain bupivacaine (50&#x2009;ml plain bupivacaine 0.5% with 30&#x2009;ml normal saline), and placebo (80&#x2009;ml normal saline). Patient-controlled intravenous opioids were used as needed. Patients, clinicians who adjusted opioid analgesia, ward nurses who evaluated pain scores, and study investigators who evaluated local anesthetic effects were blinded to treatment groups. In the modified intention-to-treat cohort of 261 patients, opioid requirements during the first 24&#x2009;h were median [interquartile range] 26 [18, 48] milligram morphine equivalents (MME) for liposomal bupivacaine (n = 89), 33 [13, 75] MME for plain bupivacaine (n = 84), and 31 [17, 53] MME for placebo (n = 88). The estimated ratio of geometric means was 0.86 (97.7% CI, 0.60 to 1.24; P = 0.355) between liposomal bupivacaine and placebo groups, and 0.91 (97.7% CI, 0.63 to 1.32; P = 0.578) between plain bupivacaine and placebo groups. Opioid requirements between 24 and 48&#x2009;h were also comparable across groups. Secondary outcomes, including time to sensation return, pain scores, and opioid requirements from 48 to 72&#x2009;h, were similar across all groups, with no significant differences observed. Single-shot, four-quadrant TAP blocks performed with liposomal bupivacaine, plain bupivacaine, or normal saline before incision for various open and laparoscopic abdominal procedures resulted in similar postoperative opioid consumption and pain scores at 24, 48, and 72&#x2009;h. Absence of early benefit suggests that routine preincision, single-shot TAP blocks in this mixed surgical population provide little analgesia.

Obesity presents significant perioperative challenges, particularly in bariatric surgery, where optimizing pain management while minimizing opioid use is crucial. Recent advancements in regional anesthesia (RA) techniques offer potential benefits in enhancing perioperative outcomes for this high-risk population. Current evidence supports the use of RA techniques such as transversus abdominis plane (TAP) block, quadratus lumborum (QL) block, erector spinae plane (ESP) block, and intraperitoneal instillation of local anesthetics in reducing postoperative pain and opioid consumption. While TAP and ESP blocks improve postoperative analgesia, the QL block offers longer-lasting pain relief. Intraperitoneal local anesthetic administration has shown potential in decreasing opioid use and improving respiratory recovery. Additionally, port-site infiltration remains a simple yet effective alternative. However, anatomical challenges in obese patients necessitate optimized ultrasound guidance for successful block placement. RA is a key component of multimodal analgesia in bariatric surgery, contributing to reduced opioid-related complications and improved recovery. Despite promising findings, further high-quality randomized controlled trials are needed to refine technique selection and enhance clinical outcomes in this patient population.

Epidural analgesia can improve early postoperative recovery after renal transplantation. Abdominal wall blocks (transversus abdominis plane (TAP) and rectus sheath (RS)) combined with patient-controlled intravenous analgesia (PCIA) have also been shown to enhance postoperative recovery. However, it remains unclear whether these techniques are as effective as epidural analgesia (EP). In this single-centre randomized non-inferiority clinical trial, participants undergoing renal transplantation were randomly assigned to receive either a TAP + RS block (combined with PCIA) or EP alone. The primary outcome was Quality of Recovery-15 (QoR-15) scores on postoperative day (POD) 1. Secondary outcomes included haemodynamics, indices of postoperative renal function, time to interventions, and postoperative pain scores. Ninety participants were included in the analysis. The TAP + RS group demonstrated non-inferiority to the EP group in terms of the mean(standard deviation) total QoR-15 score on POD1 (90.6(5.0) versus 92.4(6.4); mean difference, -1.8; 95% confidence interval -4.2 to 0.6; P < 0.001 for non-inferiority). QoR-15 scores on POD3 and POD7 and indices of postoperative renal function were comparable between the two groups, with no group-time interactions. The EP group had significantly lower mean arterial pressure and intraoperative opioid consumption, as well as shorter times to eye opening and extubation, than the TAP + RS group. However, the intervention time was longer in the EP group (P < 0.001). TAP + RS block combined with PCIA demonstrated non-inferiority to EP for postoperative QoR-15 scores after kidney transplantation. TAP + RS block offers a potentially more convenient and favourable alternative to EP, helping maintain haemodynamic stability, postoperative renal function, and a low complication profile. ChiCTR2200056455 (https://www.chictr.org.cn).

Background/Objectives: Current literature has demonstrated the benefits of transversus abdominis plane (TAP) blocks for reducing postoperative pain and opioid consumption for an array of surgical procedures. Some randomized controlled trials and retrospective studies have compared ultrasound guidance TAP blocks completed by anesthesiologists (US-TAP) to laparoscopic guidance TAP blocks completed by surgeons (LAP-TAP). However, the findings of these studies have not been consolidated to improve recommendations and patient outcomes. Our objective is to consolidate and summarize current literature regarding the efficacy of TAP blocks for postoperative pain control and opioid consumption when performed with ultrasound guidance (US-TAP, compared to laparoscopic guidance (LAP-TAP). Methods: We performed a systematic review and meta-analysis of RCTs and retrospective studies to evaluate US-TAP versus LAP-TAP blocks for postoperative pain control and opioid consumption. We searched PubMed/MEDLINE, CINAHL, Cochrane, and Web of Science databases for all articles meeting the search criteria until the time of article extraction in February 2024. The primary outcome variables were postoperative pain scores and opioid consumption. The secondary outcome variables were complications, time taken to perform the block, length of stay (LOS) in the hospital, and cost of performing the block. Results: Of the 1673 articles initially identified, 18 studies met the inclusion criteria for evaluation. Of the included studies, 88.9% and 77.8% found no significant difference in postoperative pain scores or opioid consumption, respectively, between US-TAP and LAP-TAP groups. Six studies (33.3%) found that LAP-TAP was faster to perform than US-TAP. Meta-analysis demonstrated no statistically significant differences in postoperative pain scores or opioid consumption between groups but showed that block times were significantly longer in the US-TAP group. Conclusions: US-TAP and LAP-TAP blocks may be equivocal in terms of reducing postoperative pain and opioid consumption. LAP-TAPs may be less time-consuming and more cost-effective and viable alternatives to US-TAP blocks in the perioperative setting.

Throughout its history, there have been significant advances in pain control of inguinal hernia repairs. One of the most recent developments is locoregional pain blocks. There is a multitude of literature available on laparoscopic inguinal hernia repair and transversus abdominis plane (TAP) blocks. This paper seeks to provide a thorough and systematic literature review on the role of TAP blocks in laparoscopic inguinal hernia repairs. PubMed and Google Scholar were searched for relevant literature using predetermined medical subject heading (MeSH) terms:&#xa0;"(TAP block)" AND "(Laparoscopic inguinal hernia repair)". A total of 166 publications were identified, from which 18 publications were included in the&#xa0;final review after eligibility criteria were applied. The majority of studies conclude that TAP blocks performed in the setting of laparoscopic inguinal hernia repair improve post-operative pain and mobility, decrease opiate analgesic usage, and are superior in pain control compared to other modalities of regional anesthesia. Thus, to improve post-operative outcomes and patient satisfaction, TAP blocks should be heavily considered for routine use in surgical practice for laparoscopic inguinal hernia repair.

The transversus abdominis plane (TAP) block is a regional abdominal anaesthetic technique frequently used within non-cosmetic abdominal surgery. Its use in cosmetic abdominoplasty procedures is less frequently documented. The literature is devoid of a meta-analysis to quantitatively amalgamate the results of individual reports analysing the efficacy of TAP block compared to alternative analgesic methods in abdominoplasty surgery. The authors aimed to conduct the first meta-analysis within the literature to evaluate this technique's effectiveness in abdominoplasties. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were referred to conduct this systematic review and meta-analysis. All observational and randomised controlled trials (RCTs) comparing the postoperative outcomes of patients who underwent abdominoplasties with TAP blocks versus no TAP blocks were included in this study. The time taken to first analgesia and the amount of analgesia used were the primary outcome measures. The secondary outcome measures include severity of pain, time to mobilisation, and length of stay. Random effect modelling was used for the analysis. The time taken to the first analgesic was significantly lower in the TAP cohort (p <0.05). In addition, there was a lower incidence of postoperative nausea/vomiting(OR 0.18, 95%CI 0.04 - 0.90, p=0.04). Mean total opioid use and operative time were comparable between the TAP and no TAP groups. A qualitative review of the visual analogue scale for pain amongst the included studies showed that it was lower in the TAP group. The authors report the first meta-analysis within the literature showing the efficacy of the TAP block in abdominoplasties. Further high-quality trials are recommended to further the current evidence base.