Laparoscopic Transverse Abdominis Plane Block

Abstract

<h3>Study Objective</h3> To describe a technique for laparoscopic application of a transverse abdominis plane (TAP) block. <h3>Design</h3> Video description of a laparoscopic technique in a single patient. <h3>Setting</h3> Standard operating room equipped for laparoscopic procedures. <h3>Patients or Participants</h3> Single patient undergoing total laparoscopic hysterectomy for uterine fibroids and abnormal uterine bleeding. <h3>Interventions</h3> The patient was positioned in lithotomy in Trendelenburg position to allow adequate visualization of pelvic organs. After completion of surgery, a transverse abdominis plane block was performed using 30 ml of a 1:1 mixed solution of 0.25% bupivacaine hydrochloride and 1.3% liposomal bupivacaine injected with a 22-gauge spinal needle in a space between the internal oblique and transversus abdominis muscles. The following landmarks were used to identify the insertion site externally: anterior superior iliac spine and the inferior costal margin at the level of the anterior axillary line. Direct laparoscopic visualization of the injection site was obtained to monitor development of a bulge underneath the peritoneum and transverse abdominis muscle, first by creating a peritoneal blister, followed by a bulge (Doyles bulge). The procedure was repeated in the contralateral side by the assisting surgeon. The total time of procedure is usually 1 minute or less on each side. <h3>Measurements and Main Results</h3> The patient required no opiate analgesia in the immediate postoperative period. Her pain was adequately managed with non-steroidal anti-inflammatory medication. The patient was discharged home the same day of the procedure. During a telephonic follow-up two days after the surgery, patient reported no use of opiates for pain control. <h3>Conclusion</h3> Laparoscopic transverse abdominis plane block is a quick and effective method of postoperative pain control, consistent with ERAS protocols. Further, studies have shown TAP block to provide superior pain relief and reduced opiate use in the postoperative period.^{1, 2.}