The Bilateral Tap-Block Ultrasound-Guided in Laparoscopic Abdominal Surgery: Evaluation of a Curare-Free Anaesthetic Protocol

Abstract

Introduction: The transverse abdominal plane block or TAP block consists of injecting a local anaesthetic between the internal oblique and transverse muscles. Its contribution to muscle relaxation during laparoscopic surgery has been little studied. Material and Method: We carried out a 2-years prospective, descriptive and analytical randomised study blinded to the surgeon conducted in the operating theatre of the Saint Louis Regional Hospital Centre. Patients were randomised into two groups: those who received vecuronium after rapid sequence induction (group V) and those who received bilateral TAP block without curares (group T). Anamnestic, clinical, anaesthetic, surgical and evolutionary aspects were collected and analysed. The main evaluation criteria were: pneumoperitoneum pressure, exhaled CO2, respiratory motor pressure and surgeon satisfaction scale. Results: We collected 61 patients admitted for laparoscopic abdominal surgery. The mean age was 32.9 years with a standard deviation of 14.5. Appendicitis was the indication in 55% of cases. The Propofol-celocurine-TAP-block anaesthetic protocol was used in 25 patients, i.e. in 41% of cases, and 59% of patients had undergone a conventional induction using vecuronium. The mean pressure of the pneumoperitoneum was 11.3 mmHg for the conventional induction group and 12.6 mmHg for the TAP-block group. The mean respiratory motor pressures were 12 cmH2O for the conventional induction group and 13.7 cmH2O for the TAP-block group. The mean value of exhaled CO2 was 37.5 mmHg. Fentanyl reinjections were more frequent in the conventional induction group in 55.6% of cases. The mean VAS at 6 hours post-op was 4.5 for the conventional induction group and 3 for the TAP-block group. Discussion/Conclusion: The ultrasound-guided trans-abdominal-pelvic block remains an effective, durable and reproducible technique. Its advantages in terms of postoperative analgesia are well known. In addition, its selective effects on muscle ......