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Application of TAP Block in Laparoscopic Urological Surgery: Current Status and Future Directions

  • Endourology (P Mucksavage and B Somani, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Amid the opioid crisis, postoperative pain management is a major challenge for practitioners. Recent pain management guidelines emphasize the importance of using regional anesthesia as part of opioid-sparing multimodal analgesia. This report aims to review recent evidence regarding the utilization of transversus abdominis plane (TAP) block in minimally invasive urologic surgery.

Recent Findings

TAP block has been shown to improve early and late pain at rest, and to reduce opioid consumption after minimally invasive surgery. These benefits have indirectly reduced the incidence of postoperative delirium, pneumonia, urinary retention, and falls. Compared to epidural analgesia, TAP block provides similar pain control, has a lower incidence of hypotension, and is associated with a shorter length of stay.

Summary

Few studies focus specifically on the outcomes of TAP block in minimally invasive urologic surgery. TAP block decreases postoperative pain and reduces opioid consumption without increasing complications. TAP block should be integrated as an indispensable component in enhanced recovery after surgery protocols.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Chughtai B, Scherr D, Del Pizzo J, Herman M, Barbieri C, Mao J, et al. National trends and cost of minimally invasive surgery in urology. Urology Practice. 2015;2(2):49–54.

    Article  Google Scholar 

  2. Jacobs BL, Lai JC, Seelam R, Hanley JM, Wolf JS Jr, Hollenbeck BK, et al. Urologic diseases in America project. Variation in the use of open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy for the treatment of ureteropelvic junction obstruction in adults. J Endourol. 2017;31(2):210–5.

    Article  Google Scholar 

  3. Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology. 2004;63(5):819–22.

    Article  Google Scholar 

  4. Gill IS, Matin SF, Desai MM, Kaouk JH, Steinberg A, Mascha ED, et al. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol. 2003;170(1):64–8.

    Article  Google Scholar 

  5. Woldu SL, Weinberg AC, Bergman A, Shapiro EY, Korets R, Motamedinia P, et al. Pain and analgesic use after robot-assisted radical prostatectomy. J Endourol. 2014;28:544–8.

    Article  Google Scholar 

  6. D’Alonzo RC, Gan TJ, Moul JW, Albala DM, Polascik TJ, Robertson CN, et al. A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy. J Clin Anesth. 2009;21:322–8.

    Article  Google Scholar 

  7. Myles PS, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth. 2000;84(1):11–5.

    Article  CAS  Google Scholar 

  8. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101(1):77–86.

    Article  CAS  Google Scholar 

  9. Jin F, Chung F. Multimodal analgesia for postoperative pain control. J Clin Anesth. 2001;13(7):524–39 Review.

    Article  CAS  Google Scholar 

  10. Alam A, Gomes T, Zheng H, Mamdani MM, Juurlink DN, Bell CM. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172(5):425–30.

    Article  Google Scholar 

  11. Royds J, Khan AH, Buggy DJ. An update on existing ongoing prospective trials evaluating the effect of anesthetic and analgesic techniques during primary cancer surgery on cancer recurrence or metastasis. Int Anesthesiol Clin. 2016;54(4):e76–83.

    Article  Google Scholar 

  12. • Zajączkowska R, Leppert W, Mika J, Kocot-Kępska M, Woroń J, Wrzosek A, et al. Perioperative immunosuppression and risk of cancer progression: the impact of opioids on pain management. Pain Res Manag. 2018;2018:9293704. Interesting review summarizing the available evidence of surgical stress and immunosuppression.

    Article  Google Scholar 

  13. Page GG, Blakely WP, Ben-Eliyahu S. Evidence that postoperative pain is a mediator of the tumor-promoting effects of surgery in rats. Pain. 2001;90(1):191–9.

    Article  CAS  Google Scholar 

  14. Mari G, Crippa J, Costanzi A, Mazzola M, Rossi M, Maggioni D. ERAS protocol reduces IL-6 secretion in colorectal laparoscopic surgery: results from a randomized clinical trial. Surg Laparosc Endosc Percutan Tech. 2016;26(6):444–8.

    Article  Google Scholar 

  15. Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence:a retrospective analysis. Anesthesiology. 2008 Aug;109(2):180–7.

    Article  Google Scholar 

  16. Tavare AN, Perry NJ, Benzonana LL, Takata M, Ma D. Cancer recurrence after surgery: direct and indirect effects of anesthetic agents. Int J Cancer. 2012;130(6):1237–50.

    Article  CAS  Google Scholar 

  17. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57.

    Article  Google Scholar 

  18. Joshi GP, Jaschinski T, Bonnet F, et al. PROSPECT collaboration. Optimal pain management for radical prostatectomy surgery: what is the evidence? BMC Anesthesiol. 2015;15:159.

    Article  Google Scholar 

  19. Chelly JE, Ploskanych T, Dai F, Nelson JB. Multimodal analgesic approach incorporating paravertebral blocks for open radical retropubic prostatectomy: a randomized double-blind placebo-controlled study. Can J Anaesth. 2011;58(4):371–8.

    Article  Google Scholar 

  20. Elkassabany N, Ahmed M, Malkowicz SB, Heitjan DF, Isserman JA, Ochroch EA. Comparison between the analgesic efficacy of transversus abdominis plane (TAP) block and placebo in open retropubic radical prostatectomy: a prospective, randomized, double-blinded study. J Clin Anesth. 2013;25:459–65.

    Article  Google Scholar 

  21. •• Cacciamani GE, Menestrina N, Pirozzi M, Tafuri A, Corsi P, De Marchi D, et al. Impact of combination of local anaesthetic wounds infiltration and ultrasound transversus abdominal plane block in patients undergoing robot-assisted radical prostatectomy: perioperative results of a double-blind randomized controlled trial. J Endourol. 2019. https://doi.org/10.1089/end.2018.0761. Randomized clinical trial comparing TAP block to local wound infiltration in patients undergoing robot-assisted radical prostatectomy.

    Article  Google Scholar 

  22. Dal Moro F, Aiello L, Pavarin P, Zattoni F. Ultrasound-guided transversus abdominis plane block (US-TAPb) for robot-assisted radical prostatectomy: a novel ‘4-point’ technique-results of a prospective, randomized study. J Robot Surg. 2019;13(1):147–151.

    Article  Google Scholar 

  23. De Oliveira GS Jr, Castro-Alves LJ, Nader A, Kendall MC, McCarthy RJ. Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials. Anesth Analg. 2014;118(2):454–63.

    Article  Google Scholar 

  24. Aniskevich S, Taner CB, Perry DK, Robards CB, Porter SB, Thomas CS, et al. Ultrasound-guided transversus abdominis plane blocks for patients undergoing laparoscopic hand-assisted nephrectomy: a randomized, placebo-controlled trial. Local Reg Anesth. 2014;7:11–6.

    Article  Google Scholar 

  25. Sammons G, Ritchey W. Use of transversus abdominis plane (TAP) blocks for pain management in elderly surgical patients. AORN J. 2015 Nov;102(5):493–7.

    Article  Google Scholar 

  26. Azawi NH, Mosholt KS, Fode M. Unilateral ultrasound-guided transversus abdominis plane block after nephrectomy; postoperative pain and use of opioids. Nephrourol Mon. 2016;8(2):e35356.

    Article  Google Scholar 

  27. Freir NM, Murphy C, Mugawar M, Linnane A, Cunningham AJ. Transversus abdominis plane block for analgesia in renal transplantation: a randomized controlled trial. Anesth Analg. 2012;115(4):953–7.

    Article  CAS  Google Scholar 

  28. Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024–6.

    Article  CAS  Google Scholar 

  29. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007;35(4):616–7.

    CAS  PubMed  Google Scholar 

  30. Hebbard P, Barrington MJ, Vasey C. Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade. Reg Anesth Pain Med. 2010;35:436–41.

    Article  Google Scholar 

  31. Belavy D, Cowlishaw PJ, Howes M, Philips F. Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery. Br J Anaesth. 2009;103:726–30.

    Article  CAS  Google Scholar 

  32. Furuya T, Kato J, Yamamoto Y, Hirose N, Suzuki T. Comparison of dermatomal sensory block following ultrasound-guided transversus abdominis plane block by the lateral and posterior approaches: a randomized controlled trial. J Anaesthesiol Clin Pharmacol. 2018;34(2):205–10.

    PubMed  PubMed Central  Google Scholar 

  33. Carney J, Finnerty O, Rauf J, Bergin D, Laffey JG, Mc Donnell JG. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia. 2011;66(11):1023–30.

    Article  CAS  Google Scholar 

  34. Desmet M, Helsloot D, Vereecke E, Missant C, van de Velde M. Pneumoperitoneum does not influence spread of local anesthetics in midaxillary approach transversus abdominis plane block: a descriptive cadaver study. Reg Anesth Pain Med. 2015;40(4):349–54.

    Article  CAS  Google Scholar 

  35. Chahar P, Cummings KC 3rd. Liposomal bupivacaine: a review of a new bupivacaine formulation. J Pain Res. 2012;5:257–64.

    PubMed  PubMed Central  Google Scholar 

  36. Hutchins JL, Kesha R, Blanco F, Dunn T, Hochhalter R. Ultrasound-guided subcostal transversus abdominis plane blocks with liposomal bupivacaine vs. non-liposomal bupivacaine for postoperative pain control after laparoscopic hand-assisted donor nephrectomy: a prospective randomised observer- blinded study. Anaesthesia. 2016;71(8):930–7.

    Article  CAS  Google Scholar 

  37. Kendall MC, Castro Alves LJ, De Oliveira G Jr. Liposome bupivacaine compared to plain local anesthetics to reduce postsurgical pain: an updated meta-analysis of randomized controlled trials. Pain Res Treat. 2018;2018:5710169.

    PubMed  PubMed Central  Google Scholar 

  38. Hamilton TW, Athanassoglou V, Trivella M, Strickland LH, Mellon S, Murray D, et al. Liposomal bupivacaine peripheral nerve block for the management of postoperative pain. Cochrane Database Syst Rev. 2016;8:CD011476.

    Google Scholar 

  39. Beachler JA, Kopolovich DM, Tubb CC, Sayeed SA. Liposomal bupivacaine in total hip arthroplasty: do the results justify the cost? J Orthop. 2017;14:161–5.

    Article  Google Scholar 

  40. Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. MASTER Anaethesia Trial Study Group. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet. 2002;359(9314):1276–82.

    Article  Google Scholar 

  41. Ganapathy S, Sondekoppam RV, Terlecki M, et al. Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery: a randomised, open-label feasibility study. Eur J Anaesthesiol. 2015;32:797–804.

    Article  CAS  Google Scholar 

  42. Wahba SS, Kamal SM. Analgesic efficacy and outcome of transversus-abdominis plane block versus low thoracic-epidural analgesia after laparotomy in ischemic heart disease patients. J Anesth. 2014;28:517–23.

    Article  Google Scholar 

  43. Baeriswyl M, Zeiter F, Piubellini D, Kirkham KR, Albrecht E. The analgesic efficacy of transverse abdominis plane block versus epidural analgesia: a systematic review with meta-analysis. Medicine. 2018;97(26).

    Article  Google Scholar 

  44. • Babazade R, Saasouh W, Naylor AJ, Makarova N, Udeh CI, Turan A, Udeh BL. The cost-effectiveness of epidural, patient-controlled intravenous opioid analgesia, or transversus abdominis plane infiltration with liposomal bupivacaine for postoperative pain management. J Clin Anesth. 2019;53:56–63. Cost effective analysis of different post-operative pain management options.

    Article  CAS  Google Scholar 

  45. Cerfolio RJ, Ferrari-Light D, Ren-Fielding C, Fielding G, Perry N, Rabinovich A, et al. Improving operating room turnover time in a New York City academic hospital via lean. Ann Thorac Surg. 2019. https://doi.org/10.1016/j.athoracsur.2018.11.071.

    Article  Google Scholar 

  46. Reinhart M, Scarpati LM, Kirson NY, Patton C, Shak N, Erensen JG. The economic burden of abuse of prescription opioids: a systematic literature review from 2012 to 2017. Appl Health Econ Health Policy. 2018;20:1–24.

    Google Scholar 

  47. Güner Can M, Göz R, Berber İ, Kaspar Ç, Çakır Ü. Ultrasound/laparoscopic camera-guided transversus abdominis plane block for renal transplant donors: a randomized controlled trial. Ann Transplant. 2015;20:418–23.

    Article  Google Scholar 

  48. Hosgood SA, Thiyagarajan UM, Nicholson HF, Jeyapalan I, Nicholson ML. Randomized clinical trial of transversus abdominis plane block versus placebo control in live-donor nephrectomy. Transplantation. 2012;94(5):520–5.

    Article  CAS  Google Scholar 

  49. Parikh BK, Waghmare VT, Shah VR, Mehta T, Butala BP, Parikh GP, et al. The analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic donor nephrectomy: a randomized controlled study. Saudi J Anaesth. 2013;7(1):43–7.

    Article  Google Scholar 

  50. Shahait M, Yezdani M, Katz B, Lee A, Yu SJ, Lee DI. Robot-assisted transversus abdominis plane block: description of the technique and comparative analysis. J Endourol. 2019. https://doi.org/10.1089/end.2018.0828.

    Article  Google Scholar 

  51. Shahait M, Hockenberry M, Wang A, McGill A, Monahan K, Elkassabany N, et al. Consistent peritoneal-to-transversus abdominis plane (TAP) depth under pneumoperitoneum enables appropriate placement of robot-assisted TAP block during robot-assisted radical prostatectomy. 36th World Congress of Endourology, September 2018, Paris.

  52. Matulewicz RS, Patel M, Jordan BJ, Morano J, Frainey B, Bhanji Y, et al. Transversus abdominis plane blockade as part of a multimodal postoperative analgesia plan in patients undergoing radical cystectomy. Bladder Cancer. 2018;4(2):161–7.

    Article  Google Scholar 

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  1. Department of Surgery, Division of Urology, University of Pennsylvania, 51 N 39th St, MOB 300, Philadelphia, PA, 19104, USA

    Mohammed Shahait & David I. Lee

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Shahait, M., Lee, D.I. Application of TAP Block in Laparoscopic Urological Surgery: Current Status and Future Directions. Curr Urol Rep 20, 20 (2019). https://doi.org/10.1007/s11934-019-0883-7

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