The efficacy of intrafascial transversus abdominis plane block for complex anesthesia in laparoscopic surgery
Aim: to assess the efficacy and safety of 0.5% ropivacaine for ultrasound-guided transversus abdominis plane block (TAP block) in laparoscopic surgery in multidisciplinary hospital. Patients and Methods: 88 patients who underwent bilateral laparoscopic hernia repair were enrolled in this randomized study. The patients were subdivided into two groups (n=44) depending on the type of anesthesia. Mean age of the control and study group was 55.77±14.74 years and 51.61±14.61 years, respectively. In the control group, the surgery was performed under inhalation anesthesia. In the study group, the surgery was performed under inhalation anesthesia with ultrasound-guided TAP block using 20 ml of 0.5% ropivacaine bilaterally. The efficacy and safety in both groups were assessed by the need in narcotic analgetics, i.e., the severity of pain syndrome after extubation, 2 and 4 hours after the surgery. The severity of pain syndrome was evaluated using visual analogue scale (VAS). The safety of TAP block was assessed by comparing the changes in hemodynamic parameters and the incidence of post-op nausea and vomiting (PONV) in both groups. Results: the need in intra- and postoperative narcotic analgetics was significantly lower in the study group as compared with the control group. Heart rate after extubation in the study group was significantly lower as compared with the control group (p < 0.0001) thus demonstrating effective TAP block and the lack of significant pain syndrome. Pain severity assessed by VAS 2 and 4 hours after the surgery was significantly lower (p < 0.0001) as compared with the control group. PONV in both groups was similar. Conclusions: bilateral TAP block using 20 ml of 0.5% ropivacaine for bilateral laparoscopic hernia repair is an effective and safe procedure.