title: Transversus abdominis plane block after ambulatory total laparoscopic hysterectomy: randomized controlled trial.
abstract: OBJECTIVE
  To determine if transversus abdominis plane anesthetic blockage (TAP block) diminishes early postoperative pain scores and facilitates ambulatory management following total laparoscopic hysterectomy.
  
  
  METHODS
  Randomized triple blind trial.
  
  
  METHODS
  Gynecological endoscopy unit at a referral center for laparoscopic surgery.
  
  
  METHODS
  A total of 197 patients.
  
  
  METHODS
  Comparison of a treatment group receiving TAP block with bupivacaine 0.25% and placebo group with comparably placed bilateral injection of sterile saline solution.
  
  
  METHODS
  Pain scores at discharge 24, 48 and 72 h after surgery, opioid requirement after procedure.
  
  
  RESULTS
  Patients who had TAP block had a significant reduction in their pain score at discharge compared with the placebo group (p = 0.017). There were no significant differences in the pain scores between groups at 24 h (95% CI 1.36-0.133, p = 0.237), 48 h (95% CI 0.689-0.465, p = 0.702) and 72 h (95% CI -0.631 to 0.223, p = 0.347). No differences were found between the groups regarding opioid requirements following the procedure (χ(2)  = 3.62, p = 0.46).
  
  
  CONCLUSIONS
  Although TAP block after a total laparoscopic hysterectomy reduced the pain score at discharge compared with placebo, its role in this setting is debatable due to the possible lack of clinical significance of the small difference found.
authors.affiliation: Gynecological Endoscopy Unit, Del Prado Clinic, CES University, Medellín, Colombia; Gynecological Endoscopy Program, CES University, Medellín, Colombia.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Calle
authors.forename: Claudia C
authors.initials: CC
authors.lastname: López
authors.forename: Enrique
authors.initials: E
authors.lastname: Sánchez
authors.forename: José F
authors.initials: JF
authors.lastname: De Los Ríos
authors.forename: Elsa M
authors.initials: EM
authors.lastname: Vásquez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Serna
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Arango
authors.forename: Juan D
authors.initials: JD
authors.lastname: Castañeda
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Vásquez
authors.forename: Antonio
authors.initials: A
authors.lastname: González
authors.forename: Alvaro
authors.initials: A
authors.lastname: Escobar
authors.forename: Luis A
authors.initials: LA
authors.lastname: Almanza
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation*; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001340:Autonomic Nerve Block / Q000379:methods; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D007267:Injections; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D017211:Treatment Failure
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine
keywords: Transversus abdominis plane block; hysterectomy; laparoscopy; randomized controlled trial; visual analog scale