title: The analgesic efficacy of ultrasound-guided transversus abdominis plane block with mid-axillary approach after gynecologic laparoscopic surgery: A randomized controlled trial.
abstract: OBJECTIVE
  The transversus abdominis plane (TAP) block is widely used in clinical practice as a part of the multimodal analgesic regimen after abdominal surgery. The analgesic efficacy of ultrasound (US)-guided TAP block with the mid-axillary approach was investigated in patients undergoing laparoscopic gynecologic surgery in a randomized controlled clinical trial.
  
  
  METHODS
  Adult patients (n = 119) undergoing laparoscopic gynecologic surgery were randomized to undergo either TAP block with ropivacaine (Group A, n = 60) or that with saline (Group B, n = 59), in a blinded manner. Following general anesthesia, TAP block was performed bilaterally by infusion of either 20-mL 0.375% ropivacaine/one side in Group A or 20-mL saline/one side in Group B, under US guidance with a mid-axillary approach. Patient-controlled analgesia (PCA) was performed postoperatively with tramadol. The analgesic effect was postoperatively evaluated using a four-grade pain score and the prince Henry pain scale (PHS) at 0, 6, 12, and 24 h. Postoperative tramadol PCA consumption and vomiting/nausea were recorded. Statistical analyses were performed using the Mann-Whitney U-test or Fisher's exact probability test. A P < 0.05 was considered significant.
  
  
  RESULTS
  There was no statistically significant difference in background characteristics. The dose of remifentanil was significantly higher in Group B (P = 0.01). The pain score (P = 0.02) and PHS (P = 0.01) were significantly lower in Group A at 0 h. Tramadol PCA consumption in the period of 0-6 h (P = 0.01) and postoperative nausea (P = 0.04) were significantly less in Group A.
  
  
  CONCLUSIONS
  Postoperative pain/nausea and PCA consumption were significantly lower in patients with TAP block in the early postoperative stage. TAP block with a mid-axillary approach holds considerable promise as a part of a balanced postoperative analgesic regimen following laparoscopic gynecologic surgery.
authors: Department of Anesthesiology and Palliative Care, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan.
authors: Ryoko
authors: R
authors: Kawahara
authors: Department of Anesthesiology and Palliative Care, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan.
authors: Yutaka
authors: Y
authors: Tamai
authors: Department of Anesthesiology and Palliative Care, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan.
authors: Kyoko
authors: K
authors: Yamasaki
authors: Department of Anesthesiology and Palliative Care, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan.
authors: Satoko
authors: S
authors: Okuno
authors: Department of Anesthesiology and Palliative Care, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan.
authors: Rumi
authors: R
authors: Hanada
authors: Department of Obstetrics and Gynecology, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka - 550 - 0012, Japan.
authors: Takao
authors: T
authors: Funato
keywords: Anesthetic technique; laparoscopic surgery; transversus abdominis plane block; ultrasound