Tranversus abdominis plane block during abdominoplasty to improve postoperative patient comfort

Abstract

Background: The transversus abdominis plane (TAP) block is an effective regional nerve block for the anterior abdominal wall. An anesthesiologist typically administers the TAP block preoperatively with ultrasound guidance. It is not yet commonly used during abdominoplasty, where postprocedural pain remains a major concern for patients and surgeons. Objectives: The author investigated the feasibility of administering the TAP block under direct vision and compared postoperative narcotic use in patients who received analgesia by TAP block vs by a standard nerve block, both performed under direct vision during abdominoplasty with or without flank liposuction. Methods: In this pilot study, 32 consecutive patients received either a TAP block (n = 16) or a combination of pararectus injections and ilioinguinal/iliohypogastric nerve blocks (n = 16) during abdominoplasty. Patients in both groups also received an injection of bupivacaine in the rectus plication. All patients were then monitored for narcotic use patterns during the first 16 hours after surgery. Statistical significance was ascertained with the t test. Results: Patients in the TAP block group required a significantly smaller mean dose of postoperative hydromorphone (TAP block group: 2.63 mg; standard treatment group: 4.31 mg; P =.024) and had a significantly longer mean time to first request for as-needed pain medication (TAP block group: 3 hours 11 minutes; standard treatment group: 1 hour 27 minutes; P =.022). Conclusions: The open TAP block provided more effective analgesia than a standard nerve block in the observation period after abdominoplasty with or without flank liposuction. Larger studies are needed to confirm the results.