Because of later marriage and postponement of childbearing, the number of fibroid cases being treated via uterine preservation procedures is increasing. Although the available choices for uterine preservation are increasing (i.e., gonadotropin releasing hormone analogs, uterine artery embolization, and focused ultrasound ablation), a myomectomy is the only well-established procedure for preservation of fertility. In order to decrease blood loss and ensure safety during a myomectomy, the most important element is prompt suturing of the myometrium. However, when we perform a laparoscopic myomectomy, several restrictions make suturing difficult (i.e., needle direction, suturing speed, and visibility

Objective: To compare a transverse abdominal plane nerve (TAP) block and epidural anesthesia in terms of effectiveness for postoperative analgesia following gynecologic laparoscopic surgery. Design: Non-randomized trialSetting: The TAP block was conducted by an anesthesiologist. With the use of ultrasound, 20 ml of 0.375% ropivacaine was injected into the right and left sides of the tissue plane between the internal oblique and the transversus abdominis muscles. In epidural anesthesia, the continuous infusion was administered at a rate of 4 ml/h of 0.375% ropivacaine using a PCA dose of 2 ml with a lock-out time of 30 min. The catheter was extracted on postoperative day 2. Pentazocine, ketoprofen, and loxoprofen sodium were used for analgesia, unless contraindications existed.Patients: The patients underwent gynecologic laparoscopic surgery at our hospital.Intervention: The patients were divided into two groups. The Epi Group received epidural anesthesia and the TAP Group received a TAP block. Using a visual analog scale (VAS) and a Prince Henry pain scale, the postoperative patient pain was separately measured at rest and at motion through postoperative day 3. The frequency of analgesic use was also monitored.Main outcome: The TAP Group had higher VAS and PRS scores than the Epi Group primarily on postoperative days 1 and 2.. Results:The TAP group comprised eight patients and the Epi Group comprised 12 patients for Epi-group. Through postoperative day 2, the pain scale scores in the TAP Group were significantly higher (Student's t-test; P < 0.05) than those of the Epi Group. The mean time for the first postoperative analgesic use was 7 h 42 min in the Epi Group and 56 min in the TAP Group. The frequency of analgesic use was significantly higher in TAP Group than in the Epi Ggroup at any postoperative time point (3, 6, and 12 h). Conclusion:The TAP block was found to be less effective than epidural anesthesia for postoperative analgesia after gynecologic laparoscopic surgery.