Effectiveness of ultrasound-guided transversus abdominis plane block and rectus sheath block in pain control and recovery after gynecological transumbilical single-incision laparoscopic surgery

Abstract

To evaluate the effectiveness of ultrasound-guided transversus abdominis plane (TAP) and rectus sheath (RS) blocks in pain management and recovery after gynecological single-incision laparoscopic surgery (SILS). Materials and Methods: A bilateral TAP block (Group A, n=9), bilateral TAP and RS blocks (Group B, n=10), and a bilateral RS block (Group C, n=9) with 40 ml ropivacaine per patient were conducted in 28 patients undergoing SILS for ovarian tumors. A pain score and walking distance in a 6-minute walk test (6MWT) were examined. Results: Pain scores were significantly lower on postoperative day (POD) 3 than on POD 1 in Groups B (p = 0.03) and C (p = 0.02). The walking distance on POD 3 was comparable with that before surgery in Group C (p = 0.75), but shorter in Groups A (p = 0.004) and B (p = 0.02). Conclusions: The RS block alone was the most effective in relieving pain and accelerating general recovery after gynecological SILS.

Historical Changes in Anesthesia Practice for Laparoscopic Gynecological Surgery at Juntendo University Hospital – A Retrospective Observational Study Focusing on Factors Affecting the Incidence of Postoperative Nausea and Vomiting

“…Multimodal analgesia was not used during the study period, whereas multimodal analgesia, e.g. employing rectus abdominis sheath block as well as transversus abdominis plane block 15) , and intravenous acetaminophen 16) , is now commonly used to reduce postoperative requirements of opioids and thus to reduce the incidence of PONV. During the study period, vecuronium was commonly used as a muscle relaxant, whereas recently, shorter-acting rocuronium is commonly used.…”