Application of TAP Block in Laparoscopic Urological Surgery: Current Status and Future Directions - Beyond the Abstract

There is evidence emerging that the implementation of enhanced recovery after surgery (ERAS) protocols, as well as opioid-sparing multimodal pain control (including regional anesthesia), might improve perioperative outcomes. In this review, we sought to explore the role of the transversus abdominis plane (TAP) block in minimally invasive urological surgeries.

We were intrigued by the paucity of the data about utilizing TAP block in urology literature. The available data shows that TAP block is an effective pain control modality for early pain and might reduce postoperative opioid consumption after minimally invasive urologic surgery. Our study is unique in that our TAP block is administered laparoscopically and can be performed under direct vision in literally 2 minutes as compared to the alternative standard which is ultrasound-guided percutaneous injection.

Also, we identified the need for clinical trials comparing the effectiveness of different regional anesthetic techniques. Such clinical trials should include the ERAS protocols as an integral component of the study design. Moreover, these trials should identify novel outcome measures, such as patient mobility, functional recovery, inflammatory biomarkers, circulating tumor cells, response to immunotherapy, and disease recurrence. Future studies involving TAP block should focus on identifying the most effective location and timing of local anesthetic injection.

Written by: David Lee, MD, FACS and Mohammed Shahait, MBBS, Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania

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