Laparoscopic transverse abdominis plane block: how I do it and a cost efficiency analysis

Area of Science:

• Surgical Anesthesiology
• Minimally Invasive Surgery
• Pain Management

Background:

• Transverse abdominis plane (TAP) blocks are crucial for postoperative pain management in abdominal surgeries.
• Evaluating novel techniques like laparoscopic TAP (Lap-TAP) against established methods like ultrasound-guided TAP (US-TAP) is essential for optimizing surgical outcomes.

Purpose of the Study:

• To compare the efficacy and efficiency of Lap-TAP versus US-TAP in patients undergoing pancreatoduodenectomy and gastrectomy.
• To assess the impact of Lap-TAP on operative time, cost, and postoperative pain control.

Main Methods:

• Retrospective analysis of 194 patients undergoing pancreatoduodenectomy or gastrectomy between November 2018 and September 2021.
• Patients received either Lap-TAP or US-TAP.
• Comparison of operative time, associated costs, postoperative opioid use, and pain scores.

Main Results:

• The median time to skin incision was significantly shorter for Lap-TAP (45 min) compared to US-TAP (59 min) (P < 0.001).
• Lap-TAP resulted in an estimated cost reduction of $602 per procedure.
• Postoperative pain scores and opioid consumption were similar between Lap-TAP and US-TAP groups in open surgery patients.

Conclusions:

• Lap-TAP demonstrates equivalent pain control efficacy to US-TAP following pancreatectomy and gastrectomy.
• Lap-TAP offers significant advantages in reducing operative time and associated costs.
• Lap-TAP is recommended as the preferred approach for minimally invasive pancreatectomy and gastrectomy.