Optimizing transversus abdominis plane blocks in colorectal surgery: methodological queries and the fundamental...

This letter to the editor critically appraises the recent trial by Li et al. evaluating liposomal bupivacaine transversus abdominis plane (TAP) blocks in laparoscopic colorectal surgery. First, we raise three methodological concerns: the complete absence of a justified sample size calculation, an implausibly large 36-point difference in Quality of Recovery-40 (QoR-40) scores that far exceeds the accepted minimal clinically important difference, and the concerning inclusion of irrelevant references to support liposomal bupivacaine. Beyond these specific queries, we address a conceptually important clinical framework. Relying on the landmark CLEVELAND trial as a counterweight, we emphasize that within a true multimodal analgesia (MMA) pathway, routine TAP blocks may offer limited incremental benefits because they primarily target somatic rather than predominant visceral pain. We strongly advocate that TAP blocks must transition from a habitual, universal protocol to highly selective, indication-based utilization; not every patient requires a TAP block.