Transversus abdominis block (TAP) as a strategy for effective pain management in patients with pain during laparoscopic cholecystectomy: a systematic review

Abstract: Laparoscopic cholecystectomy (LC), unlike laparotomy, is an invasive surgical procedure, and some patients report mild to moderate pain after surgery. Transversus abdominis plane
(TAP) block has been shown to be an appropriate method for postoperative analgesia in patients
undergoing abdominal surgery. However, there have been few studies on the efficacy of TAP block
after LC surgery, with unclear information on the optimal dose, long-term effects, and clinical significance, and the analgesic efficacy of various procedures, hence the need for this review. Five
electronic databases (PubMed, Academic Search Premier, Web of Science, CINAHL, and Cochrane
Library) were searched for eligible studies published from inception to the present. Post-mean and
standard deviation values for pain assessed were extracted, and mean changes per group were
calculated. Clinical significance was determined using the distribution-based approach. Four different local anesthetics (Bupivacaine, Ropivacaine, Lidocaine, and Levobupivacaine) were used at
varying concentrations from 0.2% to 0.375%. Ten different drug solutions (i.e., esmolol, Dexamethasone, Magnesium Sulfate, Ketorolac, Oxycodone, Epinephrine, Sufentanil, Tropisetron, normal
saline, and Dexmedetomidine) were used as adjuvants. The optimal dose of local anesthetics for
LC could be 20 mL with 0.4 mL/kg for port infiltration. Various TAP procedures such as ultrasound-guided transversus abdominis plane (US-TAP) block and other strategies have been shown
to be used for pain management in LC; however, TAP blockade procedures were reported to be the
most effective method for analgesia compared with general anesthesia and port infiltration. Instead of 0.25% Bupivacaine, 1% Pethidine could be used for the TAP block procedures. Multimodal
analgesia could be another strategy for pain management. Analgesia with TAP blockade decreases
opioid consumption significantly and provides effective analgesia. Further studies should identify
the long-term effects of different TAP block procedures.