Does a transversus abdominis plane (TAP) local anaesthetic block improve pain control in patients undergoing laparoscopic cholecystectomy? A best evidence topic

A best evidence topic was written according to a structured protocol. The question addressed whether local anaesthetic infiltration of the transversus abdominis plane (TAP block) during a laparoscopic cholecystectomy improves pain control. Ten papers were found using the reported search, of which four represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and key results of these papers were tabulated. Three of the randomised controlled trials demonstrated a reduction in analgesic requirements associated with TAP blocks following laparoscopic cholecystectomy as compared to placebo. The remaining randomised study compared TAP blocks with local anaesthetic infiltration of laparoscopic port sites and showed no significant difference in clinical outcomes between these two techniques. We conclude that there is good evidence that TAP block in laparoscopic cholecystectomy leads to a reduction in pain scores and analgesic requirement, however there is no significant difference when compared to local anaesthetic infiltration of trocar insertion sites. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.