Effect of transversus abdominis plane block on the quality of recovery in laparoscopic nephrectomy: A prospective double-blinded randomized controlled clinical trial

Background: Poorly controlled acute postoperative pain after laparoscopic nephrectomy may adversely affect surgical outcomes and increase morbidity rates. In addition, excessive use of opioids during surgery may slow postoperative endocrine and metabolic responses and cause opioid-related side effects and opioid-induced hyperalgesia. The purpose of this study was to evaluate the effect of ultrasound-guided transversus abdominis plane (TAP) block on the postoperative quality of recovery and intraoperative remifentanil requirement in laparoscopic nephrectomy. Methods: Sixty patients who underwent laparoscopic nephrectomy were randomly divided into 2 groups: TAP and Control groups. After induction of anesthesia and before awakening from anesthesia, the TAP group was administered 40 mL of 0.375% ropivacaine and the Control group was administered 40 mL of normal saline to deliver ultrasound-guided TAP block using 20 mL of each of the above drugs. The main objectives of this study were to evaluate the effect of the TAP block on quality of recovery using the Quality of Recovery 40 (QoR-40) questionnaire and assessments of intraoperative remifentanil requirement. In addition, to evaluate the postoperative analgesic effect of the TAP block, the total usage time for patient-controlled analgesia (PCA) and the number of PCA bolus buttons used in both groups were analyzed. Results: The QoR-40 score, measured when visiting the ward on the third day after surgery, was significantly higher in the TAP group (171.9 +/- 23.1) than in the Control group (151.9 +/- 28.1) (P = .006). The intraoperative remifentanil requirement was not significantly different between the groups (P = .439). In the TAP group, the frequency of bolus dose accumulation at 1, 2, 3, 6, 12, 24, 48, and 72 hours after surgery was low enough to show a significant difference, and the total usage time for PCA was long enough to show a significant difference. Conclusion: In conclusion, we determined that ultrasound-guided TAP block during laparoscopic nephrectomy improves the quality of postoperative recovery and is effective for postoperative pain control but does not affect the amount of remifentanil required for adequate anesthesia during surgery.