The goal of this study was to compare the efficacy of an ultrasound-guided block (US-Tap) and laparoscopically-guided transversus abdominis plane block (Lap-Tap) with liposomal bupivacaine in the treatment of postoperative pain in gynecological cancer patients undergoing robotic surgery. Patients were randomly assigned to 1 of 2 groups in this prospective randomized controlled trial: Cohort 1 received a US-Tap of liposomal bupivacaine before the procedure, while Cohort 2 had a Lap-Tap of the same drug under laparoscopic visualization. In the first 3 days following surgery, primary outcomes included pain scores and total opioid use measured in Oral Morphine Equivalents (OME). Both patient-reported pain intensity and the requirement for oral narcotics following surgery were considered secondary outcomes. When comparing the first 24 hours of oral narcotic use between the Lap-Tap and US-Tap groups, there was a significant increase in the US-Tap group. The US-Tap group averaged 12.69 ± 12.94, P=0.018, while the Lap-Tap group averaged 6.73±8.22 OME. The increase was the same as taking an extra Hydrocodone-Acetaminophen 7.5 mg/325 mg tablet within the 1st 24 hours following surgery. In contrast, there was little difference between the 2 groups regarding the total amount of oral narcotics used over the 1st 72 hours Lap-Tap mean equals 21.73 ± 19.83 OME, US-Tap mean equals 32.50±29.47, P=0.062 OME.  Finally, after 24 hours, 48 hours, and 72 hours, there was no discernible difference in pleasure or discomfort between the US-Tap and Lap-Tap groups. When it comes to postoperative analgesia in the 1st 72 hours after robotic-assisted gynecologic cancer surgery, Lap-Taps are on par with US-Taps.

Source: sciencedirect.com/science/article/pii/S0090825822004061