The Effect of Abdominal Insufflation on Transversus Abdominis Plane (TAP) Block Efficacy in Laparoscopic Gynecologic Surgery

Introduction: Approximately 15 million laparoscopic procedures are performed annually worldwide, with 4.8 million (32%) occurring in the United States. Laparoscopy is widely used for procedures such as bilateral tubal sterilizations, hysterectomies, and treatments for endometriosis and adhesions. During gynecologic laparoscopic surgeries, the abdomen is inflated with pressurized carbon dioxide for surgical visualization. Pain management typically involves a transversus abdominis plane (TAP) block, which provides intermediate postoperative pain relief (lasting 12–24 hours). This study evaluates the efficacy of TAP blocks performed during insufflation to improve postoperative pain outcomes compared to the traditional technique. Methods: This patient-blinded study included female gynecologic patients aged 18–85 undergoing laparoscopic procedures at Harper University Hospital or Detroit Receiving Hospital. Patients using opioid medications or those allergic to local anesthetics were excluded. Participants were randomized into two groups: (1) TAP blocks performed intraoperatively with an insufflated abdomen (Insufflated OR) and (2) TAP blocks performed postoperatively with a non-insufflated abdomen in the PACU (Non-Insufflated PACU). Statistical analyses included Student’s t-test and repeated measures ANOVA for continuous variables and Fisher’s Exact test for categorical data, with significance set at p ≤ 0.05. Results: Contrary to the hypothesis, TAP blocks in the OR were not quicker and easier to perform compared to those in the PACU. While the OR group demonstrated better early postoperative pain control, the PACU group was more effective for later pain management, as reflected by reduced opioid consumption. Both groups achieved high patient satisfaction, with scores exceeding 85%. Discussion: Both approaches provided effective postoperative pain relief and high patient satisfaction. However, no operator advantage was observed for TAP blocks performed in an insufflated abdomen in the OR. Anecdotal observations suggest that OR TAP blocks may benefit nervous patients by providing superior early pain control. Conversely, PACU TAP blocks were more effective for managing later pain, as evidenced by lower opioid use at 24 hours.