The transversus abdominis plane (TAP) block involves the sensory nerve supply of the anterior
-lateral abdominal wall where the T7-12 intercostal nerves, ilioinguinal, iliohypogastric and
the lateral cutaneous branches of the dorsal rami of L1-3 are blocked with an injection of
local anesthetic between the internal oblique abdominal muscle (IOAM) and the transverse
abdominal muscle(TAM)This technique allows sensory blockade of the anterolateral abdominal
wall via local anesthetic deposition superficial to the transversus abdominis muscle. It was
first described by McDonnell et al. as a landmark technique to provide analgesia for lower
abdominal surgery.
Hebbart et al. subsequently described an ultrasound guided technique for the TAP block which
they named posterior TAP block. The ultrasound allows identification of the external oblique
abdominal muscles (EOAM),IOAM and TAM. Previous studies about ultrasound -guided regional
anesthetic techniques suggest improved block quality and safety, which is primarily due to
direct visualization of the relevant anatomy, the tip of the needle, and the spread of the
local anesthetics.
Clinical trials of the single shot posterior TAP block have shown a significant reduction in
morphine consumption during the first 24-36 hours after surgery. More recently, El-dawlatly
et al. demonstrated that ultrasound guided TAP block in patients undergoing laparoscopic
cholecystectomy reduced perioperative opioid consumption by more than 50%.
This is the first study to evaluate the effect of TAP block in the quality of recovery in
patients undergoing laparoscopic hysterectomy and may help the pathway to make this an
outpatient procedure.