From the Guidelines
Transversus abdominis plane (TAP) block is a safer alternative to lumbar epidural analgesia for patients with increased risk for bleeding. According to the guidelines for perioperative care in elective abdominal and pelvic surgery, TAP blocks have been shown to reduce opioid consumption, promote earlier return of bowel function, and shorten length of hospital stay in abdominal and gynecologic surgery 1. This technique is particularly useful for patients at high risk of bleeding, as it avoids the spinal canal and does not carry the risk of epidural hematoma formation. The use of TAP blocks as part of a multimodal pain management approach can help minimize the risk of bleeding complications while still providing effective pain relief. Key benefits of TAP blocks include:
- Reduced opioid consumption
- Earlier return of bowel function
- Shorter length of hospital stay
- Avoidance of spinal canal and reduced risk of epidural hematoma formation
- Can be performed using ultrasound guidance for accurate placement of anesthetic.
From the Research
Safer Alternative to Lumbar Epidural Analgesia
- The transversus abdominis plane (TAP) block is considered a safer alternative to lumbar epidural analgesia for patients with increased risk for bleeding 2, 3, 4, 5, 6.
- TAP block has been shown to provide comparable analgesia to thoracic epidural analgesia (TEA) in patients undergoing abdominal surgery, with a lower risk of hypotension and other complications 2, 5, 6.
- The use of TAP block may be particularly beneficial in patients who are at high risk for bleeding or have contraindications to epidural analgesia, such as those with coagulopathy or taking anticoagulant medications 4.
- While the evidence suggests that TAP block is a safer alternative to lumbar epidural analgesia, the choice of analgesic technique ultimately depends on the individual patient's needs and medical history, as well as the surgeon's and anesthesiologist's preferences 5, 6.
Comparison of TAP Block and Epidural Analgesia
- Several studies have compared the efficacy and safety of TAP block and epidural analgesia in patients undergoing abdominal surgery, with mixed results 2, 3, 5, 6.
- A systematic review and meta-analysis found that epidural analgesia was associated with a lower pain score at rest at 12 hours postoperatively, but there was no significant difference in pain scores at other time points 6.
- Another study found that TAP block was associated with a lower incidence of hypotension and other complications compared to epidural analgesia 5.
- The choice between TAP block and epidural analgesia should be based on a careful consideration of the individual patient's needs and medical history, as well as the potential benefits and risks of each technique 4, 5, 6.