Functional recovery after two-stage laparoscopic transversus abdominis plane block (L-TAP block) in patients with bowel resection

<title>Abstract</title> <p>Introduction: Functional recovery is a combined endpoint that measures how quickly patients regain their everyday abilities after surgery. The two-stage laparoscopic transverse abdominis plane block (L-TAPB) can generate advantages beyond pain optimisation. The aim of this study was to optimise functional recovery in laparoscopic intestinal surgery through correctly applied two-stage L-TAPB. Methods Between April 2021 and April 2022, 62 patients underwent elective intestinal surgery were included. Standard L-TAPB was a two-stage bilateral L-TAPB with 266 mg bupivacaine at the beginning and end of the operation according to SOP (Standard Operating Procedure). The actual implementation was observed in the operating theatre and divided into correct (Corr-TAPB) and incorrect L-TAPB (Incorr-TAPB). Patients underwent laparoscopic intestinal surgery were examined one hour postoperatively and daily at 8 a.m. and 8 p.m. for three days. In addition to the pain scale (NRS), mobility, bowel movements, nutrition and satisfaction were evaluated. From this, a combined endpoint of NRS score &lt; 3, mobility in the room, successful bowel movements and tolerance of a light full diet was defined as successful functional recovery. Results 62 patients were included (InCorr-TAPB = 13; Corr-TAPB = 49). The causes of an incorrect TAP were an incorrect local anaesthetic or dilution, incorrect positioning, lack of laparoscopic visual control or only one L-TAPB being performed. In the recovery room, patients with a correct L-TAPB reported a significantly lower median NRS (1 vs. 4; p = 0.045), as well as on the third day at 8 a.m. (0 vs. 2; p = 0.026). Satisfaction at the last point of evaluation, on the third day at 8 p.m., was also significantly better in terms of subjective recovery (p = 0.006) and pain (p = 0.05). In the combined endpoint, Corr-TAPB performed significantly better than InCorr-TAPB on the morning of the third postoperative day: 86% of patients with Corr-TAPB and only 54% in the InCorr-TAPB group achieved the defined goals (p = 0.021). Discussion The correct performance of the two-stage L-TAPB not only led to better pain relief, but also to advantages in functional recovery and patient satisfaction within the first three postoperative days. With L-TAPB, continuous attention should be paid to the correct dosage, injection under laparoscopic view and the second administration before removing the trocars.</p>