Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims Even though the robotic-assisted approach to the abdominal cavity is less invasive than conventional laparotomy, postoperative pain may still affect early recovery after gynaecological surgery. Transversus Abdominis Plane (TAP) block has been studied for robotic gynaecological surgery with inconsistent results. We performed a review of the literature to evaluate the effect of TAP block in postoperative pain following robotic-assisted gynaecologic surgery.

Methods We searched PubMed, Embase and MEDLINE using the key words gynaecology, surgery, robotic, postoperative and pain. We investigated postoperative pain scores, amount of analgesia required, and adverse events associated with the block.

Results Four studies were included in our review. Pain scores at 4 hours and at 7 days postoperatively were lower in patients that had received TAP block when urogynaecological procedures were studied. Reduced opioid use was noted at 24, 48 and 72 hours after the surgical procedure for robotic-assisted hysterectomy when liposomal bupivacaine was used for the TAP block. However, no difference in pain scores, opioid consumption or nausea/vomiting at 24 hours was found when plain bupivacaine was used for the TAP block.

Conclusions TAP block doesn’t seem to offer any advantage for gynaecological surgery in terms of postoperative pain relief and opioid consumption unless liposomal bupivacaine is used. It seems to reduce pain scores after urogynaecological procedures but further studies are needed.