Background and Aims Ultrasound-guided (USG) Transversus Abdominis Plane (TAP) blocks are fascial plane blocks widely used because of their technical ease and analgesic implications in abdominal surgery.¹ However, only a few small-scale TAP studies in laparoscopic nephrectomies for tumor removal exist, none in an outpatient setting.² We assessed the impact of TAP on pain, PONV and other clinical outcomes when included in an ERAS pathway for extended ambulatory nephrectomies.

Methods We performed a retrospective chart review of 209 ambulatory surgery patients who underwent partial laparoscopic and robotic nephrectomies using an ERAS protocol from 09/2016–12/2019. Preoperative TAP blocks were performed bilaterally with 20 ml of 0.25% bupivacaine or ropivacaine, 50 mcg clonidine and 2 mg dexamethasone. We assessed the association between preoperative administration USG TAP (51%) vs. no block (49%) on postoperative outcomes: intraoperative fentanyl, postoperative opioid consumption using morphine milligram equivalent units (MME), PONV rate and hours to first ambulation.

Results Our results demonstrated a trend toward decreased intraoperative MME requirements in the TAP group vs no TAP (p=0.061). Patients receiving a TAP also required less postoperative narcotic (p=0.043). After adjusting for Apfel Score, age and operative time, the need for PONV rescue medication although not significant trended 8.6% higher in those without a TAP (95% CI -2.7%, 19%; p=0.11).

Conclusions We found evidence that US guided bilateral TAP blocks are associated with a reduced need for postoperative narcotics in ambulatory laparoscopic and robotic nephrectomies with a trend toward decreased intraoperative MME requirements. ERAS pathways should consider including TAP blocks, even for these minimally invasive surgeries.