Adequate postoperative pain relief is key to early recovery. The use of intrathecal morphine (IT morphine) in addition to a general anaesthetic has become increasingly common practice. The use of a Transversus Abdominal Plane block (TAP block) administered under direct vision by the surgeon is also thought to improve postoperative pain relief and reduce opiate requirement.
The aim of our study was to determine if the addition of a TAP block did indeed improve postoperative outcomes.
We did a retrospective review of all major elective laparoscopic urological surgeries dating as far back as December 2014. We looked at all the procedures in which IT morphine was administered at the time of induction of anaesthesia. The patients were divided in to two groups: Those who received IT Morphine with a TAP Block or IT Morphine alone. The primary outcome was to compare VAS pain scores and use of IV PCA Morphine/Fentanyl.
The patients who received IT morphine alone had lower pain scores and less use of IV PCA morphine than the patients who received IT morphine with TAP block (P=0.00124 and P=0.04036).
Our study demonstrates that the addition of a TAP block does not add any benefit in terms of postoperative VAS pain scores or use of IV PCA morphine. However, it does lead to a reduction in the use of other postoperative analgesics, particularly Oramorph.

INTRATHECAL MORPHINE WITH OR WITHOUT TAP BLOCK FOR IMPROVED POSTOPERATIVE PAIN RELIEF IN MAJOR ELECTIVE LAPAROSCOPIC UROLOGICAL SURGERY