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TAP Blocks: A Recent Review of Anesthetic Combinations

Pedro E Garcia-Quintero, Nicholas P Suraci and Jayanand D'Mello

Multimodal analgesia is an approach to optimize pain relief by treating pain through several mechanisms along multiple sites of the nociceptive pathway. This approach not only improves pain, but also patient satisfaction. It also decreases use of narcotic pain medications, and provides faster recovery and mobilization. Transversus abdominis plane (TAP) blocks are a vital part of this approach. Different techniques have been documented with combination of local anesthetics incorporating different adjuvants for abdominal surgeries; however, a formulary regimen has not been cited. An independent literature review was performed. Articles reporting TAP blocks for abdominal surgical procedures, mainly in combination with another adjuvant and comparing the outcomes. TAP blocks are safe procedures for abdominal surgeries for postoperative multimodal approach pain control. It is best achieved with the combination of long-acting local anesthetics, such as ropivicaine or bupivacaine, with an adjuvant, such as alpha-2 agonists, steroids or morphine, vs. using only local anesthetic. Minimal to no side effects has been reported regarding toxicity of local anesthetic when performing TAP blocks. This provides the opportunity to identify a particular regimen to obtain more effective results.