Discussion
peripheral nerve block, nausea, thoracolumbar nerve [, pain
SECONDARY
Our study demonstrated additional benefit of preoperative TAP block when used as part MMA after open gynecologic surgery. When TAP block was added to MMA, rescued morphine within the first 24 h was significantly reduced compared to the control group. Also, the incidence of nausea within the first 48 h and pain intensity up to postoperative 30 days were significantly reduced.TAP block is a peripheral nerve block designed to anesthetize the afferent nerves supplying the anterior abdominal wall from the T6 to L1 thoracolumbar nerve [Since MMA with non-opioid medications has become normative in clinical practice, additional effect of TAP block should be further demonstrated. A randomized trial showed the effective analgesia of TAP block with 0.75% ropivacaine in total abdominal hysterectomy. Morphine requirement for up to 48 h was reduced in the TAP block group [We also note some inconsistent results for TAP block in abdominal surgeries. Gasanova et al. [ERAS programs aim to accelerate and support patient’s return to full functional recovery. Patient-reported outcomes measure any aspect of a patient’s health status. The QoR-40 is a 40-item quality of recovery score measuring five dimensions. It was specifically designed to evaluate a patient’s early postoperative recovery after different type of surgery. A negative association between the global score and duration of hospital day was demonstrated in different types of surgery [De Oliveira GS Jr. et al. [Our study did not show any differences in QoR-40 score at 24 h and SF-36 score on POD 30 between two groups. However, it is noteworthy that the TAP block group had higher SF-36 bodily pain subscale score compared to the Control group. Nieboer et al. [This study has several limitations. First, TAP block was accomplished after the induction of anesthesia. Hence, we did not assess the definite blockade range before surgery. Secondly, only one dosage of ropivacaine was used in this trial, thus further investigations are needed to demonstrate optimal concentration of local anesthetic in TAP block. Finally, the QoR-40 and SF-36 score were secondary outcomes and the power was insufficient to detect a difference between the two groups. Future research focused on better quality of recovery provided by multimodal analgesia for this population may be desirable.