The Efficacy and Safety of Transversus Abdominis Plane Blocks After Open Cholecystectomy in Low- and Middle-Income Countries

J Surg Res. 2020 Dec;256:136-142. doi: 10.1016/j.jss.2020.06.020. Epub 2020 Jul 18.


Background: Postoperative pain management is challenging in low- and middle-income countries (LMICs). This study assesses the safety and efficacy of transversus abdominis plane (TAP) blocks as an adjunct for postoperative pain control after an open cholecystectomy in LMICs during short-term surgical missions (STSMs). TAP block is a regional anesthesia technique that has been shown to be effective in providing supplementary analgesia to the anterolateral wall post abdominal surgery.

Methods: A retrospective chart review of patients undergoing open cholecystectomy during STSMs was performed. STSMs took place in Guatemala, the Philippines, and Peru from 2009 to 2019. Measured outcomes including pain scores, presence of postoperative nausea or vomiting, and opioid consumption were compared between TAP block and non-TAP block groups.

Results: Of the 48 patients analyzed, 28 underwent TAP block (58%). Non-TAP block patients received, on average, 8 mg of oral morphine equivalents more than the TAP patients (P = 0.035). No significant difference was noted in pain scores, which were taken immediately after surgery, 2 h after surgery, and at multiple times between these time points to calculate an average. Of the patients who received a TAP block, 11% reported nausea or vomiting compared with 45% in the standard group (P < 0.01). There were no reported procedure-related complications.

Conclusions: TAP blocks are safe and effective adjuncts for postoperative pain management on STSMs to LMICs. Additional studies are needed to investigate the potential advantages and disadvantages of more widespread use of TAP blocks in LMICs.

Keywords: Low- and middle-income countries; Open cholecystectomy; Opioids; Safety; Short-term surgical missions; Transversus abdominis plane block.

MeSH terms

  • Abdominal Muscles / innervation*
  • Adult
  • Cholecystectomy / adverse effects*
  • Developing Countries / statistics & numerical data
  • Female
  • Guatemala
  • Humans
  • Male
  • Middle Aged
  • Nerve Block / adverse effects
  • Nerve Block / methods*
  • Pain Management / adverse effects
  • Pain Management / methods
  • Pain, Postoperative / etiology
  • Pain, Postoperative / therapy*
  • Peru
  • Philippines
  • Postoperative Nausea and Vomiting / epidemiology*
  • Postoperative Nausea and Vomiting / etiology
  • Postoperative Nausea and Vomiting / prevention & control
  • Retrospective Studies
  • Treatment Outcome