Response to Letter to the Editor: Laparoscopic Posterior Versus Lateral Transversus Abdominis Plane Block in Gynecology.

Dear Editor,

We would like to thank Austin et al. for their comments regarding our recent manuscript.[1] The authors of the letter raised concern over the use of “Doyle's internal bulge sign” as a visual indicator of correct placement of transversus abdominis plane (TAP) block during laparoscopy. Austin et al. described an interesting study performed on 24 patients, who received laparoscopic-assisted TAP block followed by ultrasonographic evaluation. The authors reported correct placement of laparoscopic-assisted TAP block, as determined by ultrasonographic findings, in approximately half of patients. However, the authors did not mention patient characteristics or whether there were any differences in postoperative pain and pain medication usage in their study.

Furthermore, the results of our study are supported by a large systematic review, which included nearly 2,000 patients across 19 randomized controlled trials, comparing laparoscopic-assisted TAP with ultrasound-guided TAP block, local infiltration analgesia, or inactive control.[2] Laparoscopic-assisted TAP was comparable to ultrasound-guided TAP block and superior to local analgesia, in recovery parameters, 24-hour opioid consumption, and postoperative nausea and vomiting.[2] This data, along with results from our prior study, support the continued use of laparoscopic-assisted TAP block for reduced postoperative pain and narcotic usage.

Sincerely,