A prospective, randomized, double-blind controlled study demonstrated that the TAPB + N approach can offer better postsurgery analgesia and minimize the usage of strong opioids in gynecological surgery. Fan Zhang et al. aimed to determine the effect of improved combined analgesia methodology on postoperative nausea and vomiting (PONV), visual analog scale (VAS) pain scores, and sedation in 72 people undergoing elective laparoscopic gynecological surgery.

Participants were randomized to 2 groups: (i) TAPB + N group (n=36): Given a continuous intravenous infusion 2 ml/hour of 1 mg/kg nalbuphine hydrochloride and 30 mg metoclopramide postoperatively, and (ii) TAPB + S group (n=36): Given a continuous intravenous infusion 2 ml/hour of 1 μg/kg sufentanil and 30 mg metoclopramide through 100 ml elastomeric pumps postoperatively. After inducing anesthesia, participants in both arms underwent transversus abdominis plane block (TAPB).

Ramsay sedation score (RSS) after surgery, rescue analgesics, postsurgery pain intensity (VAS score), and PONV occurrence rate were the endpoints ascertained. At two, four, and six hours after surgery, the TAPB + S group exhibited considerably greater RSS when compared to the TAPB + N group. But, the VAS score of TAPB + S group was more in comparison with the TAPB + N group.

Regarding consumption of opioids and other narcotic drugs at two, four, six, 24, and 48 hours following surgery, no profound differences were noted between the study groups. Regarding PONV and other adverse events in both groups, no profound differences were witnessed. The higher optimized scheme of perioperative analgesia requires to be investigated, concluded the study authors.