Transversus abdominis plane block after laparoscopic colonic resection in cancer patients: A randomised clinical trial.

Abstract

BACKGROUND:

A key point in pathways for optimal rehabilitation and enhanced recovery is an effective postoperative multimodal pain treatment regimen.

OBJECTIVE:

To investigate the analgesic effects of transversus abdominis plane (TAP) block in conjunction with paracetamol and ibuprofen in patients undergoing laparoscopic colonic resection.

DESIGN:

Randomised placebo-controlled double-blind study.

SETTING:

Herlev University Hospital, Copenhagen, Denmark, from March 2010 to February 2013.

PATIENTS:

Eighty adult patients scheduled for elective laparoscopic colectomy.

INTERVENTIONS:

Bilateral TAP block with 20 ml of either ropivacaine or isotonic saline.

MAIN OUTCOME MEASURES:

Visual analogue scale (VAS) pain scores (0 to 100 mm) while coughing at 6 h after surgery (primary outcome). Secondary outcomes were area under the curve pain scores (2 to 24 h) at rest and while coughing, 24-h morphine consumption and incidence of nausea and vomiting.

RESULTS:

VAS pain scores at 6 h while coughing was not different between groups (median, interquartile range), TAP, 27 (11 to 45) mm vs. placebo, 33 (20 to 49) mm (P = 0.20). Total 24-h morphine consumption was reduced in the TAP block group vs. placebo group, 30 (15 to 41) mg vs. 43 (30 to 67) mg, respectively (P = 0.008). This difference was most pronounced in the first postoperative hours. The remaining outcomes did not differ between groups.

CONCLUSION:

TAP block used in combination with paracetamol and ibuprofen did not reduce pain after laparoscopic colonic surgery. However, we found a 30% reduction in opioid use, most marked in the early postoperative period.

TRIAL REGISTRATION:

www.clinicaltrials.gov (NCT01418144).

• Authors: Henrik Torup, Egon G Hansen, Mikkel Bøgeskov, Jacob Rosenberg, Anja U Mitchell, Pernille L Petersen, Ole Mathiesen, Jørgen B Dahl, Ann M Møller
• Journal: European journal of anaesthesiology (Eur J Anaesthesiol) Vol. 33 Issue 10 Pg. 725-30 (10 2016) ISSN: 1365-2346 [Electronic] England
• PMID: 27487909 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Acetaminophen
• Ibuprofen

Topics

• Abdominal Muscles (surgery)
• Acetaminophen (administration & dosage)
• Aged
• Colectomy (adverse effects, trends)
• Colonic Neoplasms (drug therapy, epidemiology, surgery)
• Denmark (epidemiology)
• Double-Blind Method
• Female
• Humans
• Ibuprofen (administration & dosage)
• Laparoscopy (adverse effects, trends)
• Male
• Middle Aged
• Nerve Block (methods, trends)
• Pain, Postoperative (diagnosis, epidemiology, prevention & control)