Abstract
Background
Although hand-assisted laparoscopic surgery (HALS) offers patients smaller surgical incisions, they still experience pain. Currently, there is no consensus on the optimal analgesic package for patients undergoing HALS. The aim of this prospective, randomized, double-blinded, placebo-controlled clinical trial was to evaluate the effect of transversus abdominis plane (TAP) block on postoperative pain control (pain score and analgesic use) and other outcomes in colon cancer patients undergoing hand-assisted laparoscopic left hemicolectomy.
Methods
Sixty-four patients with colon cancer scheduled for an elective colon resection were enrolled in this study. Patients were randomized into two groups to receive either TAP block using 20 mL of 0.375% ropivacaine (TAP block group: 32 patients) or 20 mL of 0.9% normal saline infusion (placebo group: 32 patients). Anaesthetic and surgical techniques were standardized. Twenty-four-hour postoperative analgesia was maintained by continuous infusion of 0.1–0.9 µg/kg/h fentanyl and intravenous injection of ketorolac. The primary outcome of the study was postoperative pain control (pain score and analgesic use). Pain was assessed using numeric rating scale at 2, 4, 8, 12, and 24 h after surgery at rest and during movement. Secondary outcomes included the time to resumption of intestinal function and the length of hospital stay. The data of the two groups were compared using Mann–Whitney U test. All statistical tests were two-tailed at a significance level of 0.05.
Results
The patients’ mean age was 60.50 ± 6.77 years, and 68.75% of patients were males. The mean body mass index was 26.23 ± 4.83 kg/m2. The TAP block group had lower pain scores after surgery at 2, 4, and 12 h at rest (p < 0.05), at 2 and 4 h during movement (p < 0.01) and used less fentanyl and ketorolac than the placebo group (p < 0.01). The mean time to resumption of intestinal function was shorter in the TAP block group than that in the placebo group (p < 0.0001). The mean length of hospital stay was by 2.7 days shorter in the TAP block group than in the placebo group (p = 0.001).
Conclusions
The ultrasound-guided TAP block given during hand-assisted laparoscopic colon surgery as part of a multimodal analgesic regimen is a feasible and effective technique for postoperative analgesia in colon cancer patients and significantly reduces both pain experienced by patients and short-term postoperative analgesic use and promotes early ambulation. Future studies are needed to determine the efficacy and costs/benefits of the ultrasound-guided TAP block in HALS.
Similar content being viewed by others
References
Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomized trial. Lancet Oncol 6:477–484
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Jones OM, Lindsey I, Cunningham C (2011) Laparoscopic colorectal surgery. BMJ 343:d8029
Schwenk W, Haase O, Neudecker JJ, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 3:CD003145
Kehlet H, Holte K (2001) Effect of post-operative analgesia on surgical outcome. Br J Anaesth 87:62–72
Kehlet H (1989) Surgical stress: the role of pain and analgesia. Br J Anaesth 63:189–195
Kehlet H, Rung GW, Callesen T (1996) Post-operative opioid analgesia: time for reconsideration? J Clin Anesth 8:441–445
Senagore AJ, Delaney CP, Mekhail N, Fazio VW (2003) Prospective randomized controlled trial evaluating epidural anesthesia/analgesia in laparoscopic segmental colectomy. Br J Surg 90:1195–1199
Levy BF, Scott MJ, Fawcett W, Fry C, Rockall TA (2011) Randomized clinical trial of epidural, spinal, or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery. Br J Surg 98:1068–1078
Stuhldreher JM, Adamina M, Konopacka A, Brady K, Delaney CP (2012) Effect of local anesthetics on post-operative pain and opioid consumption in laparoscopic colorectal surgery. Surg Endosc 26:1617–1623
Park JS, Choi GS, Kwak HK et al (2015) Effect of local wound infiltration and transversus abdominis plane block on morphine use after laparoscopic colectomy: a nonrandomized, single-blind prospective study. J Surg Res 195:61–66
Rafi AN (2001) Abdominal field block: a new approach via the lumbar triangle. Anesthesia 56:1024–1026
Kadam RV, Field JB (2011) Ultrasound-guided continuous transverse abdominis plane block for abdominal surgery. J Anaesthesiol Clin Pharmacol 27:333–336
Belavy D, Cowlishaw PJ, Howes M, Phillips F (2009) Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery. Br J Anaesth 103:726–730
Fowler DL, White SA (1991) Laparoscopy-assisted sigmoid resection. Surg Laparosc Endosc 1:183–188
Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150
Schwab K, Dowson H, Van Dellen J, Marks C, Rockall T (2009) The uptake of laparoscopic colorectal surgery in Great Britain and Ireland: a questionnaire survey of consultant members of the ACPGBI. Colorectal Dis 11:320–324
Harinath G, Shah PR, Haray PN, Foster ME (2005) Laparoscopic colorectal surgery in Great Britain and Ireland—where are we now? Colorectal Dis 7:86–89
Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2007) Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival. Ann Surg 245:1–7
Jayne DG, Guillou PJ, Thorpe H, UK MRC CLASICC Trial Group et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol 25:3061–3068
Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824
Chiono J, Bernard N, Bringuier S et al (2010) The ultrasound-guided transversus abdominis plane block for anterior iliac crest bone graft post-operative pain relief: a prospective descriptive study. Reg Anesth Pain Med 35:520–524
Asensio-Samper JM, De Andres-Ibanez J, Fabregat Cid G, Villanueva Perez V, Alarcon L (2010) Ultrasound-guided transversus abdominis plane block for spinal infusion and neurostimulation implantation in two patients with chronic pain. Pain Pract 10:158–162
McDonnell JG, Curley G, Carney J et al (2008) The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg 106:186–191
Aniskevich S, Taner CB, Perry DK et al (2014) Ultrasound-guided transversus abdominis plane blocks for patients undergoing laparoscopic hand-assisted nephrectomy: a randomized, placebo-controlled trial. Local Reg Anesth 7:11–16
Siddiqui MR, Sajid MS, Uncles DR, Cheek L, Baig MK (2011) A meta-analysis on the clinical effectiveness of transversus abdominis plane block. J Clin Anesth 23:7–14
Erol DD, Yilmaz S, Polat C, Arikan Y (2008) Efficacy of thoracic epidural analgesia for laparoscopic cholecystectomy. Adv Ther 25:45–52
van Zundert AA, Stultiens G, Jakimowicz JJ, van den Borne BE, van der Ham WG, Wildsmith JA (2006) Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease. Br J Anaesth 96:464–466
van Zundert AA, Stultiens G, Jakimowicz JJ et al (2007) Laparoscopic cholecystectomy under segmental thoracic spinal anaesthesia: a feasibility study. Br J Anaesth 98:682–686
Keller DS, Ermlich BO, Schiltz N et al (2014) The effect of transversus abdominis plane blocks on post-operative pain in laparoscopic colorectal surgery: a prospective, randomized, double-blind trial. Dis Colon Rectum 57:1290–1297
Walter CJ, Maxwell-Armstrong C, Pinkney TD et al (2013) A randomised controlled trial of the efficacy of ultrasound-guided transversus abdominis plane (TAP) block in laparoscopic colorectal surgery. Surg Endosc 27:2366–2372
Wassef M, Lee DY, Levine JL et al (2013) Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery. J Pain Res 6:837–841
Johns N, O’Neill S, Ventham NT, Barron F, Brady RR, Daniel T (2012) Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: a systematic review and meta-analysis. Colorectal Dis 14:e635–e642
Favuzza J, Brady K, Delaney CP (2013) Transversus abdominis plane blocks and enhanced recovery pathways: making the 23-h hospital stay a realistic goal after laparoscopic colorectal surgery. Surg Endosc 27:2481–2486
Abdallah FW, Chan VW, Brull R (2012) Transversus abdominis plane block: a systematic review. Reg Anesth Pain Med 37:193–209
Kuthiala G, Chaudhary G (2011) Ropivacaine: a review of its pharmacology and clinical use. Indian J Anaesth 55:104–110
Fields AC, Gonzalez DO, Chin EH, Nguyen SQ, Zhang LP, Divino CM (2015) Laparoscopic-assisted transversus abdominis plane block for post-operative pain control in laparoscopic ventral hernia repair: a randomized controlled trial. J Am Coll Surg 221:462–469
Sinha A, Jayaraman L, Punhani D (2013) Efficacy of ultrasound-guided transversus abdominis plane block after laparoscopic bariatric surgery: a double blind, randomized, controlled study. Obes Surg 23:548–553
Conaghan P, Maxwell-Armstrong C, Bedforth N et al (2010) Efficacy of transversus abdominis plane blocks in laparoscopic colorectal resections. Surg Endosc 24:2480–2484
Recart A, Duchene D, White PF, Thomas T, Johnson DB, Cadeddu JA (2005) Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy. J Endourol 19:1165–1169
Albrecht E, Kirkham KR, Endersby RV et al (2013) Ultrasound-guided transversus abdominis plane (TAP) block for laparoscopic gastric-bypass surgery: a prospective randomized controlled double-blinded trial. Obes Surg 23:1309–1314
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The study was conducted in accordance with the ethical standards and recommendations as laid down in the 1964 Declaration of Helsinki and its later amendments and was approved by the Local Ethics Committee.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Tikuisis, R., Miliauskas, P., Lukoseviciene, V. et al. Transversus abdominis plane block for postoperative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial. Tech Coloproctol 20, 835–844 (2016). https://doi.org/10.1007/s10151-016-1550-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-016-1550-3