Skip to main content

Advertisement

SpringerLink
Log in

Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blind randomized clinical trial

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Adequate postoperative analgesia is essential for recovery following colorectal surgery. Transversus abdominis plane (TAP) blocks have been found to be beneficial in improving pain following a variety of abdominal operations. The objective of this study was to determine if TAP blocks are useful in improving postoperative recovery following laparoscopic colorectal surgery.

Materials and methods

A prospective double-blind randomized clinical trial, involving 226 consecutive patients having laparoscopic colorectal surgery, was performed by a university colorectal surgical department. Patients were randomized to either TAP blockade using ultrasound guidance, or control, with the primary outcome being postoperative pain, as measured by analgesic consumption. Secondary outcomes assessed were pain visual analogue score (VAS), respiratory function, time to return of gut function, length of hospital stay, postoperative complications, and patient satisfaction.

Results

A total of 142 patients were followed up to trial completion (74 controls, 68 interventions). Patients were well matched with regard to demographics. No complications occurred as a result of the intervention of TAP blockade. There was no difference between groups with regards to analgesic consumption (161 mEq morphine control vs 175 mEq morphine TAP; p = 0.596). There was no difference between the two groups with regards to the secondary outcomes of daily VAS, respiratory outcome, time to return of gut function, length of hospital stay, postoperative complications, and patient satisfaction.

Conclusion

We conclude that TAP blockade appears to be a safe intervention but confers no specific advantage following laparoscopic colorectal surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Abdallah FW, Chan VW, Brull R (2012) Transversus abdominis plane block: a systematic review. Reg Anesth Pain Med 37:193–209

    Article  CAS  PubMed  Google Scholar 

  2. Bonnet F, Marret E (2005) Influence of anaesthetic and analgesic techniques on outcome after surgery. Br J Anaesth 95:52–58

    Article  CAS  PubMed  Google Scholar 

  3. Carney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG (2008) The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg 107:2056–2060

    Article  CAS  PubMed  Google Scholar 

  4. Charlton S, Cyna AM, Middleton P, Griffiths JD (2010) Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery (review):CD007705.pub2

  5. Clarke A, Rosen R (2001) Length of stay. How short should hospital care be? Eur J Public Health 11:166–170

    Article  CAS  PubMed  Google Scholar 

  6. de Morton NA, Davidson M, Keating JL (2008) The de Morton mobility index (DEMMI): an essential health index for an ageing world. Health Qual Life Outcomes 6:63

    Article  PubMed Central  PubMed  Google Scholar 

  7. Desborough JP (2000) The stress response to trauma and surgery. Br J Anaesth 85:109–117

    Article  CAS  PubMed  Google Scholar 

  8. El-Dawlatly AA, Turkistani A, Kettner SC, Machata A-M, Delvi MB, Thallaj A, Kapral S, Marhofer P (2009) Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth 102:763–767

    Article  CAS  PubMed  Google Scholar 

  9. Griffiths J, Middle JV, Barron FA, Grant SJ, Popham PA, Royse CF (2010) Transversus abdominis plane block does not provide additional benefit to multimodal analgesia in gynaecological cancer surgery. Anesth Analg 111:797–801

    Article  PubMed  Google Scholar 

  10. 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. Color Dis 14:635–642

    Article  Google Scholar 

  11. Lee TH, Barrington MJ, Tran TM, Wong D, Hebbard PD (2010) Comparison of sensory block following posterior and subcostal approaches to ultrasound-guided transversus abdominis plane block. Anaesth Intensive Care 38:452–460

    CAS  PubMed  Google Scholar 

  12. Levy BF, Tilney HS, Dowson HM, Rockall TA (2010) A systematic review of postoperative analgesia following laparoscopic colorectal surgery. Color Dis 12:5–15

    Article  CAS  Google Scholar 

  13. McDermott G, Korba E, Mata U, Jaigirdar M, Narayanan N, Boylan J, Conlon N (2012) Should we stop doing blind transversus abdominis plane blocks? Br J Anaesth 108:499–502

    Article  CAS  PubMed  Google Scholar 

  14. McDonnell JG, O’Donnell B, Heffernan A, Power C, Laffey JG (2007) The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 104:193–197

    Article  PubMed  Google Scholar 

  15. Moore SE, Reid KC, Draganic BD, Smith SR (2012) Randomized clinical trial of ropivacaine wound infusion following laparoscopic colorectal surgery. Tech Coloproctol 16:431–436

    Article  CAS  PubMed  Google Scholar 

  16. Moraca RJ, Sheldon DG, Thirlby RC (2003) The role of epidural anesthesia and analgesia in surgical practice. Ann Surg 238:663–673

    Article  PubMed Central  PubMed  Google Scholar 

  17. Mukhtar K, Singh S (2009) Transversus abdominis plane block for laparoscopic surgery. Br J Anaesth 102:143–144

    Article  CAS  PubMed  Google Scholar 

  18. Niraj G, Searle A, Mathews M, Misra V, Baban M, Kiani S, Wong M (2009) Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy. Br J Anaesth 103:601–605

    Article  CAS  PubMed  Google Scholar 

  19. Petersen PL, Hilsted KL, Dahl JB, Mathiesen O (2013) Bilateral transversus abdominis plane (TAP) block with 24 hours ropivacaine infusion via TAP catheters: a randomized trial in healthy volunteers. BMC Anesthesiol 13:30

    Article  PubMed Central  PubMed  Google Scholar 

  20. Podsiadlo D, Richardson S (1991) The timed “Up and Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148

    Article  CAS  PubMed  Google Scholar 

  21. Rafi AN (2001) Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 56:1024–1026

    Article  CAS  PubMed  Google Scholar 

  22. Schwenk W, Haase O, Neudecker JJ, Muller JM (2008) Short term benefits for laparoscopic colorectal resection;CD003145.pub2

  23. Tran TM, Ivanusic JJ, Hebbard P, Barrington MJ (2009) Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth 102:123–127

    Article  CAS  PubMed  Google Scholar 

  24. Veenhof AA, Vlug MS, van der Pas MH, Sietses C, van der Peet DL, de Lange-de Klerk ES, Bonjer HJ, Behelman WA, Cuesta MA (2012) Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial. Ann Surg 255:216–221

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Authors’ contributions

Stephen Ridley Smith MS (SS)—Study design, recruitment

Brian Draganic FRACS (BD)—Recruitment

Peter Pockney MD (PP)—Recruitment

Phillip Holz FANZCA (PH)—Study design, TAP block supervisor, and trainer

Ryan Holmes BMedSci (RH)—Independent analyst, data collector

Brendan Mcmanus FRACS (BM)—Article review plus preparation

Rosemary Carroll RN (RC)—Independent analyst, data collector

Author information

Authors and Affiliations

  1. Division of Surgery, John Hunter Hospital, University of Newcastle, Locked Bag 1, Hunter Regional Mail Centre, Newcastle, NSW, 2310, Australia

    Stephen Ridley Smith, Brian Draganic, Peter Pockney & Phillip Holz

  2. University of Newcastle, Newcastle, NSW, 2310, Australia

    Stephen Ridley Smith, Brian Draganic, Peter Pockney & Ryan Holmes

  3. John Hunter Hospital, Newcastle, NSW, 2310, Australia

    Brendan Mcmanus & Rosemary Carroll

Authors
  1. Stephen Ridley Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian Draganic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Pockney
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Phillip Holz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryan Holmes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Brendan Mcmanus
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rosemary Carroll
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephen Ridley Smith.

Additional information

This is a randomized clinical trial, assessing the efficacy of transversus abdominis local anesthetic blockade following laparoscopic colorectal surgery, in the presence of an enhanced recovery program.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, S.R., Draganic, B., Pockney, P. et al. Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blind randomized clinical trial. Int J Colorectal Dis 30, 1237–1245 (2015). https://doi.org/10.1007/s00384-015-2286-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-015-2286-7

Keywords

Search

Navigation