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On-demand (SOS) analgesia through Transversus Abdominis Plane (TAP) catheter route for post-operative pain relief in Emergency Laparotomies—a non-randomised interventional study (STAPLE trial)

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Abstract

Introduction

This study aimed to compare the efficacy and safety of on-demand bupivacaine infusion via transversus abdominis plane (TAP) catheter in emergency laparotomy patients.

Methods

A non-randomised interventional study was conducted on patients undergoing emergency midline laparotomy. The intervention group received an on-demand infusion of 10 ml 0.5% bupivacaine through TAP catheters, whilst the control group received standard analgesic care. The primary outcome was the amount of rescue analgesic consumption. Secondary outcomes included the post-operative, measured by visual analogue scores (VAS), side effects, time to first flatus, post-operative nausea and vomiting, and pulmonary complications.

Results

One-hundred-twenty patients (58 in the TAP-SOS group, 62 in the control group) were included in the final analysis. The TAP-SOS group showed significantly reduced rescue analgesic requirement by 91% (p < 0.001) and lower VAS scores at 3, 6, 12, and 24 h (adjusted p < 0.00). Time to out-of-bed mobilisation was significantly shorter in the TAP-SOS group by 12.47 h (p < 0.001), and post-operative pulmonary complications were lower by 75% (p < 0.05). There were no significant differences in bowel recovery, catheter-related complications, or post-operative morbidity. No incidences of catheter-site infection were reported on follow-up; however, the catheter tip-culture was positive in 3 (5.17%) patients.

Conclusion

On-demand bupivacaine infusion through a TAP catheter effectively reduced post-operative pain and opioid requirements in emergency laparotomy patients without complications. If an epidural is not an option, the TAP-SOS approach can be a helpful adjunct in implementing the ERAS protocol in an emergency since it allows for early ambulation and better pain management.

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Data availability

The datasheet related to this study will be available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Burns and Plastic Surgery, AIIMS Bhubaneswar, Odisha, India

    Kallol Kumar Das Poddar

  2. Department of General Surgery, AIIMS Bhubaneswar, Odisha, India

    Pankaj Kumar, Mahesh Kumar Sethi, Tushar Subhadarshan Mishra, Prakash Kumar Sasmal,  Medhavi, Pradeep Kumar Singh & Rahul Kumar

  3. Department of Trauma and Emergency, AIIMS Bhubaneswar, Odisha, India

    Upendra Hansda

Authors
  1. Kallol Kumar Das Poddar
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  2. Pankaj Kumar
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  4. Mahesh Kumar Sethi
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  5. Tushar Subhadarshan Mishra
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  9. Rahul Kumar
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Contributions

The study was conceptualised by Dr. Pankaj. Dr. Pankaj, Dr. Prakash, Dr. Tushar, and Dr. Pradeep did the data curation with Dr. Kallol, Dr. Mahesh, Dr. Rahul, and Dr. Medhavi. Dr. Pankaj, Dr. Upendra, and Dr. Kallol designed the methodology. Project administration was under Dr. Pankaj. Dr. Upendra provided supervision for TAP catheter insertion under USG guidance. Dr. Kallol did the data analysis and illustrations. Dr. Kallol and Dr. Pankaj prepared the initial draft. All the authors went through the draft and provided their inputs to finalise it before submission.

Corresponding author

Correspondence to Pankaj Kumar.

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Ethical approval

The study was approved by the Institutional Ethical Committee before recruitment was started (T/IM-NF/Gen.Surg/22/40). Written informed consent was obtained from all the participants.

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The authors declare no competing interests.

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Poddar, K.K.D., Kumar, P., Hansda, U. et al. On-demand (SOS) analgesia through Transversus Abdominis Plane (TAP) catheter route for post-operative pain relief in Emergency Laparotomies—a non-randomised interventional study (STAPLE trial). Langenbecks Arch Surg 408, 325 (2023). https://doi.org/10.1007/s00423-023-03065-2

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