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Postoperative analgesic efficacy of modified continuous transversus abdominis plane block in laparoscopic colorectal surgery: a triple-blind randomized controlled trial

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Abstract

Background

The optimal opioid-sparing analgesic regimen following laparoscopic colorectal surgery (LCS) remains uncertain. We sought to determine the efficacy of low-dose bupivacaine infusion via surgeon-inserted modified continuous transversus abdominis plane (mcTAP) catheters after LCS.

Methods

A parallel-group, placebo-controlled, randomized single-centre trial was conducted between April 2017 and February 2018. Block-of-four randomization and allocation concealment by sequentially-numbered, opaque sealed envelopes were used. Patients, surgeons and assessors were blinded. Fifty-two patients were randomized to receive either 0.2% bupivacaine or saline through mcTAP catheters. A 5 ml bolus followed by a 72 h infusion at 2 ml/h was started, with patient-controlled fentanyl analgesia and oral paracetamol given on demand. Primary outcomes were fentanyl consumptions in the first 24 h, second 24 h, and third 24 h following surgery. Secondary outcomes were pain numeric rating scores, recovery outcomes and complications.

Results

Twenty-five patients in the bupivacaine group and 26 in the control group were analysed. Patients in the bupivacaine group required significantly less fentanyl overall (106.1 vs 484.5 mcg, p < 0.001) and at all time points (first 24 h: 61.0 vs 324.3 mcg, p < 0.001; second 24 h: 36.3 vs 119.0 mcg, p = 0.033; third 24 h: 8.8 vs 41.2, p = 0.030) when compared to placebo. Significantly lower pain scores at rest at 6 h (2.32 vs 4.0, p = 0.002), and 12 h (1.80 vs 3.08, p = 0.011) and on coughing at 6 h (4.56 vs 5.84, p = 0.019), 12 h (3.76 vs 4.96, p = 0.009), and 24 h (3.44 vs 4.24, p = 0.049) as well as significantly lower opioid-related complications such as nausea or vomiting (9 (36%) vs 1 (4%), p = 0.005) were observed in the bupivacaine group. There were no major block-related complications, and recovery outcomes were similar in both groups.

Conclusions

McTAP block reduces postoperative fentanyl consumption and pain scores after LCS, highlighting its role as a safe and useful opioid-sparing analgesia.

Registration number

TCTR20150831001 (Thai Clinical Trials Registry). Full trial protocol can be assessed at https://www.clinicaltrials.in.th/.

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Acknowledgements

The authors would like to express our gratitude to Prof. Somrat Chaluluxananan, Head of Department of Anesthesiology, Chulalongkorn University, for his advice and guidance.

Funding

The authors have no sources of funding to declare for this manuscript.

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Authors and Affiliations

  1. Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    P. Haruethaivijitchock, G. Taksavanitcha & J. Theerawatanawong

  2. Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore

    J. L. Ng

  3. Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    T. Rattananupong & V. Lohsoonthorn

  4. Colorectal Surgery Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand

    C. Sahakitrungruang

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  1. P. Haruethaivijitchock
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  4. J. Theerawatanawong
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Contributions

All authors/co-authors meet the four author criteria as defined by ICMJE. Conception or design of work: PH, CS, GT, JT. Data acquisition, analysis, interpretation: all authors. Drafting work, critical revision: all authors. Final approval: all authors. Agreement to be accountable: all authors.

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Correspondence to C. Sahakitrungruang.

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Haruethaivijitchock, P., Ng, J.L., Taksavanitcha, G. et al. Postoperative analgesic efficacy of modified continuous transversus abdominis plane block in laparoscopic colorectal surgery: a triple-blind randomized controlled trial. Tech Coloproctol 24, 1179–1187 (2020). https://doi.org/10.1007/s10151-020-02311-9

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