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Efficacy of transversus abdominis plane blocks in laparoscopic colorectal resections

Surgical Endoscopy volume 24, pages 2480–2484 (2010)Cite this article

Abstract

Background

The increasing use of laparoscopic techniques for colorectal resections means that the issue of postoperative analgesia needs to be reassessed. This nonrandomized comparative study aimed to assess the efficacy of the transversus abdominis plane (TAP) block in laparoscopic colorectal resections.

Methods

Prospectively collected data from consecutive patients undergoing laparoscopic colorectal resections were used. Analgesia usage and outcome data for patients who had a TAP block and a postoperative morphine patient-controlled analgesia pump (PCA) were compared with those for patients who had a PCA alone.

Results

Data for 74 patients were used in the final analysis (40 TAP/PCA and 34 PCA alone). There was a significant reduction in overall intravenous opiate use in the TAP/PCA group (31.3 vs. 51.8 mg; P = 0.03). The TAP/PCA group showed a slight trend toward a shorter hospital stay (3 vs. 4 days; P = 0.17) but no difference in postoperative complications or any other outcome measure. There was no procedure-related morbidity relating to the use of TAP blocks.

Conclusions

It appears that TAP blocks reduce postoperative analgesia use of patients undergoing laparoscopic colorectal resections within an enhanced recovery program, and this may have an impact on their postoperative hospital length of stay.

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References

  1. Wall PDMR (ed) (1999) Pain measurements in persons in pain, 4th edn. Churchill Livingstone, Edinburgh, UK

    Google Scholar 

  2. Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93:921–928

    CAS  Article  PubMed  Google Scholar 

  3. Jorgensen H, Wetterslev J, Moiniche S, Dahl JB (2000) Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV, and pain after abdominal surgery. Cochrane Database Syst Rev (4):CD001893

  4. King PM, Blazeby JM, Ewings P, Franks PJ, Longman RJ, Kendrick AH, Kipling RM, Kennedy RH (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93:300–308

    CAS  Article  PubMed  Google Scholar 

  5. Sinnatamby C (2006) Last’s anatomy, 11th edn. Churchill Livingstone, Oxford, UK

    Google Scholar 

  6. McDonnell JG, O’Donnell B, Curley G, 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 

  7. O’Donnell BD, McDonnell JG, McShane AJ (2006) The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med 31:91

    PubMed  Google Scholar 

  8. McDonnell JG, O’Donnell BD, Farrell T, Gough N, Tuite D, Power C, Laffey JG (2007) Transversus abdominis plane block: a cadaveric and radiological evaluation. Reg Anesth Pain Med 32:399–404

    PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  10. Kehlet H (1989) Surgical stress: the role of pain and analgesia. Br J Anaesth 63:189–195

    CAS  Article  PubMed  Google Scholar 

  11. Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d’Athis F (1999) Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 91:8–15

    CAS  Article  PubMed  Google Scholar 

  12. Kehlet H, Holte K (2001) Effect of postoperative analgesia on surgical outcome. Br J Anaesth 87:62–72

    CAS  Article  PubMed  Google Scholar 

  13. Shibata Y, Sato Y, Fujiwara Y, Komatsu T (2007) Transversus abdominis plane block. Anesth Analg 105:883; author reply

    Article  PubMed  Google Scholar 

  14. Kehlet H (2008) Fast-track colorectal surgery. Lancet 371:791–793

    Article  PubMed  Google Scholar 

  15. Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA (2007) A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 245:867–872

    Article  PubMed  Google Scholar 

  16. Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, Collins KS (2002) Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 359:1276–1282

    Article  PubMed  Google Scholar 

  17. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL (2003) Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 290:2455–2463

    CAS  Article  PubMed  Google Scholar 

  18. Carli F, Mayo N, Klubien K, Schricker T, Trudel J, Belliveau P (2002) Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial. Anesthesiology 97:540–549

    Article  PubMed  Google Scholar 

  19. Zutshi M, Delaney CP, Senagore AJ, Mekhail N, Lewis B, Connor JT, Fazio VW (2005) Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. Am J Surg 189:268–272

    Article  PubMed  Google Scholar 

  20. Senagore AJ, Delaney CP, Mekhail N, Dugan A, Fazio VW (2003) Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparoscopic segmental colectomy. Br J Surg 90:1195–1199

    CAS  Article  PubMed  Google Scholar 

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Disclosures

Drs Philip Conaghan, Charles Maxwell-Armstrong, Nigel Bedforth, Chris Gornall, Bryn Baxendale, Li-lin Hong, Hyun-Mi Carty, and Austin G Acheson have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK

    Philip Conaghan, Charles Maxwell-Armstrong, Li-lin Hong, Hyun-Mi Carty & Austin G. Acheson

  2. Department of Anaesthesia, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK

    Nigel Bedforth, Chris Gornall & Bryn Baxendale

  3. Department of General Surgery, Royal Berkshire Hospital, London Road, Reading, Berks, RG1 5AN, UK

    Philip Conaghan

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  1. Philip Conaghan
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  2. Charles Maxwell-Armstrong
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Correspondence to Philip Conaghan.

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Conaghan, P., Maxwell-Armstrong, C., Bedforth, N. et al. Efficacy of transversus abdominis plane blocks in laparoscopic colorectal resections. Surg Endosc 24, 2480–2484 (2010). https://doi.org/10.1007/s00464-010-0989-y

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  • DOI: https://doi.org/10.1007/s00464-010-0989-y

Keywords

  • Analgesia
  • Colorectal
  • Laparoscopic