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Published in: Surgical Endoscopy 10/2010

01-10-2010

Efficacy of transversus abdominis plane blocks in laparoscopic colorectal resections

Authors: Philip Conaghan, Charles Maxwell-Armstrong, Nigel Bedforth, Chris Gornall, Bryn Baxendale, Li-lin Hong, Hyun-Mi Carty, Austin G. Acheson

Published in: Surgical Endoscopy | Issue 10/2010

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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.
Literature
1.
go back to reference Wall PDMR (ed) (1999) Pain measurements in persons in pain, 4th edn. Churchill Livingstone, Edinburgh, UK Wall PDMR (ed) (1999) Pain measurements in persons in pain, 4th edn. Churchill Livingstone, Edinburgh, UK
2.
go back to reference Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93:921–928CrossRefPubMed Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93:921–928CrossRefPubMed
3.
go back to reference 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 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.
go back to reference 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 93:300–308CrossRefPubMed 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 93:300–308CrossRefPubMed
5.
go back to reference Sinnatamby C (2006) Last’s anatomy, 11th edn. Churchill Livingstone, Oxford, UK Sinnatamby C (2006) Last’s anatomy, 11th edn. Churchill Livingstone, Oxford, UK
6.
go back to reference 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 104:193–197CrossRefPubMed 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 104:193–197CrossRefPubMed
7.
go back to reference O’Donnell BD, McDonnell JG, McShane AJ (2006) The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med 31:91PubMed O’Donnell BD, McDonnell JG, McShane AJ (2006) The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med 31:91PubMed
8.
go back to reference 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 32:399–404PubMed 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 32:399–404PubMed
9.
go back to reference Bonnet F, Marret E (2005) Influence of anaesthetic and analgesic techniques on outcome after surgery. Br J Anaesth 95:52–58CrossRefPubMed Bonnet F, Marret E (2005) Influence of anaesthetic and analgesic techniques on outcome after surgery. Br J Anaesth 95:52–58CrossRefPubMed
10.
11.
go back to reference 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 91:8–15CrossRefPubMed 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 91:8–15CrossRefPubMed
12.
go back to reference Kehlet H, Holte K (2001) Effect of postoperative analgesia on surgical outcome. Br J Anaesth 87:62–72CrossRefPubMed Kehlet H, Holte K (2001) Effect of postoperative analgesia on surgical outcome. Br J Anaesth 87:62–72CrossRefPubMed
13.
go back to reference Shibata Y, Sato Y, Fujiwara Y, Komatsu T (2007) Transversus abdominis plane block. Anesth Analg 105:883; author replyCrossRefPubMed Shibata Y, Sato Y, Fujiwara Y, Komatsu T (2007) Transversus abdominis plane block. Anesth Analg 105:883; author replyCrossRefPubMed
15.
go back to reference 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 245:867–872CrossRefPubMed 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 245:867–872CrossRefPubMed
16.
go back to reference 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 359:1276–1282CrossRefPubMed 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 359:1276–1282CrossRefPubMed
17.
go back to reference Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL (2003) Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 290:2455–2463CrossRefPubMed Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL (2003) Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 290:2455–2463CrossRefPubMed
18.
go back to reference 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 97:540–549CrossRefPubMed 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 97:540–549CrossRefPubMed
19.
go back to reference 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 189:268–272CrossRefPubMed 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 189:268–272CrossRefPubMed
20.
go back to reference 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 90:1195–1199CrossRefPubMed 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 90:1195–1199CrossRefPubMed
Metadata
Title
Efficacy of transversus abdominis plane blocks in laparoscopic colorectal resections
Authors
Philip Conaghan
Charles Maxwell-Armstrong
Nigel Bedforth
Chris Gornall
Bryn Baxendale
Li-lin Hong
Hyun-Mi Carty
Austin G. Acheson
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 10/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-0989-y

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