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Surgical Endoscopy

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01-07-2020 | Ultrasound

Surgeon-delivered laparoscopic transversus abdominis plane blocks are non-inferior to anesthesia-delivered ultrasound-guided transversus abdominis plane blocks: a blinded, randomized non-inferiority trial

Authors: Daniel J. Wong, Thomas Curran, Vitaliy Y. Poylin, Thomas E. Cataldo

Published in: Surgical Endoscopy | Issue 7/2020

Abstract

Background

The transversus abdominis plane (TAP) block is an important non-narcotic adjunct for post-operative pain control in abdominal surgery. Surgeons can use laparoscopic guidance for TAP block placement (LTAP), however, direct comparisons to conventional ultrasound-guided TAP (UTAPs) have been lacking. The aim of this study is to determine if surgeon placed LTAPs were non-inferior to anesthesia placed UTAPs for post-operative pain control in laparoscopic colorectal surgery.

Methods

This was a prospective, randomized, patient and observer blinded parallel-arm non-inferiority trial conducted at a single tertiary academic center between 2016 and 2018 on adult patients undergoing laparoscopic colorectal surgery. Narcotic consumption and pain scores were compared for LTAP vs. UTAP for 48 h post-operatively.

Results

60 patients completed the trial (31 UTAP, 29 LTAP) of which 25 patients were female (15 UTAP, 10 LTAP) and the mean ages (SD) were 60.0 (13.6) and 61.5 (14.3) in the UTAP and LTAP groups, respectively. There was no significant difference in post-operative narcotic consumption between UTAP and LTAP at the time of PACU discharge (median [IQR] milligrams of morphine, 1.8 [0–4.5] UTAP vs. 0 [0–8.7] LTAP P = .32), 6 h post-operatively (5.4 [1.8–17.1] UTAP vs. 3.6 [0–12.6] LTAP P = .28), at 12 h post-operatively (9.0 [3.6–29.4] UTAP vs. 7.2 [0.9–22.5] LTAP P = .51), at 24 h post-operatively (9.0 [3.6–29.4] UTAP vs. 7.2 [0.9–22.5] LTAP P = .63), and 48 h post-operatively (39.9 [7.5–70.2] UTAP vs. 22.2 [7.5–63.8] LTAP P = .41). Patient-reported pain scores as well as pre-, intra-, and post-operative course were similar between groups. Non-inferiority criteria were met at all post-op time points up to and including 24 h but not at 48 h.

Conclusions

Surgeon-delivered LTAPs are safe, effective, and non-inferior to anesthesia-administered UTAPs in the immediate post-operative period.

Trial registry

The trial was registered at clinicaltrials.gov Identifier NCT03577912.

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Title: Surgeon-delivered laparoscopic transversus abdominis plane blocks are non-inferior to anesthesia-delivered ultrasound-guided transversus abdominis plane blocks: a blinded, randomized non-inferiority trial
Authors: Daniel J. Wong
Thomas Curran
Vitaliy Y. Poylin
Thomas E. Cataldo
Publication date: 01-07-2020
Publisher: Springer US
Keywords: Ultrasound
Opioids
Opioids
Morphine
Ultrasound
Published in: Surgical Endoscopy / Issue 7/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07097-y

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Springer Medicine

Surgeon-delivered laparoscopic transversus abdominis plane blocks are non-inferior to anesthesia-delivered ultrasound-guided transversus abdominis plane blocks: a blinded, randomized non-inferiority trial

Abstract

Background

Methods

Results

Conclusions

Trial registry

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registry

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