Skip to main content
Top
Published in: International Journal of Colorectal Disease 11/2021

01-11-2021 | Opioids | Original Article

Continuous transversus abdominis plane blocks in patients undergoing minimally invasive colorectal surgery: a randomized pilot study

Authors: Michael Drew Honaker, Casey Chinn Hawes, Dana Alina Vinter, Anne Montgomery, James Cole Parker, Betsy Epps Smith

Published in: International Journal of Colorectal Disease | Issue 11/2021

Login to get access

Abstract

Purpose

Transversus abdominis plane (TAP) blocks are used in an attempt to decrease narcotic use and its subsequent consequences. The primary goal of this study was to see if TAP blocks decreased narcotic use in patients undergoing minimally invasive colorectal surgery.

Methods

A randomized pilot study was conducted. The amount of narcotic used examined in morphine milligram equivalents (MME) was collected for the first 4 post-operative days (PODs). Demographic data, length of stay (LOS), readmission rate, and 90-day mortality was also examined. Statistical analysis of the data was performed with a p < 0.05 determined to be significant.

Results

Eighty-eight patients were included. Forty-seven were randomized to the TAP group and 41 to the no TAP group. There was no difference in age, race, gender, indication for operation, or Charlson Comorbidity Index (p > 0.05). The median MME for each POD was similar for POD 1 (22.5 vs 37.5; p = 0.054), POD 3 (15 vs 22.5; p = 0.48), and POD 4 (22.5 vs 10.5; p = 0.42) on bivariate analysis. On POD 2, the TAP group had significantly less narcotic intake than the no TAP group (17.5 vs 30; p = 0.047). However, on multivariate analysis when controlling for other variables, there was no statistical difference between the groups. Median LOS was 3 days for both groups. Readmissions, post-operative complications, and mortality were also similar between the two groups (p > 0.05).

Conclusion

Our findings indicate that continuous TAP blocks do not decrease the amount of MME used during the first 4 post-operative days compared to patient receiving traditional pain control measures.
Literature
1.
go back to reference Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38:1531–1541CrossRef Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38:1531–1541CrossRef
2.
go back to reference Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 10:172–188CrossRef Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 10:172–188CrossRef
3.
go back to reference Stone AB, Grant MC, Pio Roda CP, Hobson D, Pawlik T, Wu CL, Wick EC (2016) Implementation costs of an enhanced recovery after surgery program in the United States: a financial model and sensitivity analysis based on experiences at a quaternary academic medical center. J Am Coll Surg 222:219–225CrossRef Stone AB, Grant MC, Pio Roda CP, Hobson D, Pawlik T, Wu CL, Wick EC (2016) Implementation costs of an enhanced recovery after surgery program in the United States: a financial model and sensitivity analysis based on experiences at a quaternary academic medical center. J Am Coll Surg 222:219–225CrossRef
4.
go back to reference Nelson G, Kiyang LN, Crumley ET, Chuck A, Nguyen T, Faris P, Wasylak T, Basualdo-Hammond C, McKay S, Ljungqvist O, Gramlich LM (2016) Implementation of enhanced recovery after surgery (ERAS) across a provincial healthcare system: the ERAS Alberta colorectal surgery experience. World J Surg 40:1092–1103CrossRef Nelson G, Kiyang LN, Crumley ET, Chuck A, Nguyen T, Faris P, Wasylak T, Basualdo-Hammond C, McKay S, Ljungqvist O, Gramlich LM (2016) Implementation of enhanced recovery after surgery (ERAS) across a provincial healthcare system: the ERAS Alberta colorectal surgery experience. World J Surg 40:1092–1103CrossRef
5.
go back to reference Torgeson M, Kileny J, Pfrifer C, Narkiewicz OS (2018) Conventional epidural vs transversus abdominis plane block with liposomal bupivacaine: a randomized trial in colorectal surgery. J Am Coll Surg 227(1):78–83CrossRef Torgeson M, Kileny J, Pfrifer C, Narkiewicz OS (2018) Conventional epidural vs transversus abdominis plane block with liposomal bupivacaine: a randomized trial in colorectal surgery. J Am Coll Surg 227(1):78–83CrossRef
6.
go back to reference Kim AJ, Yong RJ, Urman RD (2017) The role of transversus abdominal plane blocks in enhanced recovery after surgery pathways for open and laparoscopic surgery. J Laparoendosc Adv Surg Tech 27:909–914CrossRef Kim AJ, Yong RJ, Urman RD (2017) The role of transversus abdominal plane blocks in enhanced recovery after surgery pathways for open and laparoscopic surgery. J Laparoendosc Adv Surg Tech 27:909–914CrossRef
7.
go back to reference Damadi AA, Lax EA, Smithson L, Pearlman RD (2019) Comparison of therapeutic benefit of bupivacaine HCl transversus abdominis plane (TAP) block as part of an enhanced recovery pathway versus traditional oral and intravenous pain control after minimally invasive colorectal surgery: a prospective, randomized, double blind trial. Am Surg 85(12):1363–1368CrossRef Damadi AA, Lax EA, Smithson L, Pearlman RD (2019) Comparison of therapeutic benefit of bupivacaine HCl transversus abdominis plane (TAP) block as part of an enhanced recovery pathway versus traditional oral and intravenous pain control after minimally invasive colorectal surgery: a prospective, randomized, double blind trial. Am Surg 85(12):1363–1368CrossRef
8.
go back to reference Rashid A, Gorissen JK, Ris F, Gosselink MP, Shorthouse JR, Smith AD, Pandit JJ, Lindsey I, Crabtree NA (2017) No benefit of ultrasound guided transversus abdominis plane (TAP) blocks over local anesthetic wound infiltration in elective laparoscopic colonic surgery; results of a double-blinded randomised controlled trial. Colorectal Dis 9:681–689CrossRef Rashid A, Gorissen JK, Ris F, Gosselink MP, Shorthouse JR, Smith AD, Pandit JJ, Lindsey I, Crabtree NA (2017) No benefit of ultrasound guided transversus abdominis plane (TAP) blocks over local anesthetic wound infiltration in elective laparoscopic colonic surgery; results of a double-blinded randomised controlled trial. Colorectal Dis 9:681–689CrossRef
9.
go back to reference Pedrazzani C, Menestrine N, Moro M, Brazzo G, Mantovani G, Polati E, Guglielmi A (2016) Local wound infiltration plus transversus abdominis plan (TAP) block versus local wound infiltration in laparoscopic colorectal surgery and ERAS program. Surg Endosc 30:5117–5125CrossRef Pedrazzani C, Menestrine N, Moro M, Brazzo G, Mantovani G, Polati E, Guglielmi A (2016) Local wound infiltration plus transversus abdominis plan (TAP) block versus local wound infiltration in laparoscopic colorectal surgery and ERAS program. Surg Endosc 30:5117–5125CrossRef
10.
go back to reference Oh TK, Yim J, Kim J, Eom W, Lee SA, Park SC, Oh JH, Park JW, Park B, Kim DH (2017) Effects of preoperative ultrasound-guided transversus abdominis plane (TAP) block on pain after laparoscopic surgery for colorectal cancer: a double-blinded randomized controlled trial. Surg Endosc 31:127–134CrossRef Oh TK, Yim J, Kim J, Eom W, Lee SA, Park SC, Oh JH, Park JW, Park B, Kim DH (2017) Effects of preoperative ultrasound-guided transversus abdominis plane (TAP) block on pain after laparoscopic surgery for colorectal cancer: a double-blinded randomized controlled trial. Surg Endosc 31:127–134CrossRef
11.
go back to reference Park JS, Choi GS, Kwak KH, Jung H, Jeon Y, Park S, Yeo J (2015) Effect of local wound infiltration and transversus abdominis plane block on morphine use after laparoscopic colectomy: a randomized, single-blinded prospective study. J Surg Res 195:61–66CrossRef Park JS, Choi GS, Kwak KH, Jung H, Jeon Y, Park S, Yeo J (2015) Effect of local wound infiltration and transversus abdominis plane block on morphine use after laparoscopic colectomy: a randomized, single-blinded prospective study. J Surg Res 195:61–66CrossRef
13.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRef
15.
go back to reference Hain E, Maggiori L, Prost a la Denise J, Panis Y (2018) Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative pain management: a meta-analysis. Colorectal Dis 20:279–287CrossRef Hain E, Maggiori L, Prost a la Denise J, Panis Y (2018) Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative pain management: a meta-analysis. Colorectal Dis 20:279–287CrossRef
16.
go back to reference Smith SR, Draganic B, Pockney P, Holz P, Holmes R, Mcmanus B, Carroll R (2015) Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blinded randomized clinical trial. Int J Colorectal Dis 30:1237–1245CrossRef Smith SR, Draganic B, Pockney P, Holz P, Holmes R, Mcmanus B, Carroll R (2015) Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blinded randomized clinical trial. Int J Colorectal Dis 30:1237–1245CrossRef
17.
go back to reference Walter CJ, Maxwell-Armstrong C, Pinkney TD, Conaghan PJ, Bedforth N, Gornall CB, Aheson AG (2013) A randomized controlled trial of the efficacy of ultrasound-guided transversus abdominis plane block in laparoscopic colorectal surgery. Surg Endosc 27:2366–2372CrossRef Walter CJ, Maxwell-Armstrong C, Pinkney TD, Conaghan PJ, Bedforth N, Gornall CB, Aheson AG (2013) A randomized controlled trial of the efficacy of ultrasound-guided transversus abdominis plane block in laparoscopic colorectal surgery. Surg Endosc 27:2366–2372CrossRef
18.
go back to reference Peltrini R, Cantoni V, Green R, Greco R, Calabria M, Bucci L, Corcione F (2020) Efficacy of transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 24(8):787–802CrossRef Peltrini R, Cantoni V, Green R, Greco R, Calabria M, Bucci L, Corcione F (2020) Efficacy of transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 24(8):787–802CrossRef
Metadata
Title
Continuous transversus abdominis plane blocks in patients undergoing minimally invasive colorectal surgery: a randomized pilot study
Authors
Michael Drew Honaker
Casey Chinn Hawes
Dana Alina Vinter
Anne Montgomery
James Cole Parker
Betsy Epps Smith
Publication date
01-11-2021
Publisher
Springer Berlin Heidelberg
Keywords
Opioids
Opioids
Published in
International Journal of Colorectal Disease / Issue 11/2021
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-021-03978-8

Other articles of this Issue 11/2021

International Journal of Colorectal Disease 11/2021 Go to the issue