Transversus abdominis plane block after laparoscopic colonic resection in cancer patients: A randomised clinical trial.

BACKGROUND

A key point in pathways for optimal rehabilitation and enhanced recovery is an effective postoperative multimodal pain treatment regimen.

OBJECTIVE

To investigate the analgesic effects of transversus abdominis plane (TAP) block in conjunction with paracetamol and ibuprofen in patients undergoing laparoscopic colonic resection.

DESIGN

Randomised placebo-controlled double-blind study.

SETTING

Herlev University Hospital, Copenhagen, Denmark, from March 2010 to February 2013.

PATIENTS

Eighty adult patients scheduled for elective laparoscopic colectomy.

INTERVENTIONS

Bilateral TAP block with 20 ml of either ropivacaine or isotonic saline.

MAIN OUTCOME MEASURES

Visual analogue scale (VAS) pain scores (0 to 100 mm) while coughing at 6 h after surgery (primary outcome). Secondary outcomes were area under the curve pain scores (2 to 24 h) at rest and while coughing, 24-h morphine consumption and incidence of nausea and vomiting.

RESULTS

VAS pain scores at 6 h while coughing was not different between groups (median, interquartile range), TAP, 27 (11 to 45) mm vs. placebo, 33 (20 to 49) mm (P = 0.20). Total 24-h morphine consumption was reduced in the TAP block group vs. placebo group, 30 (15 to 41) mg vs. 43 (30 to 67) mg, respectively (P = 0.008). This difference was most pronounced in the first postoperative hours. The remaining outcomes did not differ between groups.

CONCLUSION

TAP block used in combination with paracetamol and ibuprofen did not reduce pain after laparoscopic colonic surgery. However, we found a 30% reduction in opioid use, most marked in the early postoperative period.

TRIAL REGISTRATION

www.clinicaltrials.gov (NCT01418144).