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The Effect of Transversus Abdominis Plane Blocks on Postoperative Pain in Laparoscopic Colorectal Surgery: A Prospective, Randomized, Double-Blind Trial

Keller, Deborah S. M.S., M.D.1; Ermlich, Bridget O. R.N., M.S.N.2; Schiltz, Nicholas Ph.D.3; Champagne, Bradley J. M.D.1; Reynolds, Harry L. Jr. M.D.1; Stein, Sharon L. M.D.1; Delaney, Conor P. M.D., M.Ch., Ph.D., F.R.C.S.I.1

doi: 10.1097/DCR.0000000000000211
Original Contributions: Benign Colorectal Disease

BACKGROUND: Superior early pain control has been suggested with transversus abdominis plane blocks, but evidence-based recommendations for transversus abdominis plane blocks and their effects on patient outcomes are lacking.

OBJECTIVE: The aim of this study was to determine whether transversus abdominis plane blocks improve early postoperative outcomes in patients undergoing laparoscopic colorectal resection already on an optimized enhanced recovery pathway.

DESIGN: This study is based on a prospective, randomized, double-blind controlled trial.

SETTINGS: The trial was conducted at a tertiary referral center.

PATIENTS: Patients undergoing elective laparoscopic colorectal resection were selected.

INTERVENTIONS(S): Patients were randomly assigned to receive either a transversus abdominis plane block or a placebo placed intraoperatively under laparoscopic guidance. All followed a standardized enhanced recovery pathway. Patient demographics, perioperative procedures, and postoperative outcomes were collected.

MAIN OUTCOME MEASURES: Postoperative pain and nausea/vomiting scores in the postanesthesia care unit and department, opioid use, length of stay, and 30-day readmission rates were measured.

RESULTS: The trial randomly assigned 41 patients to the transversus abdominis plane block group and 38 patients to the control group. Demographic, clinical, and procedural data were not significantly different. In the postanesthesia care unit, the transversus abdominis plane block group had significantly lower pain scores (p < 0.01) and used fewer opioids (p < 0.01) than the control group; postoperative nausea/vomiting scores were comparable (p = 0.99). The transversus abdominis plane group had significantly lower pain scores on postoperative day 1 (p = 0.04) and throughout the study period (p < 0.01). There was no significant difference between groups in postoperative opioid use (p = 0.65) or nausea/vomiting (p = 0.79). The length of stay (median, 2 days experimental, 3 days control; p = 0.50) and readmission rate (7% experimental, 5% control, p = 0.99) was similar across cohorts.

LIMITATIONS: This study was conducted a single center.

CONCLUSIONS: Transversus abdominis plane blocks improved immediate short-term opioid use and pain outcomes. Pain improvement was durable throughout the hospital stay. However, the blocks did not translate into less overall narcotic use, shorter length of stay, or lower readmission rates.

1Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio

2Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio

3Department of Statistics, Case Western Reserve University, Cleveland, Ohio

Financial Disclosures: Dr Delaney has a licensed patent from Ethicon, serves as a consultant for Cubist, Tranzyme, and Ferring, is on the advisory board for Pacira, and has ownership in Socrates Analytics. Drs Champagne and Stein serve as consultants for Covidien. The remaining authors reported no disclosures.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Hollywood, FL, May 17 to 21, 2014.

Correspondence: Conor P. Delaney, M.D., M.Ch. Ph.D., F.R.C.S.I., Chief, Division of Colorectal Surgery, Vice-Chair, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106-5047. E-mail: Conor.Delaney@uhhospitals.org

© 2014 The American Society of Colon and Rectal Surgeons