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

BACKGROUND: A key point in the pathways for optimal rehabilitation and enhanced recovery is an effective postoperative multimodal pain treatment regimen to reduce pain and minimise the use of opioids. OBJECTIVE: The objective is to investigate the analgesic effects of transversus abdominis plane (TAP) block in conjunction with paracetamol and ibuprofen in patients undergoing laparoscopic colonic resection for cancer. DESIGN: Randomised placebo-controlled double-blind study. SETTING: Herlev University Hospital, Copenhagen, Denmark, from March 2010 to February 2013. PATIENTS: Eighty adult cancer patients scheduled for elective laparoscopic colectomy. INTERVENTIONS: Patients received bilateral TAP block with 20 ml of either ropivacaine or normal 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 the incidence of postoperative nausea and vomiting. RESULTS: VAS pain scores at 6 h while coughing was not different between the 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 hour. VAS pain scores and the incidence of nausea and vomiting 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. Therefore, for the initial postoperative period, a TAP block could be considered as a relevant supplemental analgesic method for pain management after laparoscopic colonic resection. TRIAL REGISTRATION: http://ift.tt/PmpYKN (NCT01418144). (C) 2016 European Society of Anaesthesiology

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