Postoperative analgesic efficiency of pre-emptive ultrasound-guided transversus abdominis plane block in patients undergoing laparoscopic colectomy

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Abstract

Background

The transversus abdominis plane block is a nerve block that provides analgesia to the anterior abdominal wall. The aim of this study was to evaluate the analgesic efficacy of a pre-emptive ultrasound-guided transversus abdominis plane block (US-TAP block) in patients undergoing laparoscopic colectomy through a small lower abdominal skin incision.

Methods

Forty patients undergoing laparoscopic colectomy surgery were randomized to undergo standard care such as patient-controlled analgesia (control group) or to receive an additional pre-emptive US-TAP block with standard care (TAP group). A bilateral US-TAP block was performed after induction of general anaesthesia using 0.25% levobupivacaine 20 ml on each side. Postoperative demand of rescue analgesics in the postanaesthesia care unit (PACU) and ward were recorded. Each patient was assessed postoperatively by a blinded observer in PACU and at 2, 12, 24 and 48 h postoperatively to investigate pain at rest and on movement, drowsiness, nausea, itching and shivering.

Results

The US-TAP block reduced the pain score compared with standard care in the PACU (4.1±0.9 vs. 8.6±0.3) and at 24 and 48 h postoperatively (1.3±0.4 vs. 2.7±0.4, 1.3±0.6 vs. 2.6±0.2, respectively). Morphine requirements in PACU in the TAP group versus the control group were reduced (9.3±3.0 vs. 15.2±2.1 mg, P<0.05). In the ward, morphine requirements were reduced at 24 and 48 h (11.8±3.4 vs. 16.6±3.3 mg, 9.5±2.3 vs. 14.4±2.0 mg, respectively, P<0.05).

Conclusion

The US-TAP block with standard care provides more effective analgesia after a laparoscopic colectomy surgery than standard patient-controlled analgesia only, reduces opioid requirements and side effects, promotes early return of bowel activity, promotes early hospital discharge and increases patient satisfaction.

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