Comparison of preoperative versus postoperative transversus abdominis plane and rectus sheath block in patients undergoing minimally invasive colorectal surgery

Abstract

Aim Ultrasound-guided transversus abdominis plane and rectus sheath block (TAPRSB) decreases pain scores and narcotic use postoperatively after colorectal surgery (CRS). It is unclear if the effectiveness of TAPRSB varies according to whether it is performed preoperatively or postoperatively. Our aim was to investigate this.Method We compared patients who underwent preoperative TAPRSB or postoperative TAPRSB during minimally invasive CRS. Primary end-points were pain scores and oral morphine milligram equivalent (MME) use postoperatively. Secondary end-points included perioperative factors affecting pain scores and postoperative MME. Summary statistics and univariate analysis by nonparametric tests were utilized. The mixed-effect model was applied to model the repeatedly measured pain score.Results From April 2015 until May 2018 168 patients received TAPRSB before (115) or after (53) minimally invasive CRS. The cohort included 79 (47.0%) women, and had an average age of 59.11 (AE12.32) years and mean body mass index of 28.32 (AE5.82) kg/m 2 . Indication for surgery was cancer in 66 (39.3%), polyp in 43 (25.6%) and diverticulitis in 43 (25.6%). Right colec-tomy was performed in 61 (36.3%), low anterior resection in 46 (27.4%) and sigmoid colectomy in 40 (23.8%) patients. The demographics of the groups were similar. Postoperative TAPRSB was only associated with lower pain scores at 12 h postoperatively. As secondary outcomes, average pain scores and MME were lower in patients who were older, had right colectomy or intracorporeal anastomosis.Conclusions Postoperative TAPRSB resulted in lower pain scores than preoperative TAPRSB 12 h after minimally invasive CRS, but otherwise no differences were seen in pain scores or MME use.Keywords Transversus abdominis block, rectus sheath block, milligram morphine equivalent, pain score, minimally invasive colorectal surgeryWhat does this study add to the literature? This study provides data regarding the timing of transversus abdominis plane and rectus sheath block and its effect on postoperative pain scores and narcotic use in patients undergoing minimally invasive colorectal surgery. It also offers more data regarding a specific type of block, which includes four injection sites.Comparison of preoperative vs postoperative transversus abdominis plane J. Xia et al.

Analgesic efficacy of intrathecal morphine and bupivacaine during the early postoperative period in patients who underwent robotic-assisted laparoscopic prostatectomy: a prospective randomized controlled study

“…The usage frequencies and doses of the rescue analgesic drugs were recorded. Cumulative IV opioid consumption was calculated from the dose conversion of fentanyl, tramadol, and pethidine into morphine according to the equivalent analgesic dose ratio (i.e., 100 μg of fentanyl = 100 mg of tramadol = 100 mg of pethidine = 10 mg of morphine) [13][14][15], and assessed at 1, 6, and 24 h after surgery.…”

Divided method of intercostal nerve block reduces ropivacaine dose by half in thoracoscopic pulmonary resection while maintaining the postoperative pain score and 4-h mobilization: a retrospective study

“…The paravertebral block has been shown to be superior to other locoregional analgesic techniques for the management of perioperative pain [ 9 , 10 ]. Furthermore, although the timing of nerve blockade in patients undergoing gynecological, breast, gastrointestinal, and plastic surgeries has been discussed previously [ 11 , 12 ], few studies have investigated the optimal intraoperative analgesia strategy, including ICB, for TS. Therefore, in this study, the divided method of ML-ICB (at the beginning and the end of surgery) was selected to compensate for the inferior effect of ICB in the management of perioperative pain since locoregional analgesia is delivered before the patient experiences pain (preemptive anesthesia).…”

Predictors of Difficult Ultrasound-Guided Transversus Abdominis Plane Blocks

“…Some studies have indicated that a preoperative block for an extremity amputation may reduce the incidence of phantom limb pain [ 6 ]. For transversus abdominis plane (TAP) blocks specifically, there is no clear evidence of increased effectiveness if done preoperatively versus postoperatively [ 7 , 8 ]. Difficulty in performing the procedure may impact overall procedure time, leading to potential OR delays, prolonged OR time, or prolonged patient discomfort if performed post-emergence.…”