Conventional Epidural vs Transversus Abdominis Plane Block with Liposomal Bupivacaine: A Randomized Trial in Colorectal Surgery

Torgeson, Matthew; Kileny, Joel; Pfeifer, Christopher C.; Narkiewicz, Lawrence; Obi, Shawn

doi:10.1016/j.jamcollsurg.2018.04.021

Cited by 57 publications

(46 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of the initial 3213 unique article citations identified by the search strategy, 18 randomised controlled trials fulfilled the inclusion criteria [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Details of the screening process are illustrated in Fig.…”

Section: Resultsmentioning

confidence: 99%

Epidural vs. transversus abdominis plane block for abdominal surgery – a systematic review, meta‐analysis and trial sequential analysis

2020

View full text Add to dashboard Cite

Traditionally, pain relief for abdominal surgery has centred on epidural analgesia, but transversus abdominis plane block is increasingly being used. Our aim was to compare the analgesic efficacy and the side-effect profile of transversus abdominis plane block with epidural analgesia in a systematic review with meta-analysis and trial sequential analysis. After a systematic search of the electronic databases, we identified 18 randomised controlled trials with 1220 patients. Confirmed by trial sequential analysis, our first co-primary outcome, postoperative pain score at rest at 12 h, was decreased by a mean difference (95%CI) of 0.69 (0.12-1.27; p = 0.02) with epidural analgesia compared with transversus abdominis plane block, with the quality of evidence graded as low. No difference was found for the second co-primary outcome, postoperative pain score at rest at 24 h, with the quality of evidence rated as very low. Relative to transversus abdominis plane block, epidural analgesia further reduced the need for intravenous morphine-equivalent consumption during the 0-24 h interval by a mean difference (95%CI) of 5.91 mg (2.34-9.49; p = 0.001) at the expense of an increased incidence of hypotension at 72 h, with a risk ratio (95%CI) of 5.88 (2.08-16.67; p < 0.001). Our meta-analysis was limited by detection and performance bias, significant statistical heterogeneity and publication bias. In view of the minimal clinically important difference in postoperative pain scores, epidural analgesia was interpreted to not be clinically different to transversus abdominis plane block after abdominal surgery. With transversus abdominis plane block, the increase in intravenous morphine-equivalent consumption at 24 h should be balanced against the decreased risk of hypotension at 72 h. In choosing between epidural analgesia and transversus abdominis plane block, potential benefits should be balanced against the reported risk of harm, although the confidence in the evidence varied, underlining the uncertainty in our estimates.

show abstract

Section: Resultsmentioning

confidence: 99%

Epidural vs. transversus abdominis plane block for abdominal surgery – a systematic review, meta‐analysis and trial sequential analysis

2020

View full text Add to dashboard Cite

show abstract

“…[8,24] This effect persists in newer studies using liposomal formulations of the local anesthetic. [25,26] Moreover, the growing body of evidence surrounding TAP block and its inclusion in individual society ERAS guidelines demonstrate that TAP blocks are a reliable and broadly applicable non-narcotic adjunct to post-operative pain management. [4,7] Laparoscopically guided TAP blocks have been gaining popularity in recent years and several studies have demonstrated their efficacy, however, direct comparisons between LTAPs and UTAPs are lacking.…”

Section: Discussionmentioning

confidence: 99%

Surgeon-delivered laparoscopic transversus abdominis plane blocks are non-inferior to anesthesia-delivered ultrasound-guided transversus abdominis plane blocks: a blinded, randomized non-inferiority trial

et al. 2019

View full text Add to dashboard Cite

Background-The transversus abdominis plane (TAP) block is an important non-narcotic adjunct for post-operative pain control in abdominal surgery. Surgeons can use laparoscopic guidance for TAP block placement (LTAP), however, direct comparisons to conventional ultrasound guided TAP (UTAPs) have been lacking. The aim of this study is to determine if surgeon placed LTAPs were non-inferior to anesthesia placed UTAPs for post-operative pain control in laparoscopic colorectal surgery. Methods-This was a prospective, randomized, patient and observer blinded parallel-arm noninferiority trial conducted at a single tertiary academic center between 2016-2018 on adult patients undergoing laparoscopic colorectal surgery. Narcotic consumption and pain scores were compared for LTAP vs. UTAP for 48 hours post-operatively. The trial was registered at clinicaltrials.gov Identifier NCT03577912. Results-60 patients completed the trial (31 UTAP, 29 LTAP) of which 25 patients were female (15 UTAP, 10 LTAP) and the mean ages (SD) were 60.0 (13.6) and 61.5 (14.3) in the UTAP and LTAP groups, respectively. There was no significant difference in post-operative narcotic consumption between UTAP and LTAP at the time of PACU discharge (median [IQR] milligrams of morphine, 1.

show abstract

“…Ultrasound imaging allows more accurate administration of TAP block, which ensures a satisfactory block outcome and minimizes the risk of visceral organs injury 25 . The TAP block has little impact on visceral function and almost no contraindications, so it can be used routinely as analgesia for abdominal surgery 9 . The TAP block can also be individually implemented depending on the type of surgery, the location and size of incision and the condition of patient.…”

Section: Discussionmentioning

confidence: 99%

“…The rectus sheath block only has a blocking effect on the nerves innervating the antetior abdominal wall, so it is not suitable for open liver surgery when used alone. TAP block is a regional blockade developed in the past decade which can provide satisfactory analgesia for abdominal surgery 9 . Guided by ultrasound, TAP block is quite simple and safe to perform, with almost no contraindications.…”

Section: Introductionmentioning

confidence: 99%

Combined use of transversus abdominis plane block and laryngeal mask airway during implementing ERAS programs for patients with primary liver cancer: a randomized controlled trial

Huang

Chen

Zhu³

et al. 2020

Sci Rep

View full text Add to dashboard Cite

The incidence and mortality of primary liver cancer are very high and resection of tumor is the most crucial treatment for it. We aimed to assess the efficacy and safety of combined use of transversus abdominis plane (TAP) block and laryngeal mask airway (LMA) during implementing Enhanced Recovery After Surgery (ERAS) programs for patients with primary liver cancer. This was a prospective, evaluator-blinded, randomized, controlled parallel-arm trial. A total of 96 patients were enrolled (48 in each group). Patients in the control group received general anesthesia with endotracheal intubation, while patients in the TAP + LMA group received general anesthesia with LMA and an ultrasound-guided subcostal TAP block. The primary end-point was postoperative time of readiness for discharge. The secondary end-points were postoperative pain intensity, time to first flatus, quality of recovery (QoR), complications and overall medical cost. Postoperative time of readiness for discharge in the TAP + LMA group [7 (5–11) days] was shorter than that of the control group [8 (5–13) days, P = 0.004]. The postoperative apioid requirement and time to first flatus was lower in the TAP + LMA group [(102.8 ± 12.4) µg, (32.7 ± 5.8) h, respectively] than the control group [(135.7 ± 20.1) µg, P = 0.000; (47.2 ± 7.6) h, P = 0.000; respectively]. The QoR scores were significantly higher in the TAP + LMA group than the control group. The total cost for treatment in the TAP + LMA group [(66,608.4 ± 6,268.4) CNY] was lower than that of the control group [(84,434.0 ± 9,436.2) CNY, P = 0.000]. There was no difference in complications between these two groups. The combined usage of a TAP block and LMA is a simple, safe anesthesia method during implementing ERAS programs for patients with primary liver cancer. It can alleviate surgical stress, accelerate recovery and reduce medical cost.

show abstract

Conventional Epidural vs Transversus Abdominis Plane Block with Liposomal Bupivacaine: A Randomized Trial in Colorectal Surgery

Cited by 57 publications

References 25 publications

Epidural vs. transversus abdominis plane block for abdominal surgery – a systematic review, meta‐analysis and trial sequential analysis

Epidural vs. transversus abdominis plane block for abdominal surgery – a systematic review, meta‐analysis and trial sequential analysis

Surgeon-delivered laparoscopic transversus abdominis plane blocks are non-inferior to anesthesia-delivered ultrasound-guided transversus abdominis plane blocks: a blinded, randomized non-inferiority trial

Combined use of transversus abdominis plane block and laryngeal mask airway during implementing ERAS programs for patients with primary liver cancer: a randomized controlled trial

Contact Info

Product

Resources

About