Epidural versus Continuous Transversus Abdominis Plane Catheter Technique for Postoperative Analgesia after Abdominal Surgery

Abstract

Transversus abdominis plane block is an effective postoperative analgesic technique after abdominal surgery, but no study has compared continuous transversus abdominis plane block with continuous epidural analgesia.We designed a randomised controlled trial comparing these techniques for major abdominal surgery. Patients in the epidural group received a bolus of 8 to 15 ml of ropivacaine 0.2% and an infusion of 5 to 15 ml/hour and the transversus abdominis plane block group a bolus dose of 20 ml of ropivacaine 0.375% bilaterally and an infusion of 0.2% ropivacaine 8 ml/hour bilaterally, for three days. Both groups received paracetamol and patient controlled analgesia with fentanyl for three days. Primary outcomes were numerical rating scores for pain (rest and dynamic over 72 hours) and total fentanyl use; complications and satisfaction scores were also noted.The study was terminated early after 42 patients had been randomised (epidural n=19; transversus abdominis plane block n=22; one excluded). No differences were found in regards to point pain scores or scores over time, either immediately postoperatively or in surgical wards; total fentanyl requirement and Likert satisfaction scores were also similar in both groups. In this underpowered study we found comparable results between continuous transversus abdominis plane technique and epidural analgesia in regard to pain, analgesic use and satisfaction after abdominal surgery. To confirm this finding, randomised trials with larger numbers of participants are needed.

Radical Cystectomy Perioperative Care Redesign

“…No differences were found in regards to pain scores, either in the immediate postoperative period or in surgical wards. Furthermore, total fentanyl requirement and satisfaction scores were similar between both groups 56 after multivariate analysis 57 . However, rectus sheath catheters with levobupivicaine bolus infusions (20mL of 0.25% every 6h) have been described in RC and appear to contribute to a decreased LOS (17d to 10.8d) as part of a multi-modal anesthesia plan 58 .…”

Transversus Abdominis Plane Catheters for Analgesia Following Abdominal Surgery in Adults

“…10,15,16,18,21 Of these trials, only 1 trial 10 demonstrated a significant analgesic benefit via improved patient satisfaction scores.…”

“…Four trials 15,20-22 used boluses at 8-hourly intervals. Seven other trials 10,[16][17][18][19]23,25 administered local anesthetic by continuous infusion, ranging from 4 to 10 mL/h through each catheter.…”

“…Ten trials 10,[16][17][18][19][20][21][22]24 reported complications associated with TAP catheters in 405 participants. In descending order of frequency, these complications were as follows: Table 4.…”

“…In addition, a lack of objective testing for block success and a lack of ongoing monitoring for sensory block duration in most trials also limit evidence of efficacy because of potential confounding of an untested TAP catheter not providing ongoing analgesia following the initial bolus. Block efficacy may also be limited in trials that examined only 1 type of TAP catheter placement (posterior or subcostal) 15,18 against abdominal operations covering a range of dermatomes, some of which may be considered to fall outside the expected coverage of the TAP blockade (potentially showing analgesic inferiority due to inappropriate patient selection instead of block success). Future research will benefit from more structured categorization and standardization of the variables that comprise a TAP catheter technique (insertion site, catheter type, initial blockade, infusate type, infusion regimen, and specific surgical intervention).…”