Laparoscopic-Assisted Transversus Abdominis Plane Block for Postoperative Pain Control in Laparoscopic Ventral Hernia Repair: A Randomized Controlled Trial

Fields, Adam C.; Gonzalez, Dani O.; Chin, Edward; Nguyen, Scott Q.; Zhang, Linda P.; Divino, Celia M.

doi:10.1016/j.jamcollsurg.2015.04.007

Cited by 50 publications

(43 citation statements)

References 33 publications

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“…Additionally, patients receiving TAP block used less opioids than the control group in the postoperative period. The authors found no significant difference in pain scores at 24 hours postoperatively [25].…”

Section: Discussionmentioning

confidence: 78%

Postoperative analgesic efficiency of transversus abdominis plane block after ventral hernia repair: a prospective, randomized, controlled clinical trial

Chesov

Belîi

2017

Rom J Anaesth Intensive Care

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Background and aims: Effective postoperative analgesia is a key element in reducing postoperative morbidity, accelerating recovery and avoiding chronic postoperative pain.The aim of this study was to evaluate the effectiveness of ultrasound-guided Transversus Abdominis Plane (TAP) block, performed before surgical incision, in providing postoperative analgesia for patients undergoing open ventral hernia repair under general anaesthesia.Methods: Seventy elective patients scheduled for open ventral hernia repair surgery under general anaesthesia were divided randomly into two equal groups: Group I received bilateral TAP block performed before surgical incision (n = 35); Group II received systemic postoperative analgesia with parenteral opioid (morphine) alone (n = 35). Postoperatively pain scores at rest and with movement, total morphine consumption and opioid related side effects were recorded.Results: Postoperative pain scores at rest and mobilization/cough were significantly higher in patients without TAP block (p < 0.05). Mean intraoperative fentanyl consumption was comparable between the two groups: 0.75 ± 0.31 mg in group I (TAP) and 0.86 ± 0.29 mg in group II (MO), p = 0.1299. Patients undergoing preincisional TAP block had reduced morphine requirements during the first 24 hours after surgery, compared to patients from group II, without TAP block (p = 0.0001). There was no difference in the incidence of opioid related side effects (nausea, vomiting) in the both groups during the first 24 postoperative hours.Conclusion: The use of preincisional ultrasound guided TAP block reduced the pain scores at rest and with movement/cough, opioid consumption and opioid-related side effects after ventral hernia repair when compared with opioid-only analgesia.

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Section: Discussionmentioning

confidence: 78%

Postoperative analgesic efficiency of transversus abdominis plane block after ventral hernia repair: a prospective, randomized, controlled clinical trial

Chesov

Belîi

2017

Rom J Anaesth Intensive Care

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“…Additionally, they suggested that postoperative pain may have peaked at 6-12 hours, resulting in more pain medication use during this time leading to statistical significance. 24 Although these RCTs show a consistent association between narcotic use and postoperative pain, the strength of this correlation is not clear. Specifically, Keller and colleagues 23 and Fields and colleagues 24 reported that postoperative pain scores appeared to reach statistical significance, whereas narcotic use did not.…”

Section: Is There Strong Evidence That a Change In The Surrogate End mentioning

confidence: 97%

“…24 Although these RCTs show a consistent association between narcotic use and postoperative pain, the strength of this correlation is not clear. Specifically, Keller and colleagues 23 and Fields and colleagues 24 reported that postoperative pain scores appeared to reach statistical significance, whereas narcotic use did not. Although the reason for this is not certain, the literature continues to report the role of additional variables that may affect opioid consumption.…”

Section: Is There Strong Evidence That a Change In The Surrogate End mentioning

confidence: 97%

“…However, although the change in patient pain scores was deemed significant, opioid use did not meet the threshold for statistical significance, which the authors attributed to early motility and lower narcotic intake at POD 0 in the treatment group. 23 This inconsistency was again shown in a similar trial by Fields and colleagues, 24 which followed 52 patients and evaluated the effect of transversus abdominis plane block on postoperative pain and opioid consumption immediately following ventral hernia repair surgery and up to POD 1. Although this trial reported a significant decrease in cumulative opioid use and postoperative pain experienced by patients in the treatment group, the difference in pain scores reached statistical significance much earlier than narcotic use (1 hr postoperative v. 6 hr postoperative).…”

Section: Is There Strong Evidence That a Change In The Surrogate End mentioning

confidence: 98%

“…Although this trial reported a significant decrease in cumulative opioid use and postoperative pain experienced by patients in the treatment group, the difference in pain scores reached statistical significance much earlier than narcotic use (1 hr postoperative v. 6 hr postoperative). To account for this, Fields and colleagues 24 noted that some patients may have been fatigued in the immediate postoperative period, preventing them from requesting medication. Additionally, they suggested that postoperative pain may have peaked at 6-12 hours, resulting in more pain medication use during this time leading to statistical significance.…”

Section: Is There Strong Evidence That a Change In The Surrogate End mentioning

confidence: 99%

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Users’ guide to the surgical literature: how to assess an article using surrogate end points

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Phase 3 randomized controlled trials are the widely accepted gold standard through which treatment decisions are made, as they assess the efficacy of a novel treatment against the control on the relevant patient population. The effectiveness of the novel treatment should be derived by measuring patientimportant outcomes; however, to accurately assess these outcomes, clinical trials often require extensive patient follow-up and large sample sizes that can incur substantial expense. For this reason, investigators substitute surrogate end points to reduce the sample size and duration of a trial, ultimately reducing cost. The purpose of this article is to help surgeons appraise the surgical literature that use surrogate end points for patient-important outcomes. Summary DISCUSSIONS IN SURGERY

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Laparoscopic-Assisted Transversus Abdominis Plane Block for Postoperative Pain Control in Laparoscopic Ventral Hernia Repair: A Randomized Controlled Trial

Cited by 50 publications

References 33 publications

Postoperative analgesic efficiency of transversus abdominis plane block after ventral hernia repair: a prospective, randomized, controlled clinical trial

Postoperative analgesic efficiency of transversus abdominis plane block after ventral hernia repair: a prospective, randomized, controlled clinical trial

Users’ guide to the surgical literature: how to assess an article using surrogate end points

Postoperative Multimodal Pain Management

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