Liposomal Bupivacaine Transversus Abdominis Plane Block Versus Epidural Analgesia in a Colon and Rectal Surgery Enhanced Recovery Pathway: A Randomized Clinical Trial

Felling, Daniel R; Jackson, Miles W.; Ferraro, Jane; Battaglia, Michael A; Albright, Jeremy J.; Wu, Juan; Genord, Cheryl; Brockhaus, Kara; Bhave, Rohit A; McClure, Amanda M; Shanker, Beth‐Ann; Cleary, Robert K.

doi:10.1097/dcr.0000000000001211

Cited by 65 publications

(44 citation statements)

References 20 publications

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“…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

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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.

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Section: Resultsmentioning

confidence: 99%

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

2020

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“…Varying protocols may include elements such as acetaminophen, nonsteroidal anti-inflammatory medications, gabapentin, transversus abdominis plane blocks, and intrathecal or epidural analgesia options. 35 The PHD dataset does not identify which institutions had established enhanced recovery pathways with multimodal pain management strategies 25,26 and so the impact of these pathways on decreasing or obviating inpatient opioid use could not be determined in our study. 25,26 However, we implemented a multilevel random-effects regression model to control for hospital-level clustering of opioid prescribing patterns and the results support less inpatient opioid use in MIS patients.…”

Section: Discussionmentioning

confidence: 98%

Minimally invasive sigmoidectomy for diverticular disease decreases inpatient opioid use: Results of a propensity score-matched study

Bastawrous

Shih

et al. 2020

The American Journal of Surgery

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a b s t r a c tBackground: Patients undergoing gastrointestinal surgery are at high risk for postoperative opioid use. Methods: We evaluated inpatient opioid use among patients undergoing sigmoidectomy for diverticular disease from the Premier Hospital Database and compared across surgical approaches using propensity score-matching analysis. Results: After the day of surgery, minimally invasive (MIS) patients were administered significantly lower doses of parenteral opioids (median daily morphine milligram equivalents [MME]: 33.3 versus 48.3, p < 0.001). Within MIS, significantly less parenteral opioids were used by the robotic-assisted (RS) than the laparoscopic (LS) group (median daily MME: 30.0 versus 36.8, p ¼ 0.012). MIS patients were more likely than open to start oral opioids on the day of surgery (MIS vs. OS: 8.7% vs. 6.6%, p < 0.001; RS vs. LS: 12.6% vs. 10.2%, p ¼ 0.048). Conclusion: Minimally invasive sigmoidectomy for diverticular disease was associated with less postoperative parenteral opioid use and starting oral opioids sooner after surgery compared to the open approach.

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“…3 More than 200 patients were enrolled. 4 One study did not mention the randomization method, and one study did not mention how the blindness method was implemented. 5 Several studies did not mention the randomization and blindness methods.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative severe pain in patients comes mainly from the surgical incision, and visceral tissue damage is a common postoperative problem [1]. Transversus abdominis plane (TAP) block has gradually become an alternative postoperative analgesia technology since Rafi formally described it in 2001 [2], and it has resulted in effective pain relief in operations in which incisions are made in the abdomen [3][4][5][6]. However, traditional local anesthetic wound infiltration (WI) by injecting local anesthetics into the incision, favored by surgeons for its convenience, is still the major method used for postoperative analgesia in many areas.…”

Section: Introductionmentioning

confidence: 99%

Transversus Abdominis Plane Block versus Wound Infiltration with Conventional Local Anesthetics in Adult Patients Underwent Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Cai

Gao

Chen

et al. 2020

BioMed Research International

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Background. How to effectively control the postoperative pain of patients is extremely important to clinicians. Transversus abdominis plane (TAP) block is a novel analgesic method reported to greatly decrease postoperative pain. However, in many areas, there still exists a phenomenon of surgeons using wound infiltration (WI) with conventional local anesthetics (not liposome anesthetics) as the main means to decrease postoperative pain because of traditional wisdom or convenience. Here, we compared the analgesic effectiveness of the two different methods to determine which method is more suitable for adult patients. Materials and methods. A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TAP block and WI without liposome anesthetics in adult patients were performed. Frequently used databases were extensively searched. The main outcomes were postoperative pain scores in different situations (at rest or during movement) and the time until the first use of rescue analgesics. The secondary outcomes were postoperative nausea and vomiting (PONV) incidence and patient satisfaction scores. Results. Fifteen studies with 983 participants met the inclusion criteria and were included in the present study. The heterogeneity in the final analysis regarding the pain score was low to moderate. The major results of the sensitivity analysis were stable. WI had the same analgesic effect as TAP block only at the one-hour postoperative time point (mean difference=−0.32, 95% confidence interval (-0.87, 0.24), P=0.26) and was associated with a shorter time until the first rescue analgesic and poorer patient satisfaction. Conclusion. TAP block results in a more effective and steady analgesic effect than WI with conventional local anesthetics in adult patients from the early postoperative period and obtains higher patient satisfaction.

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Liposomal Bupivacaine Transversus Abdominis Plane Block Versus Epidural Analgesia in a Colon and Rectal Surgery Enhanced Recovery Pathway: A Randomized Clinical Trial

Abstract: http://www.clinicaltrials.gov (NCT02591407). See Video Abstract at http://links.lww.com/DCR/A737.

Cited by 65 publications

References 20 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

Minimally invasive sigmoidectomy for diverticular disease decreases inpatient opioid use: Results of a propensity score-matched study

Transversus Abdominis Plane Block versus Wound Infiltration with Conventional Local Anesthetics in Adult Patients Underwent Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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