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

Abstract

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.

Laparoscopic-Assisted Transversus Abdominis Plane Block Is Superior to Port Site Infiltration in Reducing Post-Operative Opioid Use in Laparoscopic Surgery

“…They used this information to guide exactly how to perform the block to make it universal across the rest of the TAP blocks in their study. The accuracy and equivalence of a L-TAP block has also been shown in a non-inferiority trial completed by Wong et al 7 This study included 60 patients who underwent laparoscopic colorectal surgery. The L-TAP block was performed just prior to closing the abdomen and the ultrasound TAP block was completed at the end of the case.…”

“…Consequently, a laparoscopic assisted TAP (L-TAP) block was developed and has been shown to be non-inferior to ultrasound-guided blocks. [6][7][8] Despite most procedures being performed laparoscopically, postoperative pain can be significant. Pain control in morbidly obese patients can be especially challenging because of increased sensitivity to opioidinduced respiratory depression.…”

<p>Timing of Transversus Abdominis Plane Block and Postoperative Pain Management</p>

“…Thus far, there is limited evidence suggesting that such surgeon-performed TAP blocks are better than ultrasoundguided TAP blocks for patients undergoing colorectal surgery. 17 Although it is unlikely, that surgeon-performed TAP blocks would have changed our results, a randomized control trial comparing the two techniques in an appropriate sample of patients would be ideal. In our analysis, we observed no difference with respect to postoperative pain control and opioid consumption between patients who received a TAP block prior to induction of anesthesia or after induction of anesthesia.…”

Transversus Abdominis Plane Block With Liposomal Bupivacaine vs. Regular Anesthetics for Pain Control After Surgery: A Systematic Review and Meta-Analysis

“…Since none of the other studies assessed the accuracy of the TAP blocks, its exact influence on the review outcomes cannot be determined. Third, there was (39,40). The precise role of variable dosage of RB in the control group and different combinations of LB and RB in the study group is also difficult to ascertain.…”