The Effect of Transversus Abdominis Plane Blocks on Postoperative Pain in Laparoscopic Colorectal Surgery

Abstract

Transversus abdominis plane blocks improved immediate short-term opioid use and pain outcomes. Pain improvement was durable throughout the hospital stay. However, the blocks did not translate into less overall narcotic use, shorter length of stay, or lower readmission rates.

Femoral Nerve Palsy Following Landmark Based Ilioinguinal-Iliohypogastric Nerve Block: Case Report and Safety Review

“…Another method of visualized infiltration is administration during laparoscopic procedures [15,16]. This nerve blockade, typically utilized for TAP blocks, is performed during pneu- moperitoneum with direct laparoscopic visualization.…”

“…This method similarly attempts to eliminate potential complications, specifically colonic or small bowel perforation which has been described with the other administration techniques. Proponents also note that there is little to no learning curve with this method which takes advantage of tactile sensation and laparoscopic visualization [15,16]. Though the incidence of FNP following II/IH-NB is an uncommon occurrence, it does represent a potential risk to patient safety.…”

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

“…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).…”

“…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.…”

“…22 This association was further substantiated by the observation that fentanyl use decreased as pain scores diminished at 2, 4, 8, 12, 24 and 48 hours postoperatively. 22 Additionally, an RCT by Keller and colleagues 23 prospectively followed 92 patients and compared the impact of transversus abdominis plane block versus placebo on postoperative pain and opioid administration following laparoscopic colorectal surgery. The authors found an association between lower pain scores and reduced opioid consumption in the immediate postoperative period, with a reduction in opioid consumption corresponding to a reduction in pain.…”