The effect of transversus abdominis plane block on the chronic pain after colorectal surgery: a retrospective cohort study

Abstract

Background: Chronic postsurgical pain (CPSP) is common and would reduce the quality of life of patients. Transversus abdominal plane (TAP) block has been widely used in lower abdominal surgery and many researches demonstrated that it could improve acute postsurgical pain. We aim to determine whether TAP block could improve chronic postoperative pain at 3 months and 6 months after colorectal surgery. Methods: A total of 307 patients received selective colorectal surgery under general anesthesia between January, 2015 and January, 2019 in a single university hospital were included: 128 patients received TAP block combined with patient-controlled intravenous analgesia (PCIA) for postsurgical analgesia (group TP) and 179 only administrated with PCIA (group P). Main outcome was the NRS score of pain at 3 months after colorectal surgery. The data was analyzed by two-way repeated measures anova and the chi-square test. Results: The NRS score at rest and during movement was decreased significantly at 24 h after surgery (rest NRS 1.07 ± 1.34 vs 1.65 ± 1.67, movement NRS 3.00 ± 1.45 vs 3.65 ± 1.89; all P = 0.003) in group TP than those of group P. There was no significant difference of NRS score at 48 h after surgery (P > 0.05). At 3 months after surgery, the NRS score during movement was also lower in group TP than that in group P (0.59 ± 1.23 vs 0.92 ± 1.65, P = 0.045). There was no significant difference of NRS score at 6 months after surgery (P > 0.05). The prevalence of CPSP was 19.5% (25/128) in group TP and 20.7% (37/179) in group P at 3 months after surgery. 13.2% (17/128) of patients suffered from CPSP in group TP and 13.9% (25/179) in group P at 6 months after surgery. Both at 3 months and 6 months after surgery, there was no statistical difference of the prevalence of CPSP between the two groups (all P > 0.05). Conclusions: TAP block reduced NRS during movement at 3 months after surgery but did not reduce the incidence of CPSP at 3 months and 6 months after selective colorectal surgery.

Prevalence and predictors of chronic postsurgical pain after colorectal surgery: A prospective study

“…TAPB is applied extensively in lower abdominal surgery and is reported to facilitate control over acute postoperative pain by several studies [44][45][46]. However, the present study, along with certain previous studies, has demonstrated that TAPB did not decrease CPSP incidence after caesarean section [47], colorectal surgery [17] and Despite the limitations, it is believed that the findings of the present study will have important clinical and research implications, as a good number of patients undergoing colorectal surgery experience persistent pain that might impair activities of daily living.…”

“…TAPB is applied extensively in lower abdominal surgery and is reported to facilitate control over acute postoperative pain by several studies [44–46]. However, the present study, along with certain previous studies, has demonstrated that TAPB did not decrease CPSP incidence after caesarean section [47], colorectal surgery [17] and inguinal hernia repair [46]. Whether TAPB administration acts as a protective factor against the development of CPSP requires further investigation.…”

“…A few previous studies on colorectal surgery have reported CPSP incidence ranging between 13% and 31%. A retrospective study reported a 20.2% CPSP incidence at 3 months after colorectal surgery, which later decreased to 13.7% at 6 months [17]. In another retrospective study conducted among 199 patients undergoing laparoscopic colorectal surgery, 33 patients (17%) reported experiencing chronic pain after a mean follow‐up period of 38 months [16].…”

“…Although colorectal surgery is quite common, little attention is paid to CPSP after colorectal surgery [16,17]. Furthermore, few studies have examined predictors of CPSP after colorectal surgery [16].…”

Predictors of Chronic Postsurgical Pain in Elderly Patients Undergoing Hip Arthroplasty: A Multi-Center Retrospective Cohort Study

“…Regarding CPSP, reports on the chronic analgesic effects of PCEA and PCIA remain controversial. [28][29][30] Our findings indicate that both PCEA and PCIA have a protective effect against CPSP. Lowering the pain threshold and minimizing APOP might be the probable mechanism.…”