Transversus abdominis plane (<scp>TAP</scp>) block in laparoscopic colorectal surgery improves postoperative pain management: a meta‐analysis

Hain, Élisabeth; Maggiori, Léon; Denise, J. Prost à la; Panis, Yves

doi:10.1111/codi.14037

Cited by 61 publications

(43 citation statements)

References 45 publications

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“…Recent randomized controlled studies (2011 ~ current) on the analgesic effect of single-shot TAP block after laparoscopic lower abdominal surgery are shown (Table 3) 7-10, [12][13][14][15][16][17][18][19] . Although a meta-analysis including these investigations suggested that TAP block reduces perioperative opioid consumption 20 , NRS was decreased in only 4 of those 12 studies. We speculated that apparent analgesic effect of TAP block might have affected by methodological factors such as block approach, block timing, and use of opioids or supplemental analgesics during surgery.…”

Section: Discussionmentioning

confidence: 99%

Transversus Abdominis Plane Block Reduced Early Postoperative Pain after Robot-assisted Prostatectomy: a Randomized Controlled Trial

Taninishi

Matsusaki

Morimatsu

2020

Sci Rep

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Analgesic effect of transversus abdominis plane block (TAP block) in lower major abdominal laparoscopic surgery with about 5 cm of maximum surgical scar has been controversial. We hypothesized that TAP block has benefits, so the analgesic effect of TAP block after robot-assisted laparoscopic prostatectomy (RALP) was evaluated. One hundred patients were enrolled in this prospective, double-blinded, randomized study. Standardized general anesthesia with wound infiltration on camera port and fentanyl dose limit of 3 µg/kg was provided. Ultrasound-guided, singleshot subcostal TAP block with either 0.375% ropivacaine (Ropivacaine group, 48 patients) or normal saline (Control group, 52 patients) was performed by anesthesiologist in charge (34 anesthesiologists) after surgical procedure. Pain score using numerical rating scale (NRS) and postoperative intravenous fentanyl were evaluated for the first 24 postoperative hours. Median values (interquartile range) of NRS scores when the patients were transferred to post-anesthesia care unit (PACU) were 5 (2-7) in Ropivacaine group and 6 (4-8) in Control group at rest (P = 0.03), 5 (2-8) in Ropivacaine group and 7 (5-8) in Control group during movement (P < 0.01). These significant differences disappeared at the time of discharging PACU. Fentanyl doses for the first 24 postoperative hours were 210 µg (120-360) in Ropivacaine group and 200 µg (120-370) in Control group (P = 0.79). These results indicated that subcostal tAp block by anesthesiologists of varied level of training reduced postoperative pain immediate after RALP. TAP block had fundamental analgesic effect, but this benefit was too small to reduce postoperative 24-hour fentanyl consumption.In the past few decades, lower abdominal major surgical procedures such as colectomy, hysterectomy and prostatectomy have changed from laparotomy to laparoscopic methods. Although epidural anesthesia has been used as gold standard in laparotomy, smaller surgical scar in laparoscopic procedures and early recovery after surgery motivated us to consider peripheral nerve blocks instead of epidural anesthesia 1,2 .Transversus abdominis plane block (TAP block), first reported in 2001 3 , has recently been spreading as an alternative to epidural anesthesia. Analgesic effect of TAP block has been established in laparoscopic cholecystectomy 4-6 . Although enhanced recovery after surgery (ERAS) protocol in elective colorectal surgery recommended abdominal wall blocks because of postoperative less opioid use and early recovery2,decrease in pain score by TAP block in lower major abdominal laparoscopic procedures remains controversial 7-10 . One of reasons for this controversy is these major procedures require a larger port scar in order to extract resected organs. Furthermore, there are several technical biases affecting TAP block efficacy such as approach options, timing of TAP block (preoperative or postoperative), local anesthetic concentration and dose, and supplementary analgesics. It is necessary to minimize these biases when evaluating ...

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Section: Discussionmentioning

confidence: 99%

Transversus Abdominis Plane Block Reduced Early Postoperative Pain after Robot-assisted Prostatectomy: a Randomized Controlled Trial

Taninishi

Matsusaki

Morimatsu

2020

Sci Rep

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“…First, the superiority of laparoscopic-guided TAP block vs ultrasound-guided TAP block, which has been underlined with regard to the recent publication of Zaghiyan et al, has to be nuanced [3]. This study, even though focusing on colorectal surgery, had limitations.…”

Section: Response Tomentioning

confidence: 96%

“…The latter method is a semi-blind technique that is performed under direct laparoscopic vision and does not require US skills [2]. A meta-analysis culling data from 13 randomized and non-randomized studies showed that TAP block was associated with a significantly shorter time to first bowel movement and a significantly reduced postoperative opioid consumption in the first 24 h following laparoscopic colorectal surgery [3]. Of note, while laparoscopic-guided TAP block consistently improved shortterm opioid use and postoperative outcomes within an enhanced recovery programme, the results for US-guided TAP block were conflicting.…”

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confidence: 99%

“…Moreover, the efficacy of US-guided TAP block is inextricably linked with the level of US experience. In the three studies where US-guided TAP block did not translate into less opioid consumption and better postoperative outcomes, either no detailed information was provided regarding the level of experience with the technique or the intervention was performed by more than one anaesthetist [3]. These observations were further bolstered by a recent randomized controlled trial which evidenced that laparoscopic-guided TAP block is superior to USguided TAP block in terms of pain control and opioid requirements at 24 h postoperatively [4].…”

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The role of laparoscopic‐guided transversus abdominis plane block in laparoscopic colorectal surgery

Hamid¹,

Ahmed²

2019

Colorectal Disease

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“…For example, transversus abdominis plane (TAP) block has been shown to reduce postoperative intravenous (IV) morphine consumption 24 h after abdominal surgery . In a study examining the use of TAP for CRS, reduced opioid consumption on the first postoperative day (POD) and a shorter time to first bowel movement were seen, without any increase in postoperative complications .…”

Section: Introductionmentioning

confidence: 99%

Comparison of preoperative versus postoperative transversus abdominis plane and rectus sheath block in patients undergoing minimally invasive colorectal surgery

et al. 2019

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Aim Ultrasound-guided transversus abdominis plane and rectus sheath block (TAPRSB) decreases pain scores and narcotic use postoperatively after colorectal surgery (CRS). It is unclear if the effectiveness of TAPRSB varies according to whether it is performed preoperatively or postoperatively. Our aim was to investigate this.Method We compared patients who underwent preoperative TAPRSB or postoperative TAPRSB during minimally invasive CRS. Primary end-points were pain scores and oral morphine milligram equivalent (MME) use postoperatively. Secondary end-points included perioperative factors affecting pain scores and postoperative MME. Summary statistics and univariate analysis by nonparametric tests were utilized. The mixed-effect model was applied to model the repeatedly measured pain score.Results From April 2015 until May 2018 168 patients received TAPRSB before (115) or after (53) minimally invasive CRS. The cohort included 79 (47.0%) women, and had an average age of 59.11 (AE12.32) years and mean body mass index of 28.32 (AE5.82) kg/m 2 . Indication for surgery was cancer in 66 (39.3%), polyp in 43 (25.6%) and diverticulitis in 43 (25.6%). Right colec-tomy was performed in 61 (36.3%), low anterior resection in 46 (27.4%) and sigmoid colectomy in 40 (23.8%) patients. The demographics of the groups were similar. Postoperative TAPRSB was only associated with lower pain scores at 12 h postoperatively. As secondary outcomes, average pain scores and MME were lower in patients who were older, had right colectomy or intracorporeal anastomosis.Conclusions Postoperative TAPRSB resulted in lower pain scores than preoperative TAPRSB 12 h after minimally invasive CRS, but otherwise no differences were seen in pain scores or MME use.Keywords Transversus abdominis block, rectus sheath block, milligram morphine equivalent, pain score, minimally invasive colorectal surgeryWhat does this study add to the literature? This study provides data regarding the timing of transversus abdominis plane and rectus sheath block and its effect on postoperative pain scores and narcotic use in patients undergoing minimally invasive colorectal surgery. It also offers more data regarding a specific type of block, which includes four injection sites.Comparison of preoperative vs postoperative transversus abdominis plane J. Xia et al.

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Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative pain management: a meta‐analysis

Abstract: Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative opioid consumption and recovery of postoperative digestive function without any significant drawback.

Cited by 61 publications

References 45 publications

Transversus Abdominis Plane Block Reduced Early Postoperative Pain after Robot-assisted Prostatectomy: a Randomized Controlled Trial

Transversus Abdominis Plane Block Reduced Early Postoperative Pain after Robot-assisted Prostatectomy: a Randomized Controlled Trial

The role of laparoscopic‐guided transversus abdominis plane block in laparoscopic colorectal surgery

Comparison of preoperative versus postoperative transversus abdominis plane and rectus sheath block in patients undergoing minimally invasive colorectal surgery

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