Transversus abdominis plane (TAP) block versus thoracic epidural analgesia (TEA) in laparoscopic colon surgery in the ERAS program

Abstract

TAP block combined with an opioid-sparing analgesia in the setting of the laparoscopic colorectal surgery and ERAS program is feasible and effective in postoperative pain control.

Implementation of an enhanced recovery program in pediatric laparoscopic colorectal patients does not worsen analgesia despite reduced perioperative opioids: a retrospective, matched, non-inferiority study

“…Although this may appear unconventional, it has been argued that epidurals should be avoided in laparoscopic colorectal procedures due to their high risk:benefit ratio despite being associated with faster bowel function return in laparoscopic low anterior resections 25 26. Also, Pirrera et al 27 showed that postoperative pain intensity was comparable between TAP blocks and thoracic epidurals for laparoscopic colonic surgeries. However, epidural placement may be a consideration in non-laparoscopic abdominal surgeries since postoperative epidural analgesia is associated with a lower incidence of chronic postsurgical pain in this patient population 28…”

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

“…Furthermore, TAP can be performed in patients who are otherwise not suitable for epidurals, such as patients who will need early postoperative anticoagulation. TAP has been shown to reduce postoperative pain as effectively as epidural analgesia . It has also been shown that TAP results in a shorter length of stay compared with thoracic epidurals .…”

“…It has also been shown that TAP results in a shorter length of stay compared with thoracic epidurals . Additionally, TAP block has been associated with lower postoperative nausea, ileus and paraesthesia rates .…”

“Minimally invasive” regional anesthesia and the expanding use of interfascial plane blocks: the need for more systematic evaluation

“…Il a été démontré que les techniques chirurgicales minimalement invasives s'accompagnaient d'une récupération plus rapide, d'un meilleur confort pour le patient et d'une réduction de la durée de séjour hospitalier -à tel point que les techniques neuraxiales traditionnelles pourraient ne pas procurer de bienfaits analgésiques comparables. 3 Les régimes d'analgésie régionale tels que l'analgésie péridurale thoracique (APT), les blocs paravertébraux et les opioïdes intrathécaux sont associés à un risque de complications majeures telles que l'hématome neuraxial, le pneumothorax, et la dépression respiratoire. En outre, en plus de soumettre les patients au risque de ces complications majeures, ces techniques analgésiques traditionnelles ont également une incidence significative d'échec.…”

“…Minimally invasive surgical techniques have shown to result in faster recovery, better patient comfort, and reduced hospital length of stay, to the point where traditional neuraxial techniques may not provide significant comparable analgesic benefits. 3 Regional analgesic regimens such as thoracic epidural analgesia (TEA), paravertebral blocks, and intrathecal opioids are associated with the risk of major complications such as neuraxial hematoma, pneumothorax, and respiratory depression. In addition, despite subjecting the patients to the risk of these major complications, these traditional analgesic techniques also have a significant incidence of failure.…”