Postoperative analgesic efficiency of pre-emptive ultrasoundguided transversus abdominis plane block in patients undergoing laparoscopic colectomy

Abstract EN

Background The transversus abdominis plane block is a nerve block that provides analgesia to the anterior abdominal wall.

The aim of this study was to evaluate the analgesic efficacy of a pre-emptive ultrasound-guided transversus abdominis plane block (US-TAP block) in patients undergoing laparoscopic colectomy through a small lower abdominal skin incision.

Methods Forty patients undergoing laparoscopic colectomy surgery were randomized to undergo standard care such as patient-controlled analgesia (control group) or to receive an additional pre-emptive US-TAP block with standard care (TAP group).

A bilateral US-TAP block was performed after induction of general anaesthesia using 0.25% levobupivacaine 20 ml on each side.

Postoperative demand of rescue analgesics in the postanaesthesia care unit (PACU) and ward were recorded.

Each patient was assessed postoperatively by a blinded observer in PACU and at 2, 12, 24 and 48 h postoperatively to investigate pain at rest and on movement, drowsiness, nausea, itching and shivering.

Results The US-TAP block reduced the pain score compared with standard care in the PACU (4.1± 0.9 vs.

8.6 ±0.3) and at 24 and 48 h postoperatively (1.3 ± 0.4 vs.

2.7 ± 0.4, 1.3 ± 0.6 vs.

2.6 ± 0.2, respectively).

Morphine requirements in PACU in the TAP group versus the control group were reduced (9.3± 3.0 vs.

15.2 ± 2.1 mg, Po0.05).

In the ward, morphine requirements were reduced at 24 and 48 h (11.8± 3.4 vs.

16.6 ± 3.3 mg, 9.5 ± 2.3 vs.

14.4± 2.0 mg, respectively, Po0.05).

Conclusion The US-TAP block with standard care provides more effective analgesia after a laparoscopic colectomy surgery than standard patient-controlled analgesia only, reduces opioid requirements and side effects, promotes early return of bowel activity, promotes early hospital discharge and increases patient satisfaction.