Abstract
Background: The transversus abdominis plane (TAP) block is an important non-narcotic adjunct for post-operative pain control in abdominal surgery. Surgeons can use laparoscopic guidance for TAP block placement (LTAP), however, direct comparisons to conventional ultrasound-guided TAP (UTAPs) have been lacking. The aim of this study is to determine if surgeon placed LTAPs were non-inferior to anesthesia placed UTAPs for post-operative pain control in laparoscopic colorectal surgery. Methods: This was a prospective, randomized, patient and observer blinded parallel-arm non-inferiority trial conducted at a single tertiary academic center between 2016 and 2018 on adult patients undergoing laparoscopic colorectal surgery. Narcotic consumption and pain scores were compared for LTAP vs. UTAP for 48 h post-operatively. Results: 60 patients completed the trial (31 UTAP, 29 LTAP) of which 25 patients were female (15 UTAP, 10 LTAP) and the mean ages (SD) were 60.0 (13.6) and 61.5 (14.3) in the UTAP and LTAP groups, respectively. There was no significant difference in post-operative narcotic consumption between UTAP and LTAP at the time of PACU discharge (median [IQR] milligrams of morphine, 1.8 [0–4.5] UTAP vs. 0 [0–8.7] LTAP P =.32), 6 h post-operatively (5.4 [1.8–17.1] UTAP vs. 3.6 [0–12.6] LTAP P =.28), at 12 h post-operatively (9.0 [3.6–29.4] UTAP vs. 7.2 [0.9–22.5] LTAP P =.51), at 24 h post-operatively (9.0 [3.6–29.4] UTAP vs. 7.2 [0.9–22.5] LTAP P =.63), and 48 h post-operatively (39.9 [7.5–70.2] UTAP vs. 22.2 [7.5–63.8] LTAP P =.41). Patient-reported pain scores as well as pre-, intra-, and post-operative course were similar between groups. Non-inferiority criteria were met at all post-op time points up to and including 24 h but not at 48 h. Conclusions: Surgeon-delivered LTAPs are safe, effective, and non-inferior to anesthesia-administered UTAPs in the immediate post-operative period. Trial registry: The trial was registered at clinicaltrials.gov Identifier NCT03577912.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 3011-3019 |
| Number of pages | 9 |
| Journal | Surgical endoscopy |
| Volume | 34 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 1 2020 |
Funding
The authors thank Shaelah Huntington and Dr. Marc Shnider for their contributions. This work was conducted with support from Harvard Catalyst|The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health. The authors thank Shaelah Huntington and Dr. Marc Shnider for their contributions. This work was conducted with support from Harvard Catalyst|The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health.
Keywords
- Enhanced recovery after surgery
- Laparoscopy
- Post-operative pain control
- Transversus abdominis plane (TAP) block
ASJC Scopus subject areas
- Surgery