Abstract
Background
Transversus abdominis plane (TAP) block using a short-acting local anesthetic as part of multimodal analgesia is efficient in various abdominal surgeries, including laparoscopic surgery. However, information regarding its use in laparoscopic colorectal surgery is still limited and sometimes controversial. Therefore, we conducted a systematic review and meta-analysis to determine whether TAP block using a short-acting anesthetic has a positive postoperative analgesic outcome in patients who have undergone laparoscopic colorectal surgery.
Methods
We searched for studies comparing the postoperative pain outcome after laparoscopic colorectal surgery between patients who received TAP block and a control group (placebo or no treatment). Outcome measures were early pain at rest (numeric rating scale [NRS] score at 0–2 h postoperatively), late pain at movement (NRS score at 24 h postoperatively), late pain at rest (NRS score at 24 h postoperatively), and postoperative opioid consumption (up to 24 h postoperatively). We used a random-effects model for the meta-analysis and Egger’s regression test to detect publication bias.
Results
We included six studies involving 452 patients (224 in the TAP block group, 228 in the control group). Early and late pain scores at movement were significantly different between the TAP block and control groups (standardized mean difference: − 0.695, P < 0.0001 for early pain and − 0.242, P = 0.029 for late pain). There was no significant difference between the TAP block and control groups in early pain at rest (P = 0.475), late pain at rest (P = 0.826), and postoperative opioid consumption (P = 0.257).
Conclusions
The TAP block using a short-acting anesthetic had a significant effect on the postoperative pain outcome in the early (0–2 h) and late (24 h) period at movement. However, it did not have a significant effect on the postoperative pain outcome in the early (0–2 h) and late (24 h) periods at rest after laparoscopic surgery.
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References
Siegel R, Desantis C, Jemal A (2014) Colorectal cancer statistics, 2014. CA Cancer J Clin 64:104–117
Sano Y, Byeon JS, Li XB, Wong MC, Chiu HM, Rerknimitr R, Utsumi T, Hattori S, Sano W, Iwatate M, Chiu P, Sung J (2016) Colorectal cancer screening of the general population in East Asia. Dig Endosc 28:243–249
Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645
De Oliveira GS Jr, Castro-Alves LJ, Nader A, Kendall MC, McCarthy RJ (2014) Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials. Anesth Analg 118:454–463
Conaghan P, Maxwell-Armstrong C, Bedforth N, Gornall C, Baxendale B, Hong LL, Carty HM, Acheson AG (2010) Efficacy of transversus abdominis plane blocks in laparoscopic colorectal resections. Surg Endosc 24:2480–2484
Ris F, Findlay JM, Hompes R, Rashid A, Warwick J, Cunningham C, Jones O, Crabtree N, Lindsey I (2014) Addition of transversus abdominis plane block to patient controlled analgesia for laparoscopic high anterior resection improves analgesia, reduces opioid requirement and expedites recovery of bowel function. Ann R Coll Surg Engl 96:579–585
Walter CJ, Maxwell-Armstrong C, Pinkney TD, Conaghan PJ, Bedforth N, Gornall CB, Acheson AG (2013) A randomised controlled trial of the efficacy of ultrasound-guided transversus abdominis plane (TAP) block in laparoscopic colorectal surgery. Surg Endosc 27:2366–2372
Keller DS, Ermlich BO, Delaney CP (2014) Demonstrating the benefits of transversus abdominis plane blocks on patient outcomes in laparoscopic colorectal surgery: review of 200 consecutive cases. J Am Coll Surg 219:1143–1148
Oh TK, Yim J, Kim J, Eom W, Lee SA, Park SC, Oh JH, Park JW, Park B, Kim DH (2017) Effects of preoperative ultrasound-guided transversus abdominis plane block on pain after laparoscopic surgery for colorectal cancer: a double-blind randomized controlled trial. Surg Endosc 31:127–134
Smith SR, Draganic B, Pockney P, Holz P, Holmes R, McManus B, Carroll R (2015) Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blind randomized clinical trial. Int J Colorectal Dis 30:1237–1245
Torup H, Hansen EG, Bogeskov M, Rosenberg J, Mitchell AU, Petersen PL, Mathiesen O, Dahl JB, Moller AM (2016) Transversus abdominis plane block after laparoscopic colonic resection in cancer patients: a randomised clinical trial. Eur J Anaesthesiol 33:725–730
Stokes AL, Adhikary SD, Quintili A, Puleo FJ, Choi CS, Hollenbeak CS, Messaris E (2017) Liposomal bupivacaine use in transversus abdominis plane blocks reduces pain and postoperative intravenous opioid requirement after colorectal surgery. Dis Colon Rectum 60:170–177
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12
Kawano C, Hirayama T, Kuroyama M (2011) Dose conversion in opioid rotation from continuous intravenous infusion of morphine hydrochloride injection to fentanyl patch in the management of cancer pain. Yakugaku Zasshi 131:463–467
Dewinter G, Van de Velde M, Fieuws S, D’Hoore A, Rex S (2014) Transversus abdominis plane block versus perioperative intravenous lidocaine versus patient-controlled intravenous morphine for postoperative pain control after laparoscopic colorectal surgery: study protocol for a prospective, randomized, double-blind controlled clinical trial. Trials 15:476
Favuzza J, Brady K, Delaney CP (2013) Transversus abdominis plane blocks and enhanced recovery pathways: making the 23-h hospital stay a realistic goal after laparoscopic colorectal surgery. Surg Endosc 27:2481–2486
Favuzza J, Delaney CP (2013) Outcomes of discharge after elective laparoscopic colorectal surgery with transversus abdominis plane blocks and enhanced recovery pathway. J Am Coll Surg 217:503–506
Favuzza J, Delaney CP (2013) Laparoscopic-guided transversus abdominis plane block for colorectal surgery. Dis Colon Rectum 56:389–391
Keller DS, Ermlich BO, Schiltz N, Champagne BJ, Reynolds HL Jr, Stein SL, Delaney CP (2014) The effect of transversus abdominis plane blocks on postoperative pain in laparoscopic colorectal surgery: a prospective, randomized, double-blind trial. Dis Colon Rectum 57:1290–1297
Niraj G, Kelkar A, Hart E, Horst C, Malik D, Yeow C, Singh B, Chaudhri S (2014) Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, non-inferiority trial. Anaesthesia 69:348–355
Park SY, Park JS, Choi GS, Kim HJ, Moon S, Yeo J (2017) Comparison of analgesic efficacy of laparoscope-assisted and ultrasound-guided transversus abdominis plane block after laparoscopic colorectal surgery: a randomized, single-blind, non-inferiority trial. J Am Coll Surg 225:403–410
Pedrazzani C, Menestrina N, Moro M, Brazzo G, Mantovani G, Polati E, Guglielmi A (2016) Local wound infiltration plus transversus abdominis plane (TAP) block versus local wound infiltration in laparoscopic colorectal surgery and ERAS program. Surg Endosc 30:5117–5125
Tikuisis R, Miliauskas P, Lukoseviciene V, Samalavicius N, Dulskas A, Zabuliene L, Zabulis V, Urboniene J (2016) Transversus abdominis plane block for postoperative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial. Tech Coloproctol 20:835–844
Srikandarajah S, Gilron I (2011) Systematic review of movement-evoked pain versus pain at rest in postsurgical clinical trials and meta-analyses: a fundamental distinction requiring standardized measurement. Pain 152:1734–1739
Gilron I, Tod D, Goldstein DH, Parlow JL, Orr E (2002) The relationship between movement-evoked versus spontaneous pain and peak expiratory flow after abdominal hysterectomy. Anesth Analg 95:1702–1707 (table of contents)
Mineo R, Sharrock NE (1992) Venous levels of lidocaine and bupivacaine after midtarsal ankle block. Reg Anesth 17:47–49
Shin HJ, Kim ST, Yim KH, Lee HS, Sim JH, Shin YD (2011) Preemptive analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision. Korean J Anesthesiol 61:413–418
Calder K, Chung B, O’Brien C, Lalonde DH (2013) Bupivacaine digital blocks: how long is the pain relief and temperature elevation? Plast Reconstr Surg 131:1098–1104
Feierman DE, Kronenfeld M, Gupta PM, Younger N, Logvinskiy E (2014) Liposomal bupivacaine infiltration into the transversus abdominis plane for postsurgical analgesia in open abdominal umbilical hernia repair: results from a cohort of 13 patients. J Pain Res 7:477–482
Chahar P, Cummings KC, 3rd (2012) Liposomal bupivacaine: a review of a new bupivacaine formulation. J Pain Res 5:257–264
Aksu R, Patmano G, Bicer C, Emek E, Coruh AE (2017) [Efficiency of bupivacaine and association with dexmedetomidine in transversus abdominis plane block ultrasound guided in postoperative pain of abdominal surgery]. Rev Bras Anestesiol. doi:10.1016/j.bjan.2017.04.021
Mishra M, Mishra SP, Singh SP (2017) Ultrasound-guided transversus abdominis plane block: What are the benefits of adding dexmedetomidine to ropivacaine?. Saudi J Anaesth 11:58–61
Borglum J, Jensen K, Christensen AF, Hoegberg LC, Johansen SS, Lonnqvist PA, Jansen T (2012) Distribution patterns, dermatomal anesthesia, and ropivacaine serum concentrations after bilateral dual transversus abdominis plane block. Reg Anesth Pain Med 37:294–301
Tran TM, Ivanusic JJ, Hebbard P, Barrington MJ (2009) Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth 102:123–127
Suresh S, Taylor LJ, De Oliveira GS Jr (2015) Dose effect of local anesthetics on analgesic outcomes for the transversus abdominis plane (TAP) block in children: a randomized, double-blinded, clinical trial. Paediatr Anaesth 25:506–510
Forero M, Heikkila A, Paul JE, Cheng J, Thabane L (2015) Lumbar transversus abdominis plane block: the role of local anesthetic volume and concentration-a pilot, prospective, randomized, controlled trial. Pilot Feasibility Stud 1:10
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Dr. Tak Kyu Oh, Se-Jun Lee, Sang-Hwan Do, and In-Ae Song have no conflicts of interest or financial ties to disclose.
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Additional Figure 1 Early pain at rest (NRS score at 0–2 hours postoperatively). Meta-analysis (top) and sensitivity analysis (bottom). NRS, numeric rating scale (TIF 364 KB)
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Additional Figure 2 Early pain at movement (NRS score at 0–2 hours postoperatively). Meta-analysis (top) and sensitivity analysis (bottom). NRS, numeric rating scale (TIF 376 KB)
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Additional Figure 3 Late pain at rest (NRS score at 24 hours postoperatively). Meta-analysis (top) and sensitivity analysis (bottom). NRS, numeric rating scale (TIF 544 KB)
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Additional Figure 4. Late pain at movement (NRS score at 24 hours postoperatively). Meta-analysis (top) and sensitivity analysis (bottom). NRS, numeric rating scale (TIF 447 KB)
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Additional Figure 5. Postoperative opioid consumption (intravenous morphine in mg up to 24 hours postoperatively). Meta-analysis (top) and sensitivity analysis (bottom). (TIF 339 KB)
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Oh, T.K., Lee, SJ., Do, SH. et al. Transversus abdominis plane block using a short-acting local anesthetic for postoperative pain after laparoscopic colorectal surgery: a systematic review and meta-analysis. Surg Endosc 32, 545–552 (2018). https://doi.org/10.1007/s00464-017-5871-8
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DOI: https://doi.org/10.1007/s00464-017-5871-8