Transversus abdominis plane block after laparoscopic colonic resection in cancer patients: A randomised clinical trial.

Background: A key point in pathways for optimal rehabilitation and enhanced recovery is an effective postoperative multimodal pain treatment regimen.

Objective: To investigate the analgesic effects of transversus abdominis plane (TAP) block in conjunction with paracetamol and ibuprofen in patients undergoing laparoscopic colonic resection.

Design: Randomised placebo-controlled double-blind study.

Setting: Herlev University Hospital, Copenhagen, Denmark, from March 2010 to February 2013.

Patients: Eighty adult patients scheduled for elective laparoscopic colectomy.

Interventions: Bilateral TAP block with 20 ml of either ropivacaine or isotonic saline.

Main Outcome Measures: Visual analogue scale (VAS) pain scores (0 to 100 mm) while coughing at 6 h after surgery (primary outcome). Secondary outcomes were area under the curve pain scores (2 to 24 h) at rest and while coughing, 24-h morphine consumption and incidence of nausea and vomiting.

Results: VAS pain scores at 6 h while coughing was not different between groups (median, interquartile range), TAP, 27 (11 to 45) mm vs. placebo, 33 (20 to 49) mm (P = 0.20). Total 24-h morphine consumption was reduced in the TAP block group vs. placebo group, 30 (15 to 41) mg vs. 43 (30 to 67) mg, respectively (P = 0.008). This difference was most pronounced in the first postoperative hours. The remaining outcomes did not differ between groups.

Conclusion: TAP block used in combination with paracetamol and ibuprofen did not reduce pain after laparoscopic colonic surgery. However, we found a 30% reduction in opioid use, most marked in the early postoperative period.

Trial Registration: www.clinicaltrials.gov (NCT01418144).