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The efficacy of a novel approach to transversus abdominis plane block for postoperative analgesia after colorectal surgery.

Abstract：

BACKGROUND:The analgesic efficacy of transversus abdominis plane (TAP) block has been established for patients undergoing abdominal surgery. We evaluated the efficacy of a novel approach to TAP block for postoperative analgesia after colorectal surgery. METHODS:Forty adult ASA physical status I to III patients undergoing colorectal surgery were recruited to this double-blind randomized controlled trial. A standard general anesthetic technique was used. TAP block was performed at the end of surgery by piercing the transversus abdominis muscle from inside the abdominal wall at the midaxillary line at the level of the umbilicus with a 22-gauge blunt needle. The patients were randomly assigned to receive either 20 mL of 0.25%bupivacaine (TAP group) or normal saline (control group) on each side of the abdominal wall. Each patient was assessed at 0, 0.5, 1, 2, 4, 8, 12, and 24 hours postoperatively for pain at rest and on coughing using a visual analog scale. IV morphine was used for postoperative rescue analgesia. Time to first request for rescue analgesia, total morphine requirement in 24 hours, cumulative morphine consumption at 2, 4, 6, 12, and 24 hours, and adverse effects (respiratory depression, sedation, nausea/vomiting) were recorded. RESULTS:A 65% decrease in 24-hour total morphine consumption was observed in the TAP group compared with the control group (P < 0.0001). The cumulative morphine requirement was also significantly lower in the TAP group at all time points. Although the time to first request for morphine was comparable, the subsequent doses of morphine were required at significantly longer time intervals in the TAP group than in the control group. TAP group patients had significantly lower pain scores at rest and on coughing as compared with the control group, at all time points assessed. The incidence of sedation was also less in the TAP group at 1, 2, 4, and 6 hours postoperatively (P < 0.05). CONCLUSIONS:This new approach to the TAP block provides effective postoperative analgesia after colorectal surgery.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Bharti N,Kumar P,Bala I,Gupta V

doi

10.1213/ANE.0b013e3182159bf8

subject

Has Abstract

pub_date

2011-06-01 00:00:00

pages

1504-8

issue

eissn

0003-2999

issn

1526-7598

pii

ANE.0b013e3182159bf8

journal_volume

112

pub_type

杂志文章,随机对照试验

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The efficacy of a novel approach to transversus abdominis plane block for postoperative analgesia after colorectal surgery.