Analgesic efficacy of postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane block for laparoscopic colorectal cancer surgery: a randomized, prospective, controlled study

Abstract

Background We assessed whether a postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane (TAP) block could reduce 24\u2009h rescue tramadol requirement compared with placebo in patients undergoing elective laparoscopic colorectal cancer surgery. Methods Patients scheduled to undergo elective laparoscopic surgery following the diagnosis of colorectal cancer were included in this study and randomized into Group and Group Control. The patients received a postoperative bilateral, ultrasound-guided, posterior TAP block in either 20\u2009mL of 0.5% ropivacaine (Group TAP) per side or an equivalent volume of normal saline (Group Control). The primary outcome was the cumulative consumption of rescue tramadol within 24\u2009h after the surgery. Secondary endpoints included (1) resting and movement numerical rating scale (NRS) pain scores at 2, 4, 6, 12, 24, 48, and 72\u2009h; (2) incidences of related side effects; (3) time to the first request for rescue tramadol; (4) patient satisfaction regarding postoperative analgesia; (5) time to restoration of intestinal function; (6) time to mobilization; and (7) the length of hospital stay. Results In total, 92 patients were randomized, and 82 patients completed the analysis. The total rescue tramadol requirement (median [interquartile range]) within the first 24\u2009h was lower in Group TAP (0 [0, 87.5] mg) than in Group Control (100 [100, 200] mg), P \u2009<\u20090.001. The posterior TAP block reduced resting and movement NRS pain scores at 2, 4, 6, 12, and 24\u2009h after surgery (all P \u2009<\u20090.001) but showed similar scores at 48\u2009h or 72\u2009h. A higher level of satisfaction with postoperative analgesia was observed in Group TAP on day 1 ( P \u2009=\u20090.002), which was similar on days 2 ( P \u2009=\u20090.702) and 3 ( P \u2009=\u20090.551), compared with the Group Control. A few incidences of opioid-related side effects (P\u2009<\u20090.001) and a lower percentage of patients requiring rescue tramadol analgesia within 24\u2009h (P\u2009<\u20090.001) were observed in Group TAP. The time to the first request for rescue analgesia was prolonged, and the time to mobilization and flatus was reduced with a shorter hospital stay in Group TAP as compared with Group Control. Conclusions A postoperative bilateral, ultrasound-guided, posterior TAP block resulted in better pain management and a faster recovery in patients undergoing laparoscopic colorectal cancer surgery, without adverse effects. Trial registration The study was registered at http://www.chictr.org.cn ( ChiCTR-IPR-17012650 ; Sep 12, 2017).