Skip to main content

Advertisement

SpringerLink
Log in

Transversus abdominis plane block using a short-acting local anesthetic for postoperative pain after laparoscopic colorectal surgery: a systematic review and meta-analysis

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Siegel R, Desantis C, Jemal A (2014) Colorectal cancer statistics, 2014. CA Cancer J Clin 64:104–117

    Article  PubMed  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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

    Article  CAS  PubMed  Google Scholar 

  15. 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

    Article  CAS  PubMed  Google Scholar 

  16. 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

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. Favuzza J, Delaney CP (2013) Laparoscopic-guided transversus abdominis plane block for colorectal surgery. Dis Colon Rectum 56:389–391

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  CAS  PubMed  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  24. 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

    Article  CAS  PubMed  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. 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)

    Article  PubMed  Google Scholar 

  27. Mineo R, Sharrock NE (1992) Venous levels of lidocaine and bupivacaine after midtarsal ankle block. Reg Anesth 17:47–49

    CAS  PubMed  Google Scholar 

  28. 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

    Article  PubMed  PubMed Central  Google Scholar 

  29. 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

    Article  CAS  PubMed  Google Scholar 

  30. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Chahar P, Cummings KC, 3rd (2012) Liposomal bupivacaine: a review of a new bupivacaine formulation. J Pain Res 5:257–264

    PubMed  PubMed Central  Google Scholar 

  32. 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

    PubMed  Google Scholar 

  33. 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

    Article  PubMed  PubMed Central  Google Scholar 

  34. 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

    Article  PubMed  Google Scholar 

  35. 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

    Article  CAS  PubMed  Google Scholar 

  36. 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

    Article  PubMed  Google Scholar 

  37. 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

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea

    Tak Kyu Oh, Sang-Hwan Do & In-Ae Song

  2. Business School, Business Statistical Analysis and Risk Management, University of Manchester, Manchester, UK

    Se-Jun Lee

Authors
  1. Tak Kyu Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Se-Jun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sang-Hwan Do
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. In-Ae Song
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to In-Ae Song.

Ethics declarations

Disclosures

Dr. Tak Kyu Oh, Se-Jun Lee, Sang-Hwan Do, and In-Ae Song have no conflicts of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

464_2017_5871_MOESM1_ESM.tif

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)

464_2017_5871_MOESM2_ESM.tif

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)

464_2017_5871_MOESM3_ESM.tif

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)

464_2017_5871_MOESM4_ESM.tif

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)

464_2017_5871_MOESM5_ESM.tif

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)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-017-5871-8

Keywords

Search

Navigation