TAP block may shorten hospital stay after colorectal surgery

Last Updated: 2018-05-31

By Will Boggs MD

NEW YORK (Reuters Health) - Use of transversus abdominis plane (TAP) block for pain control appears to shorten hospital stays after colorectal surgery compared with conventional epidural analgesia, researchers report.

"Although epidural analgesia is a time-tested, effective method of pain control after open abdominal surgery, TAP blocks may offer a reasonably effective and potentially superior alternative to epidural with a shorter length of stay in post-colectomy patients," Dr. Shawn Obi from Henry Ford Allegiance Health, in Jackson, Michigan, told Reuters Health by email.

TAP blocks provide equivalent pain scores and opioid-use reduction to epidural analgesia, but previous studies have not compared length of stay and other clinical parameters affecting patient care.

Dr. Obi's team compared length of stay, return of bowel function and other outcomes in their unblended randomized trial of TAP block versus thoracic epidural analgesia in 78 patients undergoing colorectal surgery.

Time to discharge, the primary endpoint, was significantly shorter in the TAP group (mean, 2.8 days) than in the epidural group (mean, 3.3 days), the researchers report in the Journal of the American College of Surgeons, online April 30.

Time to first flatus did not differ between the groups. Postoperative nausea/vomiting was non-significantly more common in the TAP group (31.7% vs. 13.5% in the epidural group), whereas postoperative urinary retention was non-significantly more common with epidural analgesia (29.7% vs. 14.6% in the TAP group).

"Patients with high risk for post-operative nausea and vomiting may be better served with epidurals compared with TAP, given the trends observed in our study population," Dr. Obi said. "Patients undergoing open or laparoscopic colectomy with epidurals suffered higher incidence of urinary retention, and TAP may offer an advantage over epidural in preventing this common complication."

"There remains debate on the most effective agents used in TAP blocks, and whether there is a more durable benefit to liposomal bupivacaine over the standard alternative," he said. "Cost considerations and attention to responsible resource utilization may require additional analysis to determine true clinical benefits compared with tangible costs."

Dr. Obi added, "The optimal timing of administration for the TAP is still unknown, as recent studies conclude (that it's) an effective strategy when performed intra-operatively, rather than the pre-emptive/pre-operative strategies employed in this paper."

SOURCE: https://bit.ly/2H82NR9

J Am Coll Surg 2018.