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

BACKGROUNDA key point in pathways for optimal rehabilitation and enhanced recovery is an effective postoperative multimodal pain treatment regimen. OBJECTIVETo investigate the analgesic effects of transversus abdominis plane (TAP) block in conjunction with paracetamol and ibuprofen in patients undergoing laparoscopic colonic resection. DESIGNRandomised placebo-controlled double-blind study. SETTINGHerlev University Hospital, Copenhagen, Denmark, from March 2010 to February 2013. PATIENTSEighty adult patients scheduled for elective laparoscopic colectomy. INTERVENTIONSBilateral TAP block with 20 ml of either ropivacaine or isotonic saline. MAIN OUTCOME MEASURESVisual 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. RESULTSVAS 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. CONCLUSIONTAP 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 REGISTRATIONwww.clinicaltrials.gov (NCT01418144).