title: 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.
authors.affiliation: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India. bhartineerja@yahoo.com
authors.forename: Neerja
authors.initials: N
authors.lastname: Bharti
authors.forename: Parag
authors.initials: P
authors.lastname: Kumar
authors.forename: Indu
authors.initials: I
authors.lastname: Bala
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
mesh_terms: D000009:Abdominal Muscles / Q000187:drug effects*; D000293:Adolescent; D000328:Adult; D000698:Analgesia / Q000379:methods*; D000758:Anesthesia / Q000379:methods; D000777:Anesthetics / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000494:pharmacology; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics; D009020:Morphine