title: Open transversus abdominis plane block and analgesic requirements in patients following right hemicolectomy.
abstract: BACKGROUND
  Reducing exogenously administered opioids in the post-operative period is associated with early return of bowel function and decreased post-operative complication rates. We evaluated the effectiveness of a surgeon-delivered open transversus abdominis plane (TAP) block  as a method to reduce post-operative opioid requirements, sedation and inpatient stay.
  
  
  METHODS
  The patient cohort was identified from those who had undergone a right hemicolectomy for colonic cancer. Patients received either an open TAP block and post-operative patient controlled anaesthesia  (PCA) ( n =20) or were part of a control group who received subcutaneous local anaesthetic infiltration and PCA ( n =16).
  
  
  RESULTS
  PCA morphine use was reduced within the first 24 hours post-operatively in the TAP block group compared with controls (42.1mg vs 72.3mg, p  =0.002). Sedation was also reduced significantly in the early post-operative period (p <0.04). There was a non-significant trend towards reduced length of stay in the intervention group (8.2 vs 8.73 days). There were no recorded complications attributable to the open TAP block.
  
  
  CONCLUSIONS
  Open TAP blocks are safe and reduce post-operative opioid requirements and sedation after right hemicolectomies. They should be considered as part of a multimodal enhanced recovery approach to patients undergoing abdominal surgery via a transverse incision.
authors.affiliation: Department of Surgery, NHS Fife, UK. richardbrady@btinternet.com
authors.forename: R R
authors.initials: RR
authors.lastname: Brady
authors.forename: N T
authors.initials: NT
authors.lastname: Ventham
authors.forename: D M
authors.initials: DM
authors.lastname: Roberts
authors.forename: C
authors.initials: C
authors.lastname: Graham
authors.forename: T
authors.initials: T
authors.lastname: Daniel
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000772:Anesthesia, Local; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D016292:Procedural Sedation / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine