title: The effect of transversus abdominis plane blocks on postoperative pain in laparoscopic colorectal surgery: a prospective, randomized, double-blind trial.
abstract: BACKGROUND
  Superior early pain control has been suggested with transversus abdominis plane blocks, but evidence-based recommendations for transversus abdominis plane blocks and their effects on patient outcomes are lacking.
  
  
  OBJECTIVE
  The aim of this study was to determine whether transversus abdominis plane blocks improve early postoperative outcomes in patients undergoing laparoscopic colorectal resection already on an optimized enhanced recovery pathway.
  
  
  METHODS
  This study is based on a prospective, randomized, double-blind controlled trial.
  
  
  METHODS
  The trial was conducted at a tertiary referral center.
  
  
  METHODS
  Patients undergoing elective laparoscopic colorectal resection were selected.
  
  
  METHODS
  Patients were randomly assigned to receive either a transversus abdominis plane block or a placebo placed intraoperatively under laparoscopic guidance. All followed a standardized enhanced recovery pathway. Patient demographics, perioperative procedures, and postoperative outcomes were collected.
  
  
  METHODS
  Postoperative pain and nausea/vomiting scores in the postanesthesia care unit and department, opioid use, length of stay, and 30-day readmission rates were measured.
  
  
  RESULTS
  The trial randomly assigned 41 patients to the transversus abdominis plane block group and 38 patients to the control group. Demographic, clinical, and procedural data were not significantly different. In the postanesthesia care unit, the transversus abdominis plane block group had significantly lower pain scores (p < 0.01) and used fewer opioids (p < 0.01) than the control group; postoperative nausea/vomiting scores were comparable (p = 0.99). The transversus abdominis plane group had significantly lower pain scores on postoperative day 1 (p = 0.04) and throughout the study period (p < 0.01). There was no significant difference between groups in postoperative opioid use (p = 0.65) or nausea/vomiting (p = 0.79). The length of stay (median, 2 days experimental, 3 days control; p = 0.50) and readmission rate (7% experimental, 5% control, p = 0.99) was similar across cohorts.
  
  
  CONCLUSIONS
  This study was conducted a single center.
  
  
  CONCLUSIONS
  Transversus abdominis plane blocks improved immediate short-term opioid use and pain outcomes. Pain improvement was durable throughout the hospital stay. However, the blocks did not translate into less overall narcotic use, shorter length of stay, or lower readmission rates.
authors.affiliation: 1Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio 2Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio 3Department of Statistics, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.forename: Bridget O
authors.initials: BO
authors.lastname: Ermlich
authors.forename: Nicholas
authors.initials: N
authors.lastname: Schiltz
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Champagne
authors.forename: Harry L
authors.initials: HL
authors.lastname: Reynolds
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Stein
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D000009:Abdominal Muscles; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006760:Hospitalization; D006801:Humans; D007410:Intestinal Diseases / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002045:Bupivacaine