title: Addition of transversus abdominis plane block to patient controlled analgesia for laparoscopic high anterior resection improves analgesia, reduces opioid requirement and expedites recovery of bowel function.
abstract: BACKGROUND
  Opioid sparing in postoperative pain management appears key in colorectal enhanced recovery. Transversus abdominis plane (TAP) blocks offer such an effect. This study aimed to quantify this effect on pain, opioid use and recovery of bowel function after laparoscopic high anterior resection.
  
  
  METHODS
  This was a retrospective analysis of prospective data on 68 patients. Patients received an epidural (n=24), intravenous morphine patient controlled analgesia (PCA, n=22) or TAP blocks plus PCA (n=22) determined by anaesthetist preference. Outcome measures were numerical pain scores (0-3), cumulative intravenous morphine dose and time to recovery of bowel function (passage of flatus or stool).
  
  
  RESULTS
  There were no differences in patient characteristics, complications or extraction site. The TAP block group had lower pain scores (0.7 vs 1.36, p<0.001) and morphine requirements (8 mg vs 15 mg, p=0.01) than the group receiving PCA alone at 12 hours and 24 hours. Earlier passage of flatus (2.0 vs 2.7 vs 3.4 days, p=0.002), stool (3.1 vs 4.1 vs 5.5 days, p=0.04) and earlier discharge (4 vs 5 vs 6 days, p=0.02) were also seen.
  
  
  CONCLUSIONS
  Use of TAP blocks was found to reduce pain and morphine use compared with PCA, expedite recovery of bowel function compared with PCA and epidural, and expedite hospital discharge compared with epidural.
authors.affiliation: Oxford University Hospitals NHS Trust, UK.
authors.forename: F
authors.initials: F
authors.lastname: Ris
authors.forename: J M
authors.initials: JM
authors.lastname: Findlay
authors.forename: R
authors.initials: R
authors.lastname: Hompes
authors.forename: A
authors.initials: A
authors.lastname: Rashid
authors.forename: J
authors.initials: J
authors.lastname: Warwick
authors.forename: C
authors.initials: C
authors.lastname: Cunningham
authors.forename: O
authors.initials: O
authors.lastname: Jones
authors.forename: N
authors.initials: N
authors.lastname: Crabtree
authors.forename: I
authors.initials: I
authors.lastname: Lindsey
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation*; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D004068:Digestive System Physiological Phenomena / Q000502:physiology*; D005414:Flatulence / Q000503:physiopathology; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid