title: Demonstrating the benefits of transversus abdominis plane blocks on patient outcomes in laparoscopic colorectal surgery: review of 200 consecutive cases.
abstract: BACKGROUND
  Quality improvement in colorectal surgery (CRS) requires implementation of tools to improve patient and financial outcomes, and assessment of results. Our objective was to evaluate the durability of transversus abdominis plane (TAP) blocks and a standardized enhanced recovery protocol (ERP) on a large series of laparoscopic colorectal resections.
  
  
  METHODS
  Two hundred consecutive laparoscopic CRS patients received TAP blocks under laparoscopic guidance at the end of their operation. All were managed with a standardized ERP. Demographic, perioperative, and postoperative outcomes variables were analyzed. The main outcomes measures were length of stay (LOS), readmission, reoperation, morbidity, and mortality rates.
  
  
  RESULTS
  Of 200 cases, 194 were elective and 6 emergent. The main diagnosis was colorectal cancer (45%). The mean patient age was 61.2 years, mean body mass index was 29.2 kg/m(2), and the majority (63%) were American Society of Anesthesiologists (ASA) class III. The main procedure performed was a segmental colectomy (64%). Mean operative time was 181 minutes. Nine cases (4.5%) were converted to open. The median LOS was 2 days (range 1 to 8 days). Twenty-one percent were discharged by postoperative day (POD) 1, 41% by POD 2, and 77% by POD 3. By POD 7, 99% were discharged. Twelve percent (n = 24) had complications, and 6.5% (n = 13) were readmitted. There were 3 unplanned reoperations and no mortalities. Comparing the first and second groups of 100 consecutive patients further tested the consistency of the TAP block benefit. With comparable demographics, there were no significant differences in readmission, complication, or reoperation rates over the entire series.
  
  
  CONCLUSIONS
  Adding TAP blocks to an ERP facilitated shorter LOS with low readmission and reoperation rates when compared to previously published series. The effect appears durable and consistent in a large case series. Transversus abdominis plane blocks may be an efficient, cost-effective method for improving laparoscopic CRS results.
authors.affiliation: Division of Colorectal Surgery, University Hospitals-Case Medical Center, Cleveland, OH.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.affiliation: Department of Surgery, University Hospitals-Case Medical Center, Cleveland, OH.
authors.forename: Bridget O
authors.initials: BO
authors.lastname: Ermlich
authors.affiliation: Division of Colorectal Surgery, University Hospitals-Case Medical Center, Cleveland, OH. Electronic address: Conor.Delaney@uhhospitals.org.
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D000009:Abdominal Muscles; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000601:surgery; D003107:Colorectal Surgery / Q000379:methods*; D004238:Diverticulitis / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome