title: Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blind randomized clinical trial.
abstract: BACKGROUND
  Adequate postoperative analgesia is essential for recovery following colorectal surgery. Transversus abdominis plane (TAP) blocks have been found to be beneficial in improving pain following a variety of abdominal operations. The objective of this study was to determine if TAP blocks are useful in improving postoperative recovery following laparoscopic colorectal surgery.
  
  
  METHODS
  A prospective double-blind randomized clinical trial, involving 226 consecutive patients having laparoscopic colorectal surgery, was performed by a university colorectal surgical department. Patients were randomized to either TAP blockade using ultrasound guidance, or control, with the primary outcome being postoperative pain, as measured by analgesic consumption. Secondary outcomes assessed were pain visual analogue score (VAS), respiratory function, time to return of gut function, length of hospital stay, postoperative complications, and patient satisfaction.
  
  
  RESULTS
  A total of 142 patients were followed up to trial completion (74 controls, 68 interventions). Patients were well matched with regard to demographics. No complications occurred as a result of the intervention of TAP blockade. There was no difference between groups with regards to analgesic consumption (161 mEq morphine control vs 175 mEq morphine TAP; p = 0.596). There was no difference between the two groups with regards to the secondary outcomes of daily VAS, respiratory outcome, time to return of gut function, length of hospital stay, postoperative complications, and patient satisfaction.
  
  
  CONCLUSIONS
  We conclude that TAP blockade appears to be a safe intervention but confers no specific advantage following laparoscopic colorectal surgery.
authors.affiliation: Division of Surgery, John Hunter Hospital, University of Newcastle, Locked Bag 1, Hunter Regional Mail Centre, Newcastle, NSW, 2310, Australia, steve_srs@hotmail.com.
authors.forename: Stephen Ridley
authors.initials: SR
authors.lastname: Smith
authors.forename: Brian
authors.initials: B
authors.lastname: Draganic
authors.forename: Peter
authors.initials: P
authors.lastname: Pockney
authors.forename: Phillip
authors.initials: P
authors.lastname: Holz
authors.forename: Ryan
authors.initials: R
authors.lastname: Holmes
authors.forename: Brendan
authors.initials: B
authors.lastname: Mcmanus
authors.forename: Rosemary
authors.initials: R
authors.lastname: Carroll
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation; D034861:Abdominal Wall / Q000294:innervation; D000344:Afferent Pathways; D000368:Aged; D000577:Amides; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000779:Anesthetics, Local; D003108:Colonic Diseases / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D041981:Gastrointestinal Tract / Q000503:physiopathology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010098:Oxycodone / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D017060:Patient Satisfaction; D020127:Recovery of Function; D012002:Rectal Diseases / Q000601:surgery*; D012129:Respiratory Function Tests; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D010098:Oxycodone; D005283:Fentanyl