title: Analgesic efficacy of bilateral continuous transversus abdominis plane blocks using an oblique subcostal approach in patients undergoing laparotomy for gynaecological cancer: a prospective, randomized, triple-blind, placebo-controlled study.
abstract: BACKGROUND
  The analgesic efficacy of continuous transversus abdominis plane (TAP) blocks in comparison with that of single-injection TAP blocks is not clear. This randomized, triple-blind, placebo-controlled trial investigated the benefits of adding continuous TAP blocks to single-injection TAP blocks after a laparotomy.
  
  
  METHODS
  Eighty consecutive patients undergoing midline laparotomy for gynaecological cancer were randomized and received bilateral TAP infusions with either ropivacaine 0.1% (n=40, Rop group) or normal saline (n=40, NS group) at 10 ml h-1per side for 50 h after surgery. After surgery, bilateral oblique subcostal TAP blocks were performed using ropivacaine 0.1%, 50 ml per side, and then catheters were threaded into the bilateral TAPs. Subsequently, continuous TAP infusions and patient-controlled i.v. morphine administration were initiated. The primary outcome was cumulative morphine consumption by 24 h after TAP catheter placement. Secondary outcomes included pain scores, postoperative nausea and vomiting severity, and time to first ambulation and flatus.
  
  
  RESULTS
  The cumulative morphine consumption (median [interquartile range]) 24 h after TAP catheter placement was lower in the Rop group (0.25 [0.11-0.48] mg kg-1) than in the NS group (0.44 [0.24-0.73] mg kg-1; 95% confidence interval difference in medians, -0.30 to - 0.03; P=0.01). No statistically significant differences were observed in the secondary outcomes, except for reduced pain scores in the Rop group obtained during coughing 1 and 24 h after TAP catheter placement.
  
  
  CONCLUSIONS
  Addition of continuous TAP blocks to single-injection TAP blocks reduces pain and morphine consumption after a laparotomy for gynaecological cancer.
  
  
  BACKGROUND
  UMIN Clinical Trials Registry identification number UMIN000013449 (http://www.umin.ac.jp/ctr/index.htm).
authors.affiliation: Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata-city, Osaka, Japan ytaka@mac.com.|Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata-city, Niigata, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata-city, Niigata, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Furutani
authors.affiliation: Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata-city, Niigata, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata-city, Niigata, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Ohashi
authors.affiliation: Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata-city, Niigata, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Baba
mesh_terms: D000009:Abdominal Muscles / Q000187:drug effects*; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage* / Q000627:therapeutic use; D000698:Analgesia / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D011446:Prospective Studies; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: anaesthesia recovery period; laparotomy; nerve block; pain; postoperative; ultrasonography