title: No benefit of ultrasound-guided transversus abdominis plane blocks over wound infiltration with local anaesthetic in elective laparoscopic colonic surgery: results of a double-blind randomized controlled trial.
abstract: OBJECTIVE
  Advances in laparoscopic techniques combined with enhanced recovery pathways have led to faster recuperation and discharge after colorectal surgery. Peripheral nerve blockade using transversus abdominis plane (TAP) blocks reduce opioid requirements and provide better analgesia for laparoscopic colectomies than do inactive controls. This double-blind randomized study was performed to compare TAP blocks using bupivacaine with standardized wound infiltration with local anaesthetic (LA).
  
  
  METHODS
  Seventy-one patients were randomized to receive either TAP block or wound infiltration. The TAP blocks were performed by experienced anaesthetists who used ultrasound guidance to deliver 40 ml of 0.25% bupivacaine post-induction into the transverse abdominis plane. In the control group, 40 ml of 0.25% bupivacaine was injected around the trocar and the extraction site by the surgeon. Both groups received patient-controlled analgesia (PCA) with intravenous morphine. Patients and nursing staff assessed pain scores 6, 12, 24 and 48 h after surgery. The primary outcome was overall morphine use in the first 48 h.
  
  
  RESULTS
  Of the 71 patients, 20 underwent a right hemicolectomy and 51 a high anterior resection. The modified intention-to-treat analysis showed no significant differences in overall morphine use [47.3 (36.2-58.5) mg vs 46.7 (36.2-57.3) mg; mean (95% CI), P = 0.8663] in the first 48 h. Pain scores were similar at 6, 12, 24 and 48 h. No differences were found regarding time to mobilization, resumption of diet and length of hospital stay.
  
  
  CONCLUSIONS
  In elective laparoscopic colectomies, standardized wound infiltration with LA has the same analgesic effect as TAP blocks post-induction using bupivacaine at 48 h.
authors.affiliation: Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: A
authors.initials: A
authors.lastname: Rashid
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Gorissen
authors.affiliation: Service of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Ris
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: M P
authors.initials: MP
authors.lastname: Gosselink
authors.affiliation: Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Shorthouse
authors.affiliation: Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Smith
authors.affiliation: Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Pandit
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: I
authors.initials: I
authors.lastname: Lindsey
authors.affiliation: Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: N A
authors.initials: NA
authors.lastname: Crabtree
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D000072836:Surgical Wound; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine
keywords: TAP block; enhanced recovery; laparoscopic colonic surgery; local anaesthetics; wound infiltration