Laparoscopic versus ultrasound-guided transversus abdominis plane block in colorectal surgery: a non-inferiority, multicentric randomized double-blinded clinical trial.

Autor: La Regina D; Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland.; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland., Popeskou SG; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.; Department of Surgery, Lugano Regional Hospital, EOC, Lugano, Switzerland., Saporito A; Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland., Gaffuri P; Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland., Tasciotti E; Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland., Dossi R; Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland., Christoforidis D; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.; Department of Surgery, Lugano Regional Hospital, EOC, Lugano, Switzerland.; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland., Mongelli F; Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland.; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2023 Sep; Vol. 25 (9), pp. 1921-1928. Date of Electronic Publication: 2023 Jul 31.
DOI: 10.1111/codi.16689
Abstrakt: Aim: The aim of this study was to assess if laparoscopic-assisted transversus abdominis plane (TAP) block (L-TAPB) is as efficient as ultrasound-guided TAP block (U-TAPB) in postoperative pain control.
Method: In all, 112 patients scheduled for elective laparoscopic colon resection from February 2018 to December 2021 at two Swiss hospitals were included and randomized in a 1:1 ratio before surgery with either L-TAPB or U-TAPB. The primary end-point was the non-inferiority of the L-TAPB compared to U-TAPB with regard to the total opioid consumption within the first 24 h after surgery. Data regarding patients' characteristics, opioid consumption, pain on the visual analogue scale, operative and anaesthesia induction time, complications and length of stay were collected and analysed.
Results: Fifty-five patients were allocated to the L-TAPB and fifty-seven to the U-TAPB. No significant difference was found in the overall dose of opioids within 24 h, and the non-inferiority of the L-TAPB was confirmed. There were almost twice as many patients in the L-TAPB group requesting opioid reserves compared to the U-TAPB group (54.5% vs. 29.8%, P = 0.008). The anaesthesia induction time was significantly longer in the U-TAPB group (17 ± 11 min vs. 23 ± 12 min, P = 0.014). For all other variables (pain on the visual analogue scale, opioid consumption, need of epidural analgesia, operating time, postoperative complications and hospital stay) no statistically significant difference between the L-TAPB and the U-TAPB groups was noted.
Conclusion: Our results showed the non-inferiority of the laparoscopic delivery compared to ultrasound-guided administration of the TAP block, with the advantage of not affecting anaesthesia times.
Study Registration Number: 2017-02017 CE 3294, ClinicalTrials.gov identifier NCT04575233.
(© 2023 Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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