D. Colibaseanu1, O. Osagiede2, A. Merchea1, C. Thomas6, E. Bojaxhi3, J. Panchamia5, A. Jacob5, S. Kelley4, K. Mathis4, A. Lightner4, J. Naessens6, D. W. Larson4 1Mayo Clinic – Florida,Section Of Colon And Rectal Surgery,Jacksonville, FL, USA 2Mayo Clinic – Florida,Health Sciences Research,Jacksonville, FL, USA 3Mayo Clinic – Florida,Department Of Anesthesiology,Jacksonville, FL, USA 4Mayo Clinic,Division Of Colon And Rectal Surgery,Rochester, MN, USA 5Mayo Clinic,Department Of Anesthesiology,Rochester, MN, USA 6Mayo Clinic,Health Sciences Research,Rochester, MN, USA
Introduction: Transversus abdominis plane (TAP) block is an effective alternative to neuraxial analgesia in abdominal surgery; however, limited evidence supports its use over traditional analgesic modalities in colorectal surgery. We compared the analgesic efficacy of liposomal bupivacaine TAP block and intrathecal (IT) opioids in a prospective randomized trial. The primary outcomes were the mean pain score and morphine milligram equivalents (MME) used within the first 48 hours post-surgery. Secondary outcomes included length of stay, standardized costs, postoperative ileus, and intravenous patient-controlled analgesia use.
Methods: Patients were recruited from two campuses of a single institution. Two hundred and nine patients undergoing elective small bowel or colorectal resections were enrolled. They were randomized to receive either bilateral TAP block or single-injection IT analgesia with hydromorphone. Patients were assessed at 4, 8, 16, 24, and 48 hours post-surgery.
Results: Two hundred patients completed the trial (TAP =102, IT N=98). The TAP group had a mean pain score 1.7 points higher than the IT group 4 hours post-surgery, persisting up to 16 hours post-surgery. There was evidence of higher MME use < 24 hours post-surgery in the TAP group compared to IT (median difference: 10.0 MME, 95% CI 3.0 – 20.5 MME). No difference in MME was observed between the two groups at 24 and 48 hours, or in secondary outcomes.
Conclusions: Intrathecal opioids provided better immediate postoperative pain control compared to liposomal bupivacaine TAP block, lasting up to 16 hours post-surgery. Both modalities provided adequate pain control in patients enrolled in this study, and should be considered as part of a multimodal postoperative analgesic plan for patients undergoing elective colorectal surgery.