• Deborah S Keller, Bridget O Ermlich, Nicholas Schiltz, Bradley J Champagne, Harry L Reynolds, Sharon L Stein, and Conor P Delaney.
• 1Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio 2Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio 3Department of Statistics, Case Western Reserve University, Cleveland, Ohio.
• Dis. Colon Rectum. 2014 Nov 1;57(11):1290-7.

BackgroundSuperior early pain control has been suggested with transversus abdominis plane blocks, but evidence-based recommendations for transversus abdominis plane blocks and their effects on patient outcomes are lacking.ObjectiveThe aim of this study was to determine whether transversus abdominis plane blocks improve early postoperative outcomes in patients undergoing laparoscopic colorectal resection already on an optimized enhanced recovery pathway.DesignThis study is based on a prospective, randomized, double-blind controlled trial.SettingsThe trial was conducted at a tertiary referral center.PatientsPatients undergoing elective laparoscopic colorectal resection were selected.Interventions(S)Patients were randomly assigned to receive either a transversus abdominis plane block or a placebo placed intraoperatively under laparoscopic guidance. All followed a standardized enhanced recovery pathway. Patient demographics, perioperative procedures, and postoperative outcomes were collected.Main Outcome MeasuresPostoperative pain and nausea/vomiting scores in the postanesthesia care unit and department, opioid use, length of stay, and 30-day readmission rates were measured.ResultsThe trial randomly assigned 41 patients to the transversus abdominis plane block group and 38 patients to the control group. Demographic, clinical, and procedural data were not significantly different. In the postanesthesia care unit, the transversus abdominis plane block group had significantly lower pain scores (p < 0.01) and used fewer opioids (p < 0.01) than the control group; postoperative nausea/vomiting scores were comparable (p = 0.99). The transversus abdominis plane group had significantly lower pain scores on postoperative day 1 (p = 0.04) and throughout the study period (p < 0.01). There was no significant difference between groups in postoperative opioid use (p = 0.65) or nausea/vomiting (p = 0.79). The length of stay (median, 2 days experimental, 3 days control; p = 0.50) and readmission rate (7% experimental, 5% control, p = 0.99) was similar across cohorts.LimitationsThis study was conducted a single center.ConclusionsTransversus abdominis plane blocks improved immediate short-term opioid use and pain outcomes. Pain improvement was durable throughout the hospital stay. However, the blocks did not translate into less overall narcotic use, shorter length of stay, or lower readmission rates.

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