• Christopher Blom Salmonsen, LangeKai Henrik WiborgKHW0000-0003-4510-5888North Zealand, Department of Anaesthesiology, Copenhagen University Hospital, Hillerød, Denmark.Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denm, Jakob Kleif, Rasmus Krøijer, Lea Bruun, Martynas Mikalonis, Peter Dalsgaard, Karen Busk Hesseldal, Jon Emil Philip Olsson, Claus Anders Bertelsen, and OPMICS Study Group.
• North Zealand, Department of Surgery, Copenhagen University Hospital, Hillerød, Denmark chrisbsal@gmail.com.
• Reg Anesth Pain Med. 2024 Nov 14.

Background And ObjectivesThe transversus abdominis plane (TAP) block is the most widely used abdominal field block in colorectal surgery with a postoperative enhanced recovery pathway. We aimed to determine whether the laparoscopic-assisted and ultrasound-guided TAP (US-TAP) blocks provide superior pain relief compared with placebo. We separately investigated whether the laparoscopic-assisted technique was non-inferior to the ultrasound-guided technique in providing pain relief, with a non-inferiority margin of 10 mg morphine dose equivalents.Methods340 patients undergoing elective minimally invasive colon surgery were randomly allocated to one of three groups: (1) US-TAP block, (2) laparoscopic-assisted TAP (L-TAP) block, or (3) placebo. Superiority and non-inferiority were tested for the primary outcome: 24-hour postoperative morphine equivalent consumption. Secondary outcomes, including patient-reported quality of recovery, were included in the superiority analysis.Results127 patients were included in each block group and 86 in the placebo group. The US-TAP block was no different from placebo at -1.4 mg morphine (97.5% CI -6.8 to 4.0 mg; p=0.55). The L-TAP block was superior to placebo at -5.9 mg morphine (97.5% CI -11.3 to -0.5 mg; p=0.01) and non-inferior to the US-TAP block at -4.5 mg morphine (98.75% CI -10.0 to 1.1 mg).ConclusionThe L-TAP block was superior to placebo and non-inferior to the US-TAP block. However, neither met our predetermined estimate of the minimal clinically important difference of 10 mg morphine.Trial Registration NumberNCT04311099.© American Society of Regional Anesthesia & Pain Medicine 2024. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.

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