A Comparison of Ultrasound Guided Transversus Abdominis Plane Nerve Block Techniques
Status:
Completed
Trial end date:
2017-04-30
Target enrollment:
Participant gender:
Summary
Postoperative pain can pose significant challenges in the postoperative recovery of patients
undergoing major colorectal surgery. Traditionally, opioids have played an important role in
treating postoperative pain. It is well established that opioids are highly effective in
relieving pain; however opioids are associated with numerous side effects that include
nausea, vomiting, constipation, ileus, bladder dysfunction, respiratory depression, pruritus,
drowsiness, sedation, and allergic reaction. These opioid side effects, which range in
severity, can significantly interfere with discharge home following colorectal surgery.
Significant interest exists in the use of local anesthetic based regional anesthesia
techniques as a means to extend the analgesic window for patients undergoing colorectal
surgery. Specifically, the use of the transversus abdominis plane (TAP) block as an adjunct
in postoperative pain control has been widely reported in the anesthesia and colorectal
surgery literature. Historically, the block was performed in a blind fashion with relative
success and presently the block is typically performed either with ultrasound guidance or
laparoscopic visualization. While TAP block has shown to be effective in post-operative pain
control, the techniques used to place the block have not formally been compared.
The investigators are purposing a prospective, patient-blinded, randomized study of patients
undergoing major colorectal surgery to compare TAP block under ultrasound guidance versus
laparoscopic visualization versus no TAP block. The investigators hypothesize that
laparoscopic-guided TAP block is non-inferior to ultrasound-guided TAP block with respect to
perioperative pain control and either technique is superior to no TAP. In addition the
investigators will measure procedural time, any adverse events related to the block, overall
postoperative analgesic requirement, analgesic duration, postoperative pain scores, length of
postoperative hospital stay, incidence of postoperative ileus, and overall patient
satisfaction between the three groups.