Background

The aim of this study was to compare thoracic epidural analgesia (TEA) with transversus abdominis plane (TAP) block in post-operative pain management after laparoscopic colon surgery.

Methods

One hundred thirty-six patients undergoing laparoscopic colon resection randomly received either TEA or TAP with ropivacaine only. The primary endpoint was opioid requirement up to 48 h postoperatively. Intensity of pain, time to onset of bowel function, time to mobilization, postoperative complications, length of hospital stay, and patients’ satisfaction with pain management were also assessed.

Results

We observed a significant decrease in opioid consumption on the day of surgery with TEA compared with TAP block (30 mg vs 14 mg, p < 0.001). On the first two postoperative days (POD), the balance shifted to opioid consumption being smaller in the TAP group: on POD 1 (15.2 mg vs 10.6 mg; p = 0.086) and on POD 2 (9.2 mg vs 4.6 mg; p = 0.021). There were no differences in postoperative nausea/vomiting or time to first postoperative bowel movement between the groups. No direct blockade-related complications were observed and the length of stay was similar between TEA and TAP groups.

Conclusion

TEA is more efficient for acute postoperative pain than TAP block on day of surgery, but not on the first two PODs. No differences in pain management-related complications were detected.

中文翻译：

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在升级的机构 ERAS 计划中，在选择性腹腔镜结肠手术后疼痛管理中纯基于罗哌卡因的 TEA 与单一 TAP 阻滞

背景

本研究的目的是比较胸腔硬膜外镇痛 (TEA) 与腹横肌平面 (TAP) 阻滞在腹腔镜结肠手术术后疼痛管理中的应用。

方法

136 名接受腹腔镜结肠切除术的患者随机接受了仅含罗哌卡因的 TEA 或 TAP。主要终点是术后 48 小时的阿片类药物需求。还评估了疼痛强度、肠功能开始时间、活动时间、术后并发症、住院时间和患者对疼痛管理的满意度。

结果

与 TAP 阻滞相比，我们观察到 TEA 手术当天的阿片类药物消耗显着减少（30 毫克对 14 毫克，p  < 0.001）。在术后前两天 (POD)，TAP 组的平衡转向阿片类药物消耗量减少：POD 1（15.2 mg 对 10.6 mg；p = 0.086）和 POD 2（9.2 mg 对 4.6 mg；p  = 0.021)。两组间术后恶心/呕吐或术后首次排便时间无差异。没有观察到直接的阻断相关并发症，TEA 组和 TAP 组的住院时间相似。

结论

对于术后急性疼痛，TEA 在手术当天比 TAP 阻滞更有效，但在前两个 POD 上则不然。没有发现疼痛管理相关并发症的差异。