Author(s): ,
Buckley, E.
Phelps County Regional Medical Center, Anesthesiology, Rolla, USA
Hickey, T.
Webster University, Nurse Anesthesia, St. Louis, USA
Taylor, A.
Webster University, Nurse Anesthesia, St. Louis, USA
Burns, M.*
Phelps County Regional Medical Center, Anesthesiology, Rolla, USA
ESRA Academy. Burns M. Sep 13, 2017; 190964; 148 Topic: Low Abdominal and Perineal Surgery
Disclosure(s): Consultant for TeleFlex
Mr. Michael Burns
Mr. Michael Burns

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Background and Aims:

The reduction of opioids during the postoperative period is the focus of most enhanced recovery protocols. Many of these protocols for laparoscopic colorectal surgery utilize truncal blocks such as single injection bilateral transversus abdominis plane blocks instead of low thoracic epidurals. The purpose of this study was to evaluate the effectiveness of single injection versus continuous transverse abdominis plane blocks on postoperative opioid consumption for 48 hours.


A retrospective chart review of elective laparoscopic colorectal procedures was performed (n=34). All patients received intrathecal morphine 200mcg, similar postoperative opioid orders, alvimopan 12 mg PO, and either bilateral single injection transverse abdominis plane blocks with 15ml of 0.5% ropivacaine on each side or continuous bilateral transverse abdominis plane blocks with the same initial bolus. Then a 0.2% ropivacaine infusion at 5ml/hr is started bilaterally for 48 hours. All opioid data was collected and converted to IV morphine equivalents utilizing GlobalRPh program.


The continuous TAP block group received 47% less opioids over 48 hours (p=0.031). This significant decrease was noted during the postanesthesia care unit (p= 0.049) and within the first 24 hours (p=0.006). The opioid consumption for the following 24 hours was not statistically significant (p>0.05).


Continuous transverse abdominis plane blocks significantly decreased the opioid consumption during the postoperative period. The substitution of this modality for low thoracic epidurals could assist in decreasing opioid related complications as well as known difficulties with low thoracic epidural such as systemic hypotension, foley catheter placement, delayed ambulation, and interference with anticoagulation.

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