Two-stage laparoscopic transversus abdominis plane block as an equivalent alternative to thoracic epidural anaesthesia in bowel resection

• Verfasst von: Kaufmann, Mario [VerfasserIn]
• Verfasst von: Orth, Vanessa [VerfasserIn]
• Verfasst von: Dorwarth, Tim-Janick [VerfasserIn]
• Verfasst von: Benrath, Justus [VerfasserIn]
• Verfasst von: Gerber, Benjamin [VerfasserIn]
• Verfasst von: Ghezel-Ahmadi, D. [VerfasserIn]
• Verfasst von: Reißfelder, Christoph [VerfasserIn]
• Verfasst von: Herrle, Florian [VerfasserIn]
• Titel: Two-stage laparoscopic transversus abdominis plane block as an equivalent alternative to thoracic epidural anaesthesia in bowel resection
• Titelzusatz: an explorative cohort study
• Verf.angabe: M. Kaufmann, V. Orth, T.-J. Dorwarth, J. Benrath, B. Gerber, D. Ghezel-Ahmadi, C. Reißfelder, F. Herrle
• E-Jahr: 2024
• Jahr: 11 January 2024
• Umfang: 8 S.
• Illustrationen: Illustrationen
• Fussnoten: Gesehen am 16.02.2024
• Titel Quelle: Enthalten in: International journal of colorectal disease
• Ort Quelle: Berlin : Springer, 1986
• Jahr Quelle: 2024
• Band/Heft Quelle: 39(2024), Artikel-ID 18, Seite 1-8
• ISSN Quelle: 1432-1262
• DOI: doi:10.1007/s00384-023-04592-6
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Bowel resection
• Sach-SW: L-TAP
• Sach-SW: TAP
• Sach-SW: Thoracic epidural anaesthesia
• Sach-SW: Two-stage laparoscopic transversus abdominis plane block
• K10plus-PPN: 1881030911

Abstract

Purpose: We evaluated the effect of the two-stage laparoscopic transversus abdominis plane block (TS-L-TAPB) in comparison to thoracic epidural anaesthesia (TEA) and a one-stage L-TAPB (OS-L-TAPB) in patients who underwent elective laparoscopic bowel resection. Methods: We compared a TS-L-TAPB (266 mg bupivacaine), which was performed bilaterally at the beginning and end of surgery, with two retrospective cohorts. These were patients who had undergone a TEA (ropivacaine/sufentanil) or an OS-L-TAPB (200 mg ropivacaine) at the beginning of surgery. Oral and i.v. opiate requirements were documented over the first 3 postoperative days (POD). Results: Patients were divided into three groups TEA (n = 23), OS-L-TAPB (n = 75), and TS-L-TAPB (n = 49). By the evening of the third POD, patients with a TEA had a higher cumulative opiate requirement with a median of 45.625 mg [0; 202.5] than patients in the OS-L-TAPB group at 10 mg [0; 245.625] and the TS-L-TAPB group at 5.625 mg [0; 215.625] (p = 0.1438). One hour after arrival in the recovery room, significantly more patients in the TEA group (100%) did not need oral and i.v. opioids than in the TS-L-TAPB (78%) and OS-L-TAPB groups (68%) (p = 0.0067).This was without clinical relevance however as the median in all groups was 0 mg. On the third POD, patients in the TEA group had a significantly higher median oral and i.v. opioid dose at 40 mg [0; 80] than the TS-L-TAPB and OS-L-TAPB groups, both at 0 mg [0; 80] (p = 0.0009). Conclusion: The TS-L-TAP showed statistically significant and clinically meaningful benefits over TEA and OS-L-TAP in reducing postoperative opiate requirements.