Laparoscopic-Guided Transversus Abdominis Plane (TAP) Block as Part of Multimodal Analgesia in Laparoscopic Roux-en-Y Gastric Bypass Within an Enhanced Recovery After Surgery (ERAS) Program: a Prospective Randomized Clinical Trial

2018 ◽  
Vol 28 (11) ◽  
pp. 3374-3379 ◽  
Author(s):  
Jaime Ruiz-Tovar ◽  
Alejandro Garcia ◽  
Carlos Ferrigni ◽  
Juan Gonzalez ◽  
Cesar Levano-Linares ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Gastric Bypass ◽  
Randomized Clinical Trial ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Multimodal Analgesia ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Prospective Randomized Clinical Trial

scholarly journals Optimal concentration of the transversus abdominis plane block in enhanced recovery after surgery protocols for patients of advanced age undergoing laparoscopic rectal cancer surgery

2018 ◽  
Vol 46 (11) ◽  
pp. 4437-4446 ◽  
Author(s):  
Ping-Chen ◽  
Qing-Song Lin ◽  
Xian-Zhong Lin
Keyword(s):  
Rectal Cancer ◽  
General Anesthesia ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Cancer Surgery ◽  
Optimal Concentration ◽  
Transversus Abdominis ◽  
Rectal Cancer Surgery ◽  
Tap Block ◽  
Transversus Abdominis Plane

Objective The transversus abdominis plane (TAP) block ameliorates visual analogue scale scores and decreases morphine requirements, but its role remains unclear. Patients of advanced age are susceptible to local anesthetic intoxication. We aimed to identify an optimal concentration that can be used in enhanced recovery after surgery (ERAS) without compromising analgesic efficacy. Methods In total, 120 patients aged ≥65 years undergoing laparoscopic rectal cancer surgery received general anesthesia combined with a TAP block using 0.25% ropivacaine (Group A), 0.50% ropivacaine (Group B), or 0.75% ropivacaine (Group C) in a 40-mL volume. Group D only received general anesthesia. Epinephrine, plasma cortisol, interleukin-6, and tumor necrosis factor-α were measured at baseline, skin incision, celiac exploration, and tracheal extubation. The proportions of CD4+ and CD4+/CD8+ cells were measured at baseline and postoperative days 1 and 3. Results The TAP block relieved the stress response and accelerated intestinal functional recovery as shown by significant reductions in VAS scores and anesthetic requirements. However, there was no significant difference between Groups B and C. Conclusion The TAP block plays an important role in ERAS in older patients undergoing laparoscopic rectal cancer surgery, and 0.5% ropivacaine is an optimal concentration that can reduce toxicity without undermining analgesia.

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