Laparoscopic versus Ultrasound-Guided Transversus Abdominis Plane (TAP) Block in Colorectal Surgery: A Non-Inferiority, Multicentric Randomized Double-Blinded Clinical Trial

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Abstract Background Postoperative pain management after laparoscopic colorectal surgery is of utmost importance to grant a better outcome, shorter length of hospital stay, and costs. The Transversus abdominis plane (TAP) block is a relatively new technique with great potential and is achieved through a direct blockade of pain fibers in the plane between the transversus abdominis and internal oblique muscles. Delivery can be achieved under ultrasound guidance performed by the anesthetist or under laparoscopic control performed by the surgeon, however, few studies investigated the best administration method. Aims The aim of this study was to assess if laparoscopic-assisted TAP block (L-TAPB) is as efficient as ultrasound-guided TAP block (U-TAPB) in postoperative pain control. Methods One-hundred-sixteen patients scheduled for elective laparoscopic colon resections from February 2018 to December 2021 at two Swiss hospitals, were included and randomized with a 1:1 ratio to receive either L-TAPB or U-TAPB. The primary outcome was the percentage of patients requesting reserve opioids. Secondary outcomes were total opioid consumption within the first 24 hours after surgery, postoperative pain on the visual analog scale (VAS) at 3, 6, 12, and 24 hours after surgery, and TAP block-related complications. Results There were almost twice as many patients in the L-TAPB group requesting opioid reserves compared to the U-TAPB group (54.5% vs. 29.8%, p=0.008) although no statistical significance was found in the overall dose in 24 hours. For all other variables (pain on the VAS at 3, 6, 12, and 24 hours after surgery, the need for epidural analgesia, complications related to the TAP block, and hospital stay no statistically significant difference between the L-TAPB and the U-TAPB groups was noted. Conclusions Our results, although marginal differences between groups were noted, showed the non-inferiority of the laparoscopic delivery compared to ultrasound-guided administration.

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