Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery: A randomised, open-label feasibility study

Sugantha Ganapathy, Rakesh V. Sondekoppam, Magdalena Terlecki, Jonathan Brookes, Sanjib Adhikary, Lakshmimathy Subramanian

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

BACKGROUND We recently described a lateral-to-medial approach for transversus abdominis plane (LM-TAP) block, which may permit preoperative initiation of the block. OBJECTIVE Our objective was to evaluate the feasibility of continuous LM-TAP blocks in clinical practice in comparison with thoracic epidural analgesia (TEA). DESIGN A randomised, open-label study. SETTING University Hospital, London Health Sciences Centre, London, Ontario, Canada from July 2008 to August 2012. PATIENTS Fifty adult patients undergoing open abdominal surgery via laparotomy were allocated randomly to receive preoperative catheter-congruent TEA or ultrasound-guided continuous bilateral LM-TAP block for 72 h postoperatively. Reasons for noninclusion were American Society of Anesthesiologists physical status more than 4, known allergy to study drugs, chronic pain/opioid dependence, spinal abnormalities or psychiatric illness. INTERVENTIONS In the TEA group (n=24), patient-controlled epidural analgesia was maintained using bupivacaine 0.1% with hydromorphone 10mgml1 after establishment of the initial block. In the LM-TAP group (n=26), ultrasoundguided LM-TAP catheters were inserted on each side preoperatively after a bolus of 30 ml of ropivacaine 0.5% (20 ml subcostal and 10 ml subumbilical injections on both sides). Analgesia was maintained with an infusion of ropivacaine 0.35% at a rate of 2 to 2.5 ml h-1 through each catheter, along with rescue intravenous patient-controlled analgesia. MAIN OUTCOME MEASURES The primary outcome was pain score on coughing 24 h after the end of surgery. Secondary outcomes were pain scores from 24 to 72 h, intraoperative and postoperative opioid consumption, time to onset of bowel movement and side effect profiles. RESULTS Mean [95% confidence interval (95% CI)] pain scores at rest ranged from 1. 7 (0.9 to 2.5) to 2.3 (1.1 to 3.4) in TEA vs. 1.5 (0.7 to 2.2) to 2.2 (1.3 to 3.0) in LM-TAP (P=0.829). The dynamic pain scores ranged from 2.9 (1.5 to 4.4) to 3.8 (2.8 to 4.8) in TEA vs. 3.3 (2.4 to 4.3) to 3.8 (2.7 to 4.9) in LM-TAP (P=0.551). The variability in pain scores was lower in the LM-TAP group than in the TEA group in the first 24 h postoperatively. Patient satisfaction and other secondary outcomes were similar. CONCLUSION Continuous bilateral LM-TAP block can be initiated preoperatively and may provide comparable analgesia to TEA in patients undergoing laparotomy. CLINICAL TRIALS REGISTRY not registered because registration was not mandatory at the time of starting the trial.

Original languageEnglish (US)
Pages (from-to)797-804
Number of pages8
JournalEuropean Journal of Anaesthesiology
Volume32
Issue number11
DOIs
StatePublished - Nov 1 2015

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Abdominal Muscles
Epidural Analgesia
Feasibility Studies
Thorax
Safety
Pain
Patient-Controlled Analgesia
Catheters
Analgesia
Laparotomy
Opioid Analgesics
Hydromorphone
Bupivacaine
Ontario
Patient Satisfaction
Chronic Pain
Canada
Psychiatry
Hypersensitivity
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

@article{b81f8ecc8d4d4031909b6bf17d0391dc,
title = "Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery: A randomised, open-label feasibility study",
abstract = "BACKGROUND We recently described a lateral-to-medial approach for transversus abdominis plane (LM-TAP) block, which may permit preoperative initiation of the block. OBJECTIVE Our objective was to evaluate the feasibility of continuous LM-TAP blocks in clinical practice in comparison with thoracic epidural analgesia (TEA). DESIGN A randomised, open-label study. SETTING University Hospital, London Health Sciences Centre, London, Ontario, Canada from July 2008 to August 2012. PATIENTS Fifty adult patients undergoing open abdominal surgery via laparotomy were allocated randomly to receive preoperative catheter-congruent TEA or ultrasound-guided continuous bilateral LM-TAP block for 72 h postoperatively. Reasons for noninclusion were American Society of Anesthesiologists physical status more than 4, known allergy to study drugs, chronic pain/opioid dependence, spinal abnormalities or psychiatric illness. INTERVENTIONS In the TEA group (n=24), patient-controlled epidural analgesia was maintained using bupivacaine 0.1{\%} with hydromorphone 10mgml1 after establishment of the initial block. In the LM-TAP group (n=26), ultrasoundguided LM-TAP catheters were inserted on each side preoperatively after a bolus of 30 ml of ropivacaine 0.5{\%} (20 ml subcostal and 10 ml subumbilical injections on both sides). Analgesia was maintained with an infusion of ropivacaine 0.35{\%} at a rate of 2 to 2.5 ml h-1 through each catheter, along with rescue intravenous patient-controlled analgesia. MAIN OUTCOME MEASURES The primary outcome was pain score on coughing 24 h after the end of surgery. Secondary outcomes were pain scores from 24 to 72 h, intraoperative and postoperative opioid consumption, time to onset of bowel movement and side effect profiles. RESULTS Mean [95{\%} confidence interval (95{\%} CI)] pain scores at rest ranged from 1. 7 (0.9 to 2.5) to 2.3 (1.1 to 3.4) in TEA vs. 1.5 (0.7 to 2.2) to 2.2 (1.3 to 3.0) in LM-TAP (P=0.829). The dynamic pain scores ranged from 2.9 (1.5 to 4.4) to 3.8 (2.8 to 4.8) in TEA vs. 3.3 (2.4 to 4.3) to 3.8 (2.7 to 4.9) in LM-TAP (P=0.551). The variability in pain scores was lower in the LM-TAP group than in the TEA group in the first 24 h postoperatively. Patient satisfaction and other secondary outcomes were similar. CONCLUSION Continuous bilateral LM-TAP block can be initiated preoperatively and may provide comparable analgesia to TEA in patients undergoing laparotomy. CLINICAL TRIALS REGISTRY not registered because registration was not mandatory at the time of starting the trial.",
author = "Sugantha Ganapathy and Sondekoppam, {Rakesh V.} and Magdalena Terlecki and Jonathan Brookes and Sanjib Adhikary and Lakshmimathy Subramanian",
year = "2015",
month = "11",
day = "1",
doi = "10.1097/EJA.0000000000000345",
language = "English (US)",
volume = "32",
pages = "797--804",
journal = "European Journal of Anaesthesiology",
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publisher = "Lippincott Williams and Wilkins",
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}

Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery : A randomised, open-label feasibility study. / Ganapathy, Sugantha; Sondekoppam, Rakesh V.; Terlecki, Magdalena; Brookes, Jonathan; Adhikary, Sanjib; Subramanian, Lakshmimathy.

In: European Journal of Anaesthesiology, Vol. 32, No. 11, 01.11.2015, p. 797-804.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery

T2 - A randomised, open-label feasibility study

AU - Ganapathy, Sugantha

AU - Sondekoppam, Rakesh V.

AU - Terlecki, Magdalena

AU - Brookes, Jonathan

AU - Adhikary, Sanjib

AU - Subramanian, Lakshmimathy

PY - 2015/11/1

Y1 - 2015/11/1

N2 - BACKGROUND We recently described a lateral-to-medial approach for transversus abdominis plane (LM-TAP) block, which may permit preoperative initiation of the block. OBJECTIVE Our objective was to evaluate the feasibility of continuous LM-TAP blocks in clinical practice in comparison with thoracic epidural analgesia (TEA). DESIGN A randomised, open-label study. SETTING University Hospital, London Health Sciences Centre, London, Ontario, Canada from July 2008 to August 2012. PATIENTS Fifty adult patients undergoing open abdominal surgery via laparotomy were allocated randomly to receive preoperative catheter-congruent TEA or ultrasound-guided continuous bilateral LM-TAP block for 72 h postoperatively. Reasons for noninclusion were American Society of Anesthesiologists physical status more than 4, known allergy to study drugs, chronic pain/opioid dependence, spinal abnormalities or psychiatric illness. INTERVENTIONS In the TEA group (n=24), patient-controlled epidural analgesia was maintained using bupivacaine 0.1% with hydromorphone 10mgml1 after establishment of the initial block. In the LM-TAP group (n=26), ultrasoundguided LM-TAP catheters were inserted on each side preoperatively after a bolus of 30 ml of ropivacaine 0.5% (20 ml subcostal and 10 ml subumbilical injections on both sides). Analgesia was maintained with an infusion of ropivacaine 0.35% at a rate of 2 to 2.5 ml h-1 through each catheter, along with rescue intravenous patient-controlled analgesia. MAIN OUTCOME MEASURES The primary outcome was pain score on coughing 24 h after the end of surgery. Secondary outcomes were pain scores from 24 to 72 h, intraoperative and postoperative opioid consumption, time to onset of bowel movement and side effect profiles. RESULTS Mean [95% confidence interval (95% CI)] pain scores at rest ranged from 1. 7 (0.9 to 2.5) to 2.3 (1.1 to 3.4) in TEA vs. 1.5 (0.7 to 2.2) to 2.2 (1.3 to 3.0) in LM-TAP (P=0.829). The dynamic pain scores ranged from 2.9 (1.5 to 4.4) to 3.8 (2.8 to 4.8) in TEA vs. 3.3 (2.4 to 4.3) to 3.8 (2.7 to 4.9) in LM-TAP (P=0.551). The variability in pain scores was lower in the LM-TAP group than in the TEA group in the first 24 h postoperatively. Patient satisfaction and other secondary outcomes were similar. CONCLUSION Continuous bilateral LM-TAP block can be initiated preoperatively and may provide comparable analgesia to TEA in patients undergoing laparotomy. CLINICAL TRIALS REGISTRY not registered because registration was not mandatory at the time of starting the trial.

AB - BACKGROUND We recently described a lateral-to-medial approach for transversus abdominis plane (LM-TAP) block, which may permit preoperative initiation of the block. OBJECTIVE Our objective was to evaluate the feasibility of continuous LM-TAP blocks in clinical practice in comparison with thoracic epidural analgesia (TEA). DESIGN A randomised, open-label study. SETTING University Hospital, London Health Sciences Centre, London, Ontario, Canada from July 2008 to August 2012. PATIENTS Fifty adult patients undergoing open abdominal surgery via laparotomy were allocated randomly to receive preoperative catheter-congruent TEA or ultrasound-guided continuous bilateral LM-TAP block for 72 h postoperatively. Reasons for noninclusion were American Society of Anesthesiologists physical status more than 4, known allergy to study drugs, chronic pain/opioid dependence, spinal abnormalities or psychiatric illness. INTERVENTIONS In the TEA group (n=24), patient-controlled epidural analgesia was maintained using bupivacaine 0.1% with hydromorphone 10mgml1 after establishment of the initial block. In the LM-TAP group (n=26), ultrasoundguided LM-TAP catheters were inserted on each side preoperatively after a bolus of 30 ml of ropivacaine 0.5% (20 ml subcostal and 10 ml subumbilical injections on both sides). Analgesia was maintained with an infusion of ropivacaine 0.35% at a rate of 2 to 2.5 ml h-1 through each catheter, along with rescue intravenous patient-controlled analgesia. MAIN OUTCOME MEASURES The primary outcome was pain score on coughing 24 h after the end of surgery. Secondary outcomes were pain scores from 24 to 72 h, intraoperative and postoperative opioid consumption, time to onset of bowel movement and side effect profiles. RESULTS Mean [95% confidence interval (95% CI)] pain scores at rest ranged from 1. 7 (0.9 to 2.5) to 2.3 (1.1 to 3.4) in TEA vs. 1.5 (0.7 to 2.2) to 2.2 (1.3 to 3.0) in LM-TAP (P=0.829). The dynamic pain scores ranged from 2.9 (1.5 to 4.4) to 3.8 (2.8 to 4.8) in TEA vs. 3.3 (2.4 to 4.3) to 3.8 (2.7 to 4.9) in LM-TAP (P=0.551). The variability in pain scores was lower in the LM-TAP group than in the TEA group in the first 24 h postoperatively. Patient satisfaction and other secondary outcomes were similar. CONCLUSION Continuous bilateral LM-TAP block can be initiated preoperatively and may provide comparable analgesia to TEA in patients undergoing laparotomy. CLINICAL TRIALS REGISTRY not registered because registration was not mandatory at the time of starting the trial.

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