By: 28 October 2013

Using a transversus abdominis plane (TAP) block as part of patients’ surgical care may speed up recovery and reduce hospital stays. Surgeons at the University Hospitals Case Medical Center in Cleveland have validated this procedure, alongside using a set of pre- and postoperative standards that speed up recovery in colorectal operation patients.

In a new study, surgeon Conor P Delaney, MD, PhD, FACS, FASCRS, looked at reducing patients’ postoperative pain by adding a TAP block. Although usually administered with ultrasound guidance, Dr Delaney’s group has recently described a laparoscopic tap block technique enabling injection of a regional analgesia into a layer of the abdominal wall between the oblique muscles and the transversus abdominis. The nerve block is given at the conclusion of colorectal operations and reduces pain in the operative area.

For the study, Dr Delaney employed the Enhanced Recovery Pathway protocol and the TAP block on 100 patients in 2012. Sixty-five patients needed an operation for colorectal neoplasia. Most of the other patients needed treatment for conditions like Crohn’s disease, ulcerative colitis, and diverticulitis.

After the TAP block, patients were also given intravenous painkillers, including acetaminophen. The TAP block allows patients to bypass or at least reduce the barrage of narcotics – which can slow down recovery – that they are often given after an operation.

The TAP block wears off just in time for patients to skip the worst of the pain that occurs immediately after the operation, and it does not appear to pose any significant risks to patients, said Dr Delaney.

The researchers reported that 27 patients went home the next day and another 35 went home 48 hours after their operations. “That’s a lot better than the five or six days patients usually stay in the hospital after laparoscopic colorectal procedures, and certainly better than nine days often seen after an open operation,” Dr Delaney said. “With a third of patients leaving the day after colorectal resections, we feel these results have been remarkable.

“The old thinking was that if patients went home early, they have a higher chance of readmission, but the data continue to show that’s not the case,” Dr. Delaney explained. “Patients who went home earliest had the lowest readmission rate.”

Using a TAP block to reduce hospital stay and narcotics use also has implications for reducing healthcare expenses, costing just $20 per patient.

Dr. Delaney predicts that ERP protocols will become standard practice for colorectal surgical patients in the next five years, however, including TAP blocks in that protocol will require more evidence. “The next step is a randomised clinical trial,” he said.
The results of their study appear in the Journal of the American College of Surgeons.