Effect of Preoperative Versus Postoperative Use of Transversus Abdominis Plane Block With Plain 0.25 % Bupivacaine on Postoperative Opioid Use

A Retrospective Study

Richard Kalu; Peter Boateng; Lauren Carrier; Jaime Garzon; Amy Tang; Craig Reickert; Amalia Stefanou


BMC Anesthesiol. 2021;21(114) 

In This Article


Enhanced recovery protocols (ERP) after surgery have the aim of reducing morbidity and the surgical stress response while advancing early return of patients to their baseline functioning.[1] Components of ERP include optimal pain control and surgical stress reduction with regional anesthesia, early mobilization, and early enteral nutrition.[2,3] Multiple studies including randomized controlled trials have shown a reduction in hospital length of stay, duration of postoperative ileus, reduced morbidity, and an earlier return of normal function after ERP implementation.[1,4–6]

Optimal pain management is an integral part of an ERP, particularly after colon surgery. Poor pain control may lead to longer length of stay, cost, and patient dissatisfaction.[6] Many ERPs use a multimodal approach to achieve an optimal pain control, employing neuraxial and regional anesthesia techniques and lower utilization of opioids as the primary analgesic.[7–9] Transversus abdominis plane (TAP) block is an example of a regional anesthetic technique that has been used extensively in abdominal surgery.[10,11] The TAP block involves injecting plain 0.25 % bupivacaine into the fascial plane between the internal oblique and transversus abdominis muscles. The duration of action for plain bupivacaine ranges from 2 to 10 h with peak effect noted around 30 to 45 min {Beiranvand, 2018 #348}.[12]

A TAP block may be administered at any time during the immediate perioperative period. However, whether plain bupivacaine TAP block is effective in colorectal surgery remains to be elucidated. There have been no studies assessing the timing of TAP block administration for optimal postoperative pain control. In the present study, we assessed the effect of preoperative vs. postoperative administration of TAP block using plain 0.25 % bupivacaine on postoperative opioid use in patients undergoing colorectal surgery. Furthermore, we assessed for any effects on length of stay, rates of reoperation, and readmission.