BACKGROUND: Postoperative pain can delay functional recovery after outpatient surgery. Multimodal analgesia can improve pain and possibly improve quality of recovery. In this study, we evaluated the dose-dependent effects of a preoperative transversus abdominis plane (TAP) block on patient recovery using the Quality of Recovery 40 (QoR-40) questionnaire after ambulatory gynecological laparoscopic surgery. Global QoR-40 scores range from 40 to 200, representing very poor to outstanding quality of recovery, respectively. METHODS:Healthy women undergoing outpatient gynecological laparoscopy were randomly allocated to receive a preoperative TAP block using saline, ropivacaine 0.25%, or ropivacaine 0.5%. Needle placement for the TAP blocks was performed using ultrasound guidance and 15 mL of the study solution was injected bilaterally by a blinded investigator. QoR-40 score and analgesic use were assessed 24 hours postoperatively. The primary outcome was global QoR-40 score at 24 hours after surgery. Data were analyzed using the Kruskal-Wallis test. Post hoc pairwise comparisons were made using the Dunn test with P values and 95% confidence intervals Bonferroni corrected for 6 comparisons. RESULTS:Seventy-five subjects were enrolled and 70 subjects completed the study. The median (range) for the QoR-40 score after the TAP block was 157 (127-193), 173 (133-195), and 172 (130-196) for the saline group and 0.25% and 0.5% ropivacaine groups, respectively. The median difference (99.2% confidence interval) in QoR-40 score for 0.5% bupivacaine (16 [1-30], P=0.03) and 0.25% bupivacaine (17 [2-31], P=0.01) was more than saline but not significantly different between ropivacaine groups (-1 [-16 to 12], P=1.0). Increased global QoR-40 scores correlated with decreased area under the pain score time curve during postanesthesia recovery room stay (ρ=-0.56, 99.2% upper confidence limit [UCL]=-0.28), 24-hour opioid consumption (ρ=-0.61, 99.2% UCL=-0.34), pain score (0-10 scale) at 24 hours (ρ=-0.53, 99.2% UCL=-0.25), and time to discharge readiness (ρ=-0.65, 99.2% UCL=-0.42). The aforementioned variables were lower in the TAP block groups receiving ropivacaine compared with saline. CONCLUSIONS: The TAP block is an effective adjunct in a multimodal analgesic strategy for ambulatory laparoscopic procedures. TAP blocks with ropivacaine 0.25% and 0.5% reduced pain, decreased opioid consumption, and provided earlier discharge readiness that was associated with better quality of recovery.
RCT Entities:
BACKGROUND:Postoperative pain can delay functional recovery after outpatient surgery. Multimodal analgesia can improve pain and possibly improve quality of recovery. In this study, we evaluated the dose-dependent effects of a preoperative transversus abdominis plane (TAP) block on patient recovery using the Quality of Recovery 40 (QoR-40) questionnaire after ambulatory gynecological laparoscopic surgery. Global QoR-40 scores range from 40 to 200, representing very poor to outstanding quality of recovery, respectively. METHODS: Healthy women undergoing outpatient gynecological laparoscopy were randomly allocated to receive a preoperative TAP block using saline, ropivacaine 0.25%, or ropivacaine 0.5%. Needle placement for the TAP blocks was performed using ultrasound guidance and 15 mL of the study solution was injected bilaterally by a blinded investigator. QoR-40 score and analgesic use were assessed 24 hours postoperatively. The primary outcome was global QoR-40 score at 24 hours after surgery. Data were analyzed using the Kruskal-Wallis test. Post hoc pairwise comparisons were made using the Dunn test with P values and 95% confidence intervals Bonferroni corrected for 6 comparisons. RESULTS: Seventy-five subjects were enrolled and 70 subjects completed the study. The median (range) for the QoR-40 score after the TAP block was 157 (127-193), 173 (133-195), and 172 (130-196) for the saline group and 0.25% and 0.5% ropivacaine groups, respectively. The median difference (99.2% confidence interval) in QoR-40 score for 0.5% bupivacaine (16 [1-30], P=0.03) and 0.25% bupivacaine (17 [2-31], P=0.01) was more than saline but not significantly different between ropivacaine groups (-1 [-16 to 12], P=1.0). Increased global QoR-40 scores correlated with decreased area under the pain score time curve during postanesthesia recovery room stay (ρ=-0.56, 99.2% upper confidence limit [UCL]=-0.28), 24-hour opioid consumption (ρ=-0.61, 99.2% UCL=-0.34), pain score (0-10 scale) at 24 hours (ρ=-0.53, 99.2% UCL=-0.25), and time to discharge readiness (ρ=-0.65, 99.2% UCL=-0.42). The aforementioned variables were lower in the TAP block groups receiving ropivacaine compared with saline. CONCLUSIONS: The TAP block is an effective adjunct in a multimodal analgesic strategy for ambulatory laparoscopic procedures. TAP blocks with ropivacaine 0.25% and 0.5% reduced pain, decreased opioid consumption, and provided earlier discharge readiness that was associated with better quality of recovery.
Authors: Gildasio S De Oliveira; Paul Fitzgerald; Shireen Ahmad; John Kim; Rohit Rahangdale; Robert McCarthy Journal: World J Gastrointest Surg Date: 2014-02-27
Authors: Gildasio S De Oliveira; Kenyon Duncan; Paul Fitzgerald; Antoun Nader; Robert W Gould; Robert J McCarthy Journal: Obes Surg Date: 2014-02 Impact factor: 4.129
Authors: Denise M D Özdemir-van Brunschot; Gert J Scheffer; Albert Dahan; Janneke E E A Mulder; Simone A A Willems; Luuk B Hilbrands; Frank C H d'Ancona; Rogier A R T Donders; Kees J H M van Laarhoven; Michiel C Warlé Journal: Trials Date: 2015-08-12 Impact factor: 2.279