Conventional Epidural vs Transversus Abdominis Plane Block with Liposomal Bupivacaine: A Randomized Trial in Colorectal Surgery

BACKGROUND: Colorectal surgery is a focus of enhanced recovery protocols (ERP). The use of transversus abdominis plane (TAP) block for abdominal surgery has demonstrated effectiveness in ERP, however, no direct comparison of epidural vs TAP for nonanalgesic clinical factors has been published to date. The primary aim of this study was to compare epidural with TAP for length of stay in colorectal surgery. STUDY DESIGN: Patients undergoing open and laparoscopic colorectal surgery were prospectively randomized into epidural (n = 39) or TAP (n = 44) groups preoperatively. Anesthesiologists performed blocks in the preoperative area. A standardized ERP and discharge protocol were initiated on patients. Five patients unable to complete the ERP due to unrelated postoperative complications or technical factors were excluded from analysis. RESULTS: The study arms were statistically similar for demographic factors, operations, and intraoperative measures. Time to first flatus was equivalent in both groups (postoperative day 1.7 vs 1.9; p = 0.39). Length of stay was shorter with TAP (postoperative day 3.3 vs 2.8; p = 0.023). Postoperative nausea and vomiting rates were higher with TAP (14% vs 33%; p = 0.057). Urinary retention occurred with higher frequency with epidural (30% vs 15%; p = 0.11). CONCLUSIONS: Transversus abdominis plane block was associated with a 0.5-day reduction in length of stay in a standardized ERP compared with epidural. Early indication favors TAP in patients with a history of postoperative urinary retention, as a trend of urinary retention was associated with epidural. Transversus abdominis plane block offers an effective alternative to epidural in colorectal surgery, regardless of operative approach. (C) 2018 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.