Trial Comparing Transversus Abdominis Plane Block Versus Epidural Anesthesia for Pain Management in Colorectal Surgery

A Prospective Randomized Clinical Trial Comparing the Transversus Abdominis Plane Block (TAP) Versus Epidural Anesthesia For Enhanced Recovery Pathway Perioperative Management of Pain in Elective Colorectal Surgery

The primary outcome for this study is the Numeric Pain Score (NPS) for elective patients undergoing elective colorectal surgery that have been randomized to transversus abdominis plane block or epidural anesthesia for the management of perioperative pain in elective colorectal surgery.

Adequate peri-operative analgesia is a vital component of post-operative management for patients undergoing colon and rectal surgery, affecting hospital length of stay, quality of life, and patient outcomes. There are many options for the peri-operative management of pain after elective colorectal surgery.

This is a randomized clinical trial comparing the transversus abdominis plane block using Exparel® to epidural anesthesia for the enhanced recovery pathway perioperative management of pain for elective colorectal surgery.

Inclusion Criteria:

• Patients undergoing elective open and minimally invasive (laparoscopic and robotic) colon and rectal surgery for colorectal neoplasia, diverticulitis, and other diseases of the colon and rectum;
• Surgical procedure either through standard open or minimal invasive approach (laparoscopic or robotic);
• Patients > 18 years of age;
• Able to provide informed written consent
• Patients capable of completing questionnaires at the time of consent

Exclusion Criteria:

• Documented allergic reaction to morphine, hydromorphone, lidocaine, bupivicaine and/or fentanyl;
• Contra-indication to placement of epidural catheter (spinal stenosis, spinal fusion, elevated International Normalized Ratio (INR), anticoagulation, patient refusal, etc) or TAP block (patient refusal);
• Urgent or emergent surgery precluding epidural catheter placement or TAP block;
• Systemic Infection contraindicating epidural catheter placement or TAP block;
• Unwillingness to participate in follow up assessments;
• Prisoners
• Pregnant women