Laparoscopic-guided TAP Block vs Epidural Analgesia

Laparoscopic-Guided Transversus Abdominis Plane Block Versus Epidural Analgesia in a Colorectal Laparoscopic Surgery. A Protocol for a Randomized Clinical Trial

The LAPTAP trial will provide evidence on preferred post-operative analgesia method in elective laparoscopic colon surgery.

In most previous studies TAP-block has been inserted by anesthesiologist under ultrasound guidance. TAP blockade can alternatively be performed by a surgeon with laparoscopic visual guidance during trocar placement by aiming injection into fascial plane between the internal oblique and transversus abdominis in the midaxillary line and repeated on the contralateral side. There is lack in studies comparing laparoscopic guided TAP-blockade versus epidural pain analgesia in elective laparoscopic colon surgery exist.

IInclusion criteria

• Patients who undergo elective laparoscopic colorectal surgery for colorectal neoplasia, diverticulitis, and other diseases of the colon and rectosigmal area
• Patients 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, bupivacaine, fentanyl and/or oxycodone
• Contra-indication to placement of epidural catheter (spinal stenosis, spinal fusion, elevated international normal 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
• Rectal surgery
• Pregnant or suspected pregnancy
• Age < 18 years
• Planned open surgery
• Planned bowel stoma (protective diversion and/or permanent stoma)
• Unwillingness to participate in follow-up assessments
• Patients with severe chronic pain
• Known sensibility for opioid side effects
• i.v.-PCA is contraindicated (for example drug abuse)
• No informed consent