Transversus Abdominis Plane and Rectus Sheath Block for Robotic Colectomy

Impact of Transversus Abdominis Plane Block Combined With Rectus Sheath Block on Postoperative Pain Management in Patients Undergoing Elective Robotic Colectomy

This study aimed to evaluate the impact of ultrasound-guided bilateral transversus abdominis plane block combined with rectus sheath block on postoperative pain and recovery after robotic colectomy under an enhanced recovery after surgery (ERAS) protocol.

Postoperative pain remains an important concern after robotic colectomy despite the implementation of enhanced recovery after surgery (ERAS) protocols. Although robotic colectomy is associated with smaller incisions and faster recovery than conventional open surgery, postoperative pain may still impair early ambulation, gastrointestinal recovery, and patient satisfaction. Multimodal analgesia strategies, including acetaminophen and nonsteroidal anti-inflammatory drugs, are commonly used in ERAS pathways to reduce opioid consumption and opioid-related adverse effects. However, postoperative pain during movement and opioid requirements remain clinically relevant issues.

Ultrasound-guided transversus abdominis plane (TAP) block has been reported to reduce postoperative pain and opioid consumption after colorectal surgery. In addition, rectus sheath block (RSB) may provide further analgesic benefit for midline abdominal incision pain. Nevertheless, the additional clinical benefit of combining TAP block and RSB in patients undergoing robotic colectomy within an established ERAS pathway has not been fully investigated.

This study aimed to evaluate the impact of ultrasound-guided bilateral TAP block combined with RSB on postoperative pain and recovery following robotic colectomy. Additionally, we investigated the influence of TAP block combined with RSB on postoperative opioid consumption, postoperative nausea and vomiting, early ambulation, gastrointestinal recovery, and length of hospital stay after robotic colectomy under ERAS management.

Inclusion Criteria:

• Patients scheduled for elective robotic colorectal cancer surgery for the first time

Exclusion Criteria:

• Age < 18 years or age > 80 years
• Allergic to any medication in the protocol
• Infection over the injection site
• Chronic pain history
• Severe hepatic or renal insufficiency
• Pregnancy
• Emergency surgery
• Refusal to join the study