The Impact of Thoracic Epidural Analgesia Versus Four Quadrant Transversus Abdominis Plane Block on Quality of Recovery After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Surgery: A Single-Center, Noninferiority, Randomized, Controlled Trial

Cata, Juan P.; Fournier, Keith F.; Corrales, German; Owusu-Agyemang, Pascal; Soliz, Joseph; Bravo, Mauro; Wilks, Jonathan A.; Meter, Antoinette Van; Hernandez, Mike; Gottumukkala, Vijay

doi:10.1245/s10434-021-09622-7

Cited by 9 publications

(15 citation statements)

References 35 publications

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“…A total of 1975 patients participated, of which 997 were in the TAP block group, and 978 of them were in the epidural group. Of the 22 studies , 3 studies were subjected to the patients who underwent laparoscopic surgery 11,22,32 , 15 studies were to open surgery [12][13][14][16][17][18][19][20][21]23,24,26,27,30,31 and 4 studies subjected to both types of surgery 15,25,28,29 .…”

Section: Resultsmentioning

confidence: 99%

Transverse abdominis plane block compared with patient-controlled epidural analgesia following abdominal surgery: a meta-analysis and trial sequential analysis

Jeong

Jung

Cho

et al. 2022

Sci Rep

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Thoracic epidural analgesia (TEA) and transversus abdominis plane (TAP) block are used for pain control after abdominal surgery. Although there have been several meta-analyses comparing these two techniques, the conclusion was limited by a small number of studies and heterogeneity among studies. Our meta-analysis used the Medline, EMBASE, and Cochrane central library databases from their inception through September 2022. Randomized controlled trials (RCTs) comparing TEA and TAP block were included. The pre-specified primary outcome was the pain score at rest at 12 h postoperatively. Twenty-two RCTs involving 1975 patients were included. Pooled analyses showed the pain score at rest at 12 h postoperatively was significantly different between groups favoring TEA group (Mean difference [MD] 0.58, 95% confidence interval CI − 0.01, 1.15, P = 0.04, I2 = 94%). TEA group significantly reduced the pain score at 48 h at rest (MD 0.59, 95% CI 0.15, 1.03, P = 0.009, I2 = 86%) and at 48 h at movement (MD 0.53, 95% CI 0.07, 0.99, P = 0.03, I2 = 76%). However, there was no significant difference at other time points. Time to ambulation was shorter in TAP block but the incidence of hypotension at 24 h and 72 h was significantly lower in TAP block compared to TEA. Trial sequential analysis showed that the required information size has not yet been reached. Our meta-analysis demonstrated there was no significant or clinically meaningful difference in the postoperative pain scores between TEA and TAP block group. Given the insufficient information size revealed by TSA, the high risk of bias of our included studies, and the significant heterogeneity of our meta-analysis results, our results should be interpreted carefully but it is not likely that the addition of further studies could prove any clinically meaningful difference in pain score between these two techniques.

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Section: Resultsmentioning

confidence: 99%

Transverse abdominis plane block compared with patient-controlled epidural analgesia following abdominal surgery: a meta-analysis and trial sequential analysis

Jeong

Jung

Cho

et al. 2022

Sci Rep

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“…Our data on MME are comparable to those reported in a randomized controlled trial comparing TAP blocks to epidural analgesia. Cata et al 5 reported that the ranges of MME in the epidural group on POD 1 and 2 were 0.07 to 37 mg and 0 to 51 mg, respectively. In comparison, our ranges for MME from 0 to 24 hours and 24 to 48 hours postoperatively were 7 to 46.2 mg and 6 to 37.8 mg, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of postoperative hypotension in these patients ranges from 9.9% to 60.9%. 5,9 Furthermore, 15.1% to 23% of patients had their epidural infusions paused due to hypotension. 5,8 This temporary cessation of the epidural infusion led to severe pain.…”

Section: Discussionmentioning

confidence: 99%

“…12 Our patients' intravenous opioid consumption was consistent with the intravenous opioid consumption reported in patients who had epidural analgesia for cytoreduction surgery with HIPEC. 5,13 In a series of pediatric and young adult patients who underwent cytoreduction surgery with HIPEC with epidural analgesia, the range for each patient's median MME was 0.06 to 9.64 mg/kg/d. 13 In our series of adult patients, the range for each patient's median daily MME was 0.09 to 0.55 mg/kg/d.…”

Section: Discussionmentioning

confidence: 99%

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Erector Spinae Plane Catheters for Analgesia for Cytoreduction Surgery With Hyperthermic Intraperitoneal Chemotherapy: A Case Series

Fidkowski

Hussain²,

Younger³

et al. 2022

A&A Practice

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Cytoreduction surgery with hyperthermic intraperitoneal chemotherapy is a complex and painful procedure that can cause postoperative hypotension and coagulopathy. Epidural analgesia may worsen hypotension and is contraindicated in the setting of coagulopathy. While alternative regional techniques are being explored, the use of erector spinae plane blocks has not been reported. We present a case series of 6 patients who had erector spinae plane catheters for cytoreduction surgery with hyperthermic intraperitoneal chemotherapy. They remained stable intraoperatively and had adequate pain control postoperatively. Erector spinae plane catheters may be a suitable alternative for epidural analgesia for these patients.

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“…We also believe that the TAP block alone was insufficient to replace the epidural block. Cata et al [ 22 ] reported that 4Q-TAP block after CRS with HIPEC did not delay recovery profiles, but significantly increased opioid consumption compared with thoracic epidural analgesia. Therefore, we decided to implement multimodal analgesia with low-dose fentanyl, nefopam, lidocaine, NSAIDs, steroids, and a 4Q-TAP block.…”

Section: Discussionmentioning

confidence: 99%

Analgesic effects of ultrasound-guided four-quadrant transabdominal plane block in patients with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a prospective, randomized, controlled study

et al. 2022

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Background: Postoperative pain occurring after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is difficult to control because of extensive surgical injuries and long incisions. We assessed whether the addition of a four-quadrant transabdominal plane (4Q-TAP) block could help in analgesic control.Methods: Seventy-two patients scheduled to undergo elective CRS with HIPEC and intravenous patient-controlled analgesia (IV PCA) were enrolled. The patients received 4Q-TAP blocks in a 10 ml mixture of 2% lidocaine and 0.75% ropivacaine per site (4Q-TAP group, n = 36) or normal saline (control group, n = 33). Oxycodone in the post-anesthesia care unit (PACU) and pethidine or tramadol in the ward were used as rescue analgesics. The primary outcome was less than 3 times of rescue analgesic administration (%) in the ward for 5 postoperative days. Secondary endpoints included oxycodone requirement in PACU, fentanyl doses of IV PCA, morphine milligram equivalent (MME) of total opioid use, hospital stay, and postoperative complications. Results: During 5 postoperative days, there was no difference in pain scores and total rescue analgesic administration between two groups. However, the use of oxycodone in PACU (P = 0.011), fentanyl requirement in IV PCA (P = 0.029), and MME/kg of total opioid use (median, 2.35 vs. 3.21 mg/kg, P = 0.009) were significantly smaller in the 4Q-TAP group. Hospital stay and incidence of postoperative morbidity were similar in both groups. Conclusions: The 4Q-TAP block enhanced multimodal analgesia and decreased opioid requirements in patients with CRS with HIPEC, but did not change postoperative recovery outcomes.

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The Impact of Thoracic Epidural Analgesia Versus Four Quadrant Transversus Abdominis Plane Block on Quality of Recovery After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Surgery: A Single-Center, Noninferiority, Randomized, Controlled Trial

Cited by 9 publications

References 35 publications

Transverse abdominis plane block compared with patient-controlled epidural analgesia following abdominal surgery: a meta-analysis and trial sequential analysis

Transverse abdominis plane block compared with patient-controlled epidural analgesia following abdominal surgery: a meta-analysis and trial sequential analysis

Erector Spinae Plane Catheters for Analgesia for Cytoreduction Surgery With Hyperthermic Intraperitoneal Chemotherapy: A Case Series

Analgesic effects of ultrasound-guided four-quadrant transabdominal plane block in patients with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a prospective, randomized, controlled study

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