Postoperative analgesia by a surgically inserted transversus abdominis plane catheter versus a thoracic epidural catheter after flank incision: randomized-controlled trial

Abstract

Introduction Transversus abdominis plane (TAP) block has been reported to be an effective method of analgesia after abdominal surgery. This prospective randomized study compared the analgesic effect by a surgically inserted TAP catheter versus a thoracic epidural catheter in the postoperative period after a flank incision. Patients and methods Sixty-four American Society of Anesthesiologists physical status I and II patients, 18–59 years of age scheduled for renal surgery for a nonmalignant lesion with a flank incision, were allocated randomly to two equal groups. The group E ( n =29; three excluded) received 0.125% bupivacaine with fentanyl 2 µg/ml at the rate of 5–8 ml/h, whereas the group T ( n =30; two excluded) received 1 mg/kg bupivacaine 0.375%/8 h. Rescue analgesia of 5 mg morphine bolus doses was administered upon patients’ requests with a maximum dose of 10 mg/4 h. Visual analog scale, morphine consumption in 48 h, and incidence of postoperative complications were assessed. Results Visual analog scale and morphine consumption were comparable in the two groups. No significant complications were found in the TAP group, whereas the incidences of hypotension and motor block were higher in the epidural group. Conclusion A surgically assisted-TAP catheter is an easy, safe and effective method for analgesia after a flank incision and can be a good alternative to epidural analgesia, especially when the latter is contraindicated.