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Session: ePoster: Quality and Cost 1 (Sun8)

EP365 - Transverse Abdominis Plane Block with Liposomal Bupivacaine versus Neuroaxial Anesthesia in Colorectal Surgery: A Systematic Review and Meta-Analysis of Trials

Sunday, May 11, 2025
9:44 AM – 9:49 AM PT
Location: Monitor 9, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Dante L. S Souza, MD

    General Surgery Resident
    TriHealth Good Samaritan Hospital
    TriHealth Good Samaritan Hospital
    Cintinnati, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • TP

    Túlio Pimentel, n/a

    Student
    Federal University of Pernambuco
    Recife, Pernambuco, Brazil

    Disclosure information not submitted.

  • KC

    Kristen Coleman, D.O.

    Colorectal Surgeon
    TriHealth
    Cincinnati, Ohio, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • hG

    hamza Guend, MD

    Staff Colorectal Surgeon
    TriHealth
    Cincinnati, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Dante L. S Souza, MD: This individual has no financial relationships with ineligible companies.
hamza Guend, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Pain control after colorectal surgery remains challenging even after the widespread implementation of Enhanced Recovery After Surgery (ERAS) protocols. In this context, multiple pain control adjuncts have emerged, including new medications and analgesia delivery techniques. This is the first analysis comparing Transverse Abdominis Plane block (TAPb) with liposomal bupivacaine versus Neuroaxial Anesthesia (NA) in colorectal surgery.

Methods/Interventions: A comprehensive search of PubMed, Embase, and Cochrane databases was conducted for randomized or nonrandomized controlled trials comparing transverse abdominis plane block (TAPb) with liposomal bupivacaine versus Neuroaxial Anesthesia (NA) including Epidural or Intrathecal in colorectal surgery. The primary outcomes were numeric pain scores (0-10) on postoperative (POD) 0, POD 1, and POD 2. The secondary outcomes were length of hospital stay (LOS), overall complications, urinary retention, and ileus. Heterogeneity was examined using I² statistics. Risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) were computed with the use of a random-effects model. This systematic review and meta-analysis followed Cochrane and PRISMA recommendations. The statistical analysis was conducted using Review Manager 5.4.

Results/Outcomes: From a total of 159 studies, four were included comprising three randomized controlled trial and one nonrandomized controlled trial, with a total of 608 patients of which 300 underwent TAPb and 308 had NA. The patient’s baseline characteristics and the method used for TAPb or NA are described in Figure 1. Pain scores on POD 0 were higher in patients that received TAPb (MD 1.42; 95% CI 1.03, 1.80; p< 0.0001; I2= 0%). There was no significant difference on pain scores on POD 1 (MD -0.01; 95% CI -0.35, 0.32; p=0.94; I2= 0%) and on POD 2 (MD -0.25; 95% CI -0.58, 0.09; p=0.15; I2= 0%). Patients who received TAPb had shorter LOS (MD -0.40; 95% CI -0.69, -0.11; p=0.007; I2= 0%). There were no significant differences in overall complications (MD 0.97; 95% CI 0.67, 1.40; p=0.88; I2= 0%), and postoperative ileus (MD 0.81; 95% CI 0.47, 1.40); p=0.45; I2= 0%) – Figure 2.

Conclusion/Discussion: In this comprehensive meta-analysis of 608 patients, neuroaxial anesthesia is associated with improved pain control on the day of surgery, but that difference is not present on POD-1 and POD-2. In addition, TAP block with liposomal bupivacaine is associated with a shorter length of stay.