Role of transversus abdominis plane block combined with multimodal analgesia in early recovery after radical colorectal cancer surgery

Abstract

BACKGROUND

Colorectal cancer remains a leading cause of cancer-related morbidity and mortality worldwide. Despite advancements in laparoscopic surgical techniques, 30%-40% of patients experience moderate-to-severe postoperative pain, which can impede recovery and increase complications. Within the enhanced recovery after surgery (ERAS) framework, multimodal analgesia is essential for optimal pain management. Transversus abdominis plane (TAP) block, a regional anesthetic technique providing prolonged abdominal analgesia, has shown promise in abdominal surgeries. However, its role in enhancing multimodal analgesia and facilitating early recovery after radical colorectal cancer surgery remains inadequately investigated.

AIM

To investigate multiple clinical parameters in patients undergoing laparoscopic radical colorectal cancer surgery, specifically examining pain control effectiveness, markers of early postoperative recovery, physiological stress indicators, and treatment safety profile when ultrasound-guided TAP block was incorporated into multimodal analgesic protocols.

METHODS

Clinical records of 117 laparoscopic radical colorectal cancer surgery patients treated at our institution between December 2022 and December 2024 underwent retrospective examination. Patient allocation into study arms was determined by their postoperative pain management protocol: 59 patients constituted the observation arm (TAP block integrated with multimodal analgesia), while 58 patients formed the control arm (standard multimodal analgesia approach). The observation arm protocol involved a bilateral TAP block performed under ultrasound guidance during general anesthesia, administering 0.375% ropivacaine (20 mL per side), supplemented with postoperative patient-controlled intravenous analgesia (PCIA) and oral celecoxib administration. The control arm received an identical regimen minus the TAP block component. Comparative analysis encompassed Visual Analog Scale (VAS) pain measurements across multiple postoperative intervals, analgesic medication requirements, recovery milestone timings (initial ambulation, bowel function return, oral intake resumption), inflammatory and stress biomarkers [interleukin-6 (IL-6), C-reactive protein (CRP), cortisol (Cor) concentrations], Quality of Recovery-15 (QoR-15) assessment scores, adverse event profiles, and complication frequencies.

RESULTS

Pain intensity measurements using VAS methodology demonstrated significantly lower values in the observation cohort compared to controls at all assessment points (6 hours, 12 hours, 24 hours, 48 hours, and 72 hours postoperatively) during both rest and activity (P < 0.001). Within the initial 72-hour postoperative period, the observation group demonstrated reduced PCIA pump activation frequency, diminished total sufentanil consumption, lower rescue analgesia requirement rate (10.2% vs 31.0%), and superior patient satisfaction ratings regarding pain control (P < 0.05). Recovery milestones were achieved earlier in the observation cohort, with shorter intervals to first ambulation, initial flatus passage, and first oral intake compared to the control cohort (P < 0.001). Inflammatory and stress biomarker analysis revealed lower serum concentrations of IL-6, CRP, and Cor in the observation group on both postoperative day 1 and day 3 (P < 0.001). Recovery quality assessment using QoR-15 scoring demonstrated higher values in the observation group at both 24-hour and 48-hour postoperative evaluations (P < 0.001). The observation cohort experienced reduced severity of nausea/vomiting symptoms and lower frequencies of dizziness and somnolence compared to controls (P < 0.05). No statistically significant inter-group differences emerged regarding urinary retention incidence, pruritus occurrence, or postoperative complication rates (P > 0.05). Neither study group experienced respiratory depression events.

CONCLUSION

Ultrasound-guided TAP block combined with multimodal analgesia applied after laparoscopic radical colorectal cancer surgery can provide excellent analgesic effects, reduce opioid consumption, promote early ambulation and gastrointestinal function recovery, reduce postoperative stress response, improve recovery quality, reduce opioid-related adverse reactions, and has good safety, which is helpful in achieving ERAS goals.

Keywords: Transversus abdominis plane block; Multimodal analgesia; Colorectal cancer; Enhanced recovery after surgery; Postoperative pain; Ultrasound guidance

Core Tip: This retrospective study evaluates whether integrating an ultrasound-guided transversus abdominis plane (TAP) block into multimodal analgesia can further enhance postoperative recovery after laparoscopic radical colorectal cancer surgery. The findings show that TAP block significantly improves pain control, reduces opioid consumption, accelerates gastrointestinal and functional recovery, attenuates stress responses, and enhances early quality-of-recovery outcomes without increasing complications. These results provide important clinical evidence supporting optimized analgesic strategies and enhanced recovery after surgery implementation for colorectal cancer patients.