Transversus Abdominis Plane Block Improves Perioperative Outcome After Esophagectomy Versus Epidural

Background. Pain control is challenging during esophagectomy. An epidural is commonly used, but the sympathetic blockade can have unintended consequences such as hypotension or delayed return of bowel function. A transversus abdominis plane (TAP) block has the potential to control upper abdominal pain without these adverse consequences. We aimed to compare bilateral TAP blocks with patient-controlled analgesia (PCA) for immediate management after esophagectomy with a cohort using a thoracic (T5 to T8) epidural. Methods. This was a retrospective review of patients undergoing esophagectomy between 2012 and 2016. Primary outcomes were pain scores (0 to 10) assessed at 24, 48, and 72 hours for adequacy of pain control. Secondary outcomes were volume resuscitation at 72 hours, hypotension (systolic blood pressure < 90 mm Hg), length of stay (LOS), return of bowel function, and complications. Results. Sixty-one patients underwent esophagectomy using bilateral TAP block and PCA (n = 32) or thoracic (T5 to T8) epidural (n = 29). Overall pain scores were not statistically different between the TAP group and the epidural group averaged over 72 hours (4.98 versus 4.39, p = 0.09). During the initial 72 hours after operation, hypotension was less prevalent in the TAP group (25% versus 76%, p < 0.05) with lower crystalloid resuscitation needs. The LOS in the intensive care unit (3.2 days versus 4.6 days, p < 0.05) and return of bowel function (5 days versus 6.7 days, p < 0.05) were considerably shorter in the TAP group. Pulmonary complications were similar. Conclusions. TAP blocks with a PCA is an alternative option for pain control in patients undergoing esophagectomy and may reduce hypotension and need for volume resuscitation with similar pulmonary complications. (C) 2018 by The Society of Thoracic Surgeons