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LETTER TO THE EDITOR

Transversus Abdominis Plane Block Should Be Compared with Epidural for Postoperative Analgesia After Abdominal Surgery

Department of Anesthesiology and Reanimation; Hospital General Universitario de Elche, Spain; gtorcam{at}hotmail.com

To the Editor:

In a recent study of the efficacy of transversus abdominis plane block for abdominal surgery, McDonnell et al. (1) report a longer time to first request for morphine and reduced overall morphine requirements, reduced pain scores at all intervals, less sedation as well as less nausea and vomiting compared with patients receiving PCA morphine, rectal diclofenac, and acetaminophen ("standard care"). The authors conclude that "transversus abdominus plane block seems to hold considerable promise for patients undergoing surgical procedures involving abdominal wall incisions."

However, the authors did not include a group of patients receiving epidural analgesia. The clinical utility of transversus abdominis plane block remains to be compared with epidural analgesia. There is ample evidence that epidural analgesia provides better postperative analgesia compared with parenteral opioids (2–4). It also enhances functional exercise capacity, health-related quality of life, and reduces hospital stay after colonic surgery (3). I suggest that epidural analgesia must be considered "standard care" for patients receiving abdominal surgery.

I therefore ask the authors if they consider transversus abdominus plane block in someway superior to epidural analgesia for patients receiving abdominal surgery.

REFERENCES

1. McDonnell JG, O'Donnell B, Curley G, et al. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 2007;104:193–7.[Abstract/Free Full Text]
2. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia: their role in postoperative outcome. Anesthesiology 1995;82:1474–506.[Web of Science][Medline]
3. Carli F, Mayo N, Klubien K, et al. Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial. Anesthesiology 2002;97: 540–9.[Web of Science][Medline]
4. Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 2003;290:2455–63.[Abstract/Free Full Text]

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