Comparison of Prolonged Transversus Abdominis Blockade with Systemic Anesthesia During Local Access to Double-Barreled Intestinal Stoma Closure (Preliminary Results of a Prospective Randomized Trial)

Abstract

AIM OF STUDY. To evaluate the effectiveness of prolonged blockade of the transverse abdominal space compared with analgesia based on ketoprofen and tramadol after operations for closing intestinal stomas from local access. MATERIAL AND METHODS. The prospective single-center randomized study included 74 patients aged from 23 to 83 years (Me = 61; Q1 = 49–Q3 = 67) during the period January–December 2021. Patients were randomly divided into two groups depending on the method of postoperative pain relief. Randomization was carried out using the envelope method. The main group consisted of 41 patients who, for pain relief after surgery, had a catheter installed for prolonged blockade of the transverse abdominal space. In case of ineffectiveness, ketoprofen and tramadol were prescribed according to the regimen. The comparison group consisted of 33 patients who received postoperative analgesia based on ketoprofen as the main drug and tramadol as a rescue drug. The groups were statistically comparable in terms of basic characteristics. Over the course of 4 days, we assessed the daily dosage of tramadol and ketoprofen, the level of dynamic and static pain on a digital rating scale, the time and degree of activity, the frequency of urinary retention, the occurrence of nausea and vomiting, the timing of return to good nutrition and restoration of bowel function, and the duration of postoperative treatment. RESULTS. The study included 74 patients. In the main group, on the first day, the frequency of additional use of tramadol (17 % versus 57.6 %, p = 0.0007) and the frequency of use of submaximal daily dosage (0 % versus 24.2 %, p = 0.003) were statistically significantly lower than in the comparison group. In the comparison group, the frequency of ketoprofen use was higher on days 2 (54 % vs. 94 %, p = 0.0004), days 3 (36.6 % vs. 76 %, p = 0.0018) and days 4 (19 % versus 52 %, p = 0.0081) due to the administration of the maximum daily dosage (all comparisons given are statistically significant). There were no statistically significant differences between the groups in terms of the level of pain at rest and movement, as well as the level of activity of the patients. The period of activity in patients of the main group during the day was statistically significantly longer on the 2nd (on average 30 minutes versus 15 minutes, p = 0.0187) and 3rd day (on average 60 minutes versus 45 minutes, p = 0.043). CONCLUSIONS. Extended blockade of the transverse abdominal space is an effective method of pain relief after operations to close an intestinal stoma from local access, significantly reducing the need for non-steroidal anti-inflammatory drugs and opioid analgesics.

Keywords

• prolonged block of the transverse abdominal space
• closure of a loop intestinal stoma
• multimodal analgesia