Peripheral Autonomic Block Plus Transversus Abdominis Plane Block for Postoperative Pain After Minimally Invasive Left-Sided Colorectal Surgery: A Randomized, Double-Blind Trial

What this Trial Is About

Researchers are evaluating two pain management strategies for adults undergoing elective laparoscopic left-sided colorectal surgery. This randomized, controlled, double-blind trial compares conventional postoperative analgesia using intravenous medications and surgical wound infiltration with a combined locoregional approach involving a peripheral autonomic plexus block and a transversus abdominis plane (TAP) block. The goal is to see if the combined method reduces pain intensity and opioid use in the first 48 hours after surgery. The study involves 140 adults aged 18 to 80 years with ASA physical status I-II, scheduled for minimally invasive left-sided colorectal resection. Participants are randomly assigned to one of two groups: the experimental group receives a laparoscopic peripheral autonomic plexus block targeting the superior hypogastric and inferior mesenteric plexuses with ropivacaine, plus a bilateral ultrasound-guided TAP block also with ropivacaine, alongside standard multimodal analgesia. The control group receives the standard multimodal analgesia plus trocar and wound infiltration with ropivacaine without the autonomic or TAP blocks. The anesthesiologist performing the block is unblinded but does not participate in postoperative care or evaluations, while participants and outcome assessors are blinded. Participants will be closely monitored for pain intensity at rest using a Numerical Rating Scale at 2, 6, 12, 24, and 48 hours after surgery, as well as for total opioid consumption during the first 48 hours. Secondary assessments include time to bowel function return, ambulation, length of hospital stay, complications related to the blocks or analgesia, patient satisfaction, and quality of recovery measured by the PAIN OUT questionnaire. Adverse events will be followed for up to 30 days postoperatively, and a brief interview will explore patient experiences related to expectations and emotional impact. The total study duration for each participant covers the surgery and follow-up period up to one month.

Peripheral Autonomic Block (BAP) Plus Transversus Abdominis Plane Block (TAP) for Postoperative Analgesia After Minimally Invasive Left-Sided Colorectal Resection (BAPTAP)