Comparative effectiveness of continuous subcostal transversus abdominis plane block versus thoracic epidural analgesia in postoperative pain management following major open abdominal surgery: a prospective observational study

This observational study compared the effectiveness of continuous subcostal transversus abdominis plane (TAP) block with bilaterally placed catheters versus continuous thoracic epidural analgesia (TEA) in managing postoperative pain following major open abdominal surgery. Thirty-one patients were enrolled between July 2019 and September 2020 at the Policlinico Paolo Giaccone in Palermo and divided into two groups. Postoperative pain, opioid consumption, incidence of postoperative nausea and vomiting (PONV), hemodynamic stability, and patient satisfaction were evaluated. No significant differences were observed in the number rating scale (NRS) values at 0, 6, 12, and 24 hours between groups. Only 3 patients in the TAP group required opioids in the first 24 hours; however, no differences were observed in median opioid consumption between groups (TEA 0.00 [0.00-0.00]; TAP 0.00 [0.00- 0.00], p=0.08). Hemodynamic stability was evaluated using mean arterial pressure and heart rate values, with no significant differences found for either parameter over time. The incidence of PONV was similar in both groups (p=0.47). The continuous TAP block represents an effective, less invasive alternative to TEA, particularly in patients with contraindications to neuraxial analgesia, aligning with Enhanced Recovery After Surgery (ERAS) protocols and the procedure-specific postoperative pain management (PROSPECT) methodology.