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

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. Gonzalo Tornero-Campello, MD Department of Anesthesiology and Reanimation Hospital General Universitario de Elche, Spain [email protected]