Continuous Transversus Abdominis Plane Infusion via Surgically Inserted Catheter for Postoperative Analgesia After Abdominal Aortic Surgery by Retroperitoneal Approach: TAPCACAO Study


      The purpose of our study was to evaluate the analgesic properties of continuous transversus abdominis plane (TAP) infusion with ropivacaine compared to placebo for postoperative analgesia in elective surgery of the abdominal aorta by retroperitoneal exposure.


      We conducted a prospective, single-center, randomized, double-blind study comparing a group of patients with a TAP catheter undoing ropivacaine infusion with a placebo group. Patients received a left retroperitoneal pararectal exposure for abdominal aortic surgery. A continuous infusion catheter was placed under visual control by the surgeon before closure and removed after 48 hr. All patients had postoperative patient-controlled analgesia with morphine. The primary endpoint was morphine consumption during the first 24 hr.


      The analysis included 25 patients in the placebo group and 24 in the ropivacaine group. The average morphine consumption during the first 24 hr was significantly different, with 31 ± 16 mg in the ropivacaine group and 41 ± 17 mg in the placebo group (P = 0.019). At 48 hr, morphine consumption was still lower in the ropivacaine group (42 ± 26 mg) than in the placebo group (64 ± 25 mg) (P = 0.003). The opioid narcotic-related side effects of opioid infusion (postoperative nausea and vomiting, constipation) and length of hospital stay were similar in both populations.


      Our study showed that continuous TAP block with ropivacaine via surgically inserted catheter significantly decreased morphine consumption at 24 and 48 hr after elective abdominal aortic surgery by retroperitoneal exposure.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lovegrove R.E.
        • Javid M.
        • Magee T.R.
        • et al.
        A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm.
        Br J Surg. 2008; 95: 677-684
        • Bardia A.
        • Sood A.
        • Mahmood F.
        • et al.
        Combined epidural-general anesthesia vs general anesthesia alone for elective abdominal aortic aneurysm repair.
        JAMA Surg. 2016; 151: 1116-1123
        • Wu C.L.
        • Cohen S.R.
        • Richman J.M.
        • et al.
        Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis.
        Anesthesiology. 2005; 103: 1079-1088
        • McDonnell J.G.
        • Curley G.
        • Carney J.
        • et al.
        The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial.
        Anesth Analg. 2008; 106: 186-191
        • Rafi A.N.
        Abdominal field block: a new approach via the lumbar triangle.
        Anaesthesia. 2001; 56: 1024-1026
        • Minami E.
        • Kawashima S.
        • Kato T.
        • et al.
        Analgesic efficacy of transversus abdominis plane block after open abdominal aortic aneurysm surgery.
        Masui. 2014; 63: 1089-1092
        • Klasen F.
        • Bourgoin A.
        • Antonini F.
        • et al.
        Postoperative analgesia after caesarean section with transversus abdominis plane block or continuous infiltration wound catheter: a randomized clinical trial. TAP vs. infiltration after caesarean section.
        Anaesth Crit Care Pain Med. 2016; 35: 401-406
        • Chaykovska L.
        • Blohmé L.
        • Mayer D.
        • et al.
        Paraincisional subcutaneous infusion of ropivacaine after open abdominal vascular surgery shows significant advantages.
        Ann Vasc Surg. 2014; 28: 837-844
        • Licker M.
        • Christoph E.
        • Cartier V.
        • et al.
        Impact of anesthesia technique on the incidence of major complications after open aortic abdominal surgery: a cohort study.
        J Clin Anesth. 2013; 25: 296-308
        • Dhanapal B.
        • Sistla S.C.
        • Badhe A.S.
        • et al.
        Effectiveness of continuous wound infusion of local anesthetics after abdominal surgeries.
        J Surg Res. 2017; 212: 94-100
        • Cheong W.K.
        • Seow-Choen F.
        • Eu K.W.
        • et al.
        Randomized clinical trial of local bupivacaine perfusion versus parenteral morphine infusion for pain relief after laparotomy.
        Br J Surg. 2001; 88: 357-359
        • Fredman B.
        • Zohar E.
        • Tarabykin A.
        • et al.
        Bupivacaine wound instillation via an electronic patient-controlled analgesia device and a double-catheter system does not decrease postoperative pain or opioid requirements after major abdominal surgery.
        Anesth Analg. 2001; 92: 189-193
        • Chenet J.
        • Dupont E.
        • Salomon du Mont L.
        • et al.
        Clinical effectiveness of ultrasound-guided dual transversus abdominis plane block for postoperative analgesia in open abdominal aortic surgery patients: the randomised, double-blind ETAP trial.
        Eur J Anaesthesiol. 2020; 37: 821-823
        • Ball L.
        • Pellerano G.
        • Corsi L.
        • et al.
        Continuous epidural versus wound infusion plus single morphine bolus as postoperative analgesia in open abdominal aortic aneurysm repair: a randomized non-inferiority trial.
        Minerva Anestesiol. 2016; 82: 1296-1305
        • Qin C.
        • Liu Y.
        • Xiong J.
        • et al.
        The analgesic efficacy compared ultrasound-guided continuous transverse abdominis plane block with epidural analgesia following abdominal surgery: a systematic review and meta-analysis of randomized controlled trials.
        BMC Anesthesiol. 2020; 20: 52
        • Ganapathy S.
        • Sondekoppam R.V.
        • Terlecki M.
        • et al.
        Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery: a randomised, open-label feasibility study.
        Eur J Anaesthesiol. 2015; 32: 797-804
        • Jankovic Z.B.
        • Pollard S.G.
        • Nachiappan M.M.
        Continuous transversus abdominis plane block for renal transplant recipients.
        Anesth Analg. 2009; 109: 1710-1711
        • Parikh B.K.
        • Waghmare V.
        • Shah V.R.
        • et al.
        The analgesic efficacy of continuous transversus abdominis plane block in renal transplant recipients.
        J Anaesthesiol Clin Pharmacol. 2015; 31: 531-534
        • Abdallah F.W.
        • Adham A.M.B.F.
        • Chan V.W.
        • et al.
        Analgesic benefits of preincisional transversus abdominis plane block for abdominal aortic aneurysm repair.
        J Cardiothorac Vasc Anesth. 2013; 27: 536-538
        • Petersen P.L.
        • Mathiesen O.
        • Torup H.
        • et al.
        The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical review.
        Acta Anaesthesiol Scand. 2010; 54: 529-535
        • Latzke D.
        • Marhofer P.
        • Kettner S.C.
        • et al.
        Pharmacokinetics of the local anesthetic ropivacaine after transversus abdominis plane block in healthy volunteers.
        Eur J Clin Pharmacol. 2012; 68: 419-425
        • Forastiere E.
        • Sofra M.
        • Giannarelli D.
        • et al.
        Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy.
        Br J Anaesth. 2008; 101: 841-847
        • McDonnell J.G.
        • 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: 193-197
        • Carney J.
        • McDonnell J.G.
        • Ochana A.
        • et al.
        The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.
        Anesth Analg. 2008; 107: 2056-2060
        • Harish R.
        Low-dose infusion with « surgical transverse abdominis plane (TAP) block » in open nephrectomy.
        Br J Anaesth. 2009; 102: 889
        • Ecoffey C.
        • Bonnet F.
        [Management of postoperative pain in 2007: the summary of a European survey and a French national audit].
        Ann Fr Anesth Reanim. 2008; 27: 661-663
        • Boldt J.
        • Thaler E.
        • Lehmann A.
        • et al.
        Pain management in cardiac surgery patients: comparison between standard therapy and patient-controlled analgesia regimen.
        J Cardiothorac Vasc Anesth. 1998; 12: 654-658
        • Matsumoto null
        • Tanaka null
        • null Ohsumi
        • et al.
        Role of pararectal retroperitoneal approach in abdominal aortic aneurysm repair.
        Int J Angiol. 2000; 9: 20-22
        • Chin K.J.
        • McDonnell J.G.
        • Carvalho B.
        • et al.
        Essentials of our current understanding: abdominal wall blocks.
        Reg Anesth Pain Med. 2017; 42: 133-183
        • Beloeil H.
        • Albaladejo P.
        • Sion A.
        • et al.
        Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study.
        Br J Anaesth. 2019; 122: e98-e106