Intraoperative Autonomic Nerve and TAP Blocks for Left-Sided Colectomy
Overview
This report demonstrates a novel intraoperative autonomic nerve block combined with transversus abdominis plane (TAP) block during minimally invasive left-sided colectomy. The technique aims to reduce postoperative visceral pain and associated symptoms such as nausea and vomiting, potentially improving recovery.
Background
Visceral pain following abdominal surgery is often inadequately controlled by conventional analgesic strategies and is frequently associated with postoperative nausea and vomiting (PONV), which can prolong hospital stay. Autonomic afferent fibers transmitting visceral pain signals can be targeted by nerve blocks, a method previously applied in pancreatic and gastric surgeries with some success. Due to anatomical differences, specific targeting of the superior hypogastric and inferior mesenteric plexuses is necessary for left-sided colonic resections. Combining this autonomic block with TAP blocks may provide enhanced analgesia.
Data Highlights
A mixed solution of 100 cc was prepared containing 20 cc (266 mg) liposomal bupivacaine, 30 cc Marcaine 0.5% HCl, and 50 cc normal saline. Each side of the abdominal wall received 30 cc total via TAP blocks at three points. Approximately 7–8 cc of the mixture was infiltrated around each autonomic plexus in 1 cc increments. Trocars sites were also infiltrated with 1–2 cc of the mixture.
Key Findings
The autonomic nerve block targets the superior hypogastric and inferior mesenteric plexuses to address visceral pain sources specific to left-sided colectomy.
The combined use of liposomal bupivacaine and Marcaine in a diluted mixture allows for prolonged and effective local anesthesia.
Laparoscopic guidance ensures accurate infiltration of the TAP block between the transversus abdominis and internal oblique muscles.
Injection around the autonomic plexuses is performed carefully with aspiration to avoid intravascular injection, confirmed visually by tissue expansion.
The technique is integrated into the surgical workflow without altering the planned minimally invasive procedure.
Further randomized and multicentric studies are planned to validate efficacy and reproducibility.
Clinical Implications
This combined block technique may improve postoperative pain control by effectively targeting both somatic and visceral pain pathways, potentially reducing opioid requirements and PONV incidence. Accurate laparoscopic-guided administration is critical to maximize analgesic benefit and minimize complications. Adoption of this approach could enhance recovery protocols for left-sided colonic resections.
Conclusion
The described intraoperative autonomic nerve block combined with TAP block represents a promising strategy to mitigate visceral pain after minimally invasive left-sided colectomy. Further clinical trials are warranted to establish its efficacy and safety.
References
Daes et al. 2019 -- Autonomic Neural Blocks in Laparoscopic Sleeve Gastrectomy
