Effective postoperative pain management is essential for enhanced recovery after laparoscopic colorectal surgery. This randomized, controlled, double-blind trial will compare conventional postoperative analgesia (intravenous medications plus surgical wound infiltration) with a locoregional strategy combining a peripheral autonomic block (inferior mesenteric and superior hypogastric plexuses) and a transversus abdominis plane (TAP) block. We hypothesize that the combined strategy (BAPTAP) reduces pain intensity and opioid consumption in the first 48 hours after Left-Sided Colorectal Resection.
Elective laparoscopic left-sided colorectal resection
ASA physical status I-II
Ability to understand the study and sign informed consent
Known allergy to study medications (e.g., local anesthetics)
Coagulation disorders
Pregnancy
Inability to understand or provide consent
Parallel
Minimally Invasive Left-Sided Colorectal Resection
Procedure/SurgeryElective laparoscopic anterior/rectosigmoid resection or sigmoid colectomy per institutional standards; not randomized.
BAPTAP (Peripheral Autonomic Blockade + TAP Block)
Procedure/SurgeryGeneral anesthesia combined with peripheral autonomic plexus blockade (superior hypogastric and inferior mesenteric plexuses) using 0.2% ropivacaine, 8 mL per site; performed laparoscopically prior to dissection, in association with bilateral ultrasound-guided TAP block with 0.33% ropivacaine, 30 mL per side.
Trocar/Incision Infiltration
Procedure/SurgeryGeneral anesthesia with trocar/incision infiltration using 0.33% ropivacaine, up to a total volume of 60 mL.
Pain intensity
Pain intensity at rest (NRS 0-10); Time Frame: 2 hours, 6 hours, 12 hours, 24 hours and 48 hours postoperatively; Higher scores indicate worse pain.
Cumulative opioid consumption
Cumulative opioid consumption (IV morphine equivalents, mg) in the first 48 hours; Time Frame: baseline to 48 hours; Calculated as: (Fentanyl mg × 100) + (Morphine IV mg) \[+ (Tramadol mg ÷ 10) if applicable\].
Pain frequency - Patient-reported outcomes via PAIN OUT (Portuguese-validated IPO)
Pain frequency is assessed by evaluating both intensity and temporal occurrence of postoperative pain. Patients are asked to report: The worst pain intensity experienced since surgery, measured on an 11-point Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst pain imaginable). The least pain intensity experienced during the same period, using the same scale. The frequency of severe pain, expressed as the estimated percentage of time the patient experienced severe pain since surgery, ranging from 0% (never) to 100% (always). This domain captures not only peak pain intensity but also pain variability and persistence over time.
Patient-reported outcomes via PAIN OUT (Portuguese-validated IPO) - interference with activities and mood
This domain evaluates the functional and emotional impact of postoperative pain. Interference with physical activities is assessed using an 11-point NRS (0 = did not interfere; 10 = completely interfered) in relation to: * Activities in bed (e.g., turning, sitting up, changing position) * Deep breathing or coughing * Sleep quality * Activities out of bed (e.g., walking, standing, sitting in a chair), when applicable Interference with mood and emotional well-being is evaluated by assessing the extent to which pain caused the patient to feel: * Anxious * Helpless Each emotional parameter is rated on an 11-point NRS from 0 (not at all) to 10 (extremely), reflecting the psychological burden associated with postoperative pain.
Patient satisfaction with pain management
Patient satisfaction with pain management is assessed through two complementary measures: Overall satisfaction with pain treatment outcomes, rated on an 11-point NRS ranging from 0 (extremely dissatisfied) to 10 (extremely satisfied). Perceived adequacy of pain relief, expressed as a percentage from 0% (no relief) to 100% (complete relief), considering all pain treatments combined (pharmacological and non-pharmacological). This domain reflects the patient's global evaluation of analgesic effectiveness and quality of care.
Time to return of bowel function
Time to return of bowel function was defined as the interval, in hours, from the end of the surgical procedure to the recovery of gastrointestinal motility. Outcome Components The return of bowel function was assessed based on the following clinical parameters: * Time to first passage of flatus * Time to first bowel movement (defecation)
Length of hospital stay.
Length of hospital stay; Time Frame: index admission
Time to ambulation.
Time to ambulation; Time Frame: up to 48 hours.
Qualitative interview (5-10 min) on expectations, trust, coping, and emotional impact.
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Faculdade de Ciências Médicas de Minas Gerais
Lead sponsor
Santa Casa de Misericórdia de Belo Horizonte
Collaborator
