Effect of Preoperative Versus Postoperative Use of Transversus Abdominis Plane Block With Plain 0.25 % Bupivacaine on Postoperative Opioid Use

A Retrospective Study

Richard Kalu; Peter Boateng; Lauren Carrier; Jaime Garzon; Amy Tang; Craig Reickert; Amalia Stefanou

Disclosures

BMC Anesthesiol. 2021;21(114) 

In This Article

Results

Descriptive Analysis

A total of 262 patients were identified through chart review. A total of 240 patients received preoperative TAP blocks and 22 received postoperative TAP blocks. The mean (SD) patient age was 57.8 years (16 years), 45 % were men, and the mean (SD) body mass index was 28.4 kg/m2 (7.32 kg/m2). There were no significant differences in the 2 groups with regard to age, sex, body mass index, American Society of Anesthesiology classification, history of cancer or inflammatory bowel disease, and opioid use at the time of the index procedure (Table 1). The 2 groups were similar in terms of comorbidities, including history of hypertension, diabetes mellitus, hyperlipidemia, congestive heart failure, chronic pulmonary obstructive disease, smoking, and alcohol use. The surgical indications and surgical approaches were similar between the 2 groups (Table 1).

Analgesic Requirements

Table 2 shows the postoperative analgesics used by the two groups. The patients who received plain bupivacaine TAP blocks postoperatively experienced a statistically significant reduction in the overall use of PCA compared with those who received preoperative TAP blocks (59.1 % vs. 83.3 %; p = 0.012). However, when given a PCA, the postoperative TAP group used a significantly higher amount of morphine compared to their counterparts (30.77 MME vs. 27.09 MME; p = 0.019). The postoperative TAP group was less likely to be prescribed opioid medication at the time of discharge (6.4 % vs. 16.9 %; p = 0.004). For patients who received prescription opioid at the time of discharge, the patients who had postoperative TAP received a significantly smaller amount of opioid (128.09 MME vs. 73.64 MME; p = 0.047). There were no differences between the groups with regard to duration of PCA or intravenous and oral opioid use.

Procedure-related Details, Length of Stay, Reoperation, and Readmission

Table 3 presents the procedure-related details, length of stay, and reoperation and readmission rates for the 2 groups. Surgical approach did not differ based on timing of the regional anesthesia. There was no statistically significant difference in procedure length, estimated blood loss, length of hospital stays, reoperation, or readmission rates between the 2 groups.

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