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October 20, 2019
10/20/2019 10:15:00 AM - 10/20/2019 12:15:00 PM
Room WA2 - Area B
The Transversus Abdominis Plane Block Improves Outcomes and Reduces Discharge Time in an Enhanced Recovery from Anesthesia and Surgery Protocol in Patients Undergoing Laparoscopic Bariatric Surgery
Robert McCarthy, Pharm.D, Emily A. Ramirez, MBA, Arjun K. Ramesh, M.D., Katarina G. Ivankovich, B.S., Asokumar Buvanendran, M.D.
Rush University Medical Center, Chicago, Illinois , United States
Disclosures: R. McCarthy: None.E.A. Ramirez: None.A.K. Ramesh: None.K.G. Ivankovich: None.A. Buvanendran: None.
Introduction: Obesity is a significant cause of morbidity worldwide with a current estimated incidence of greater than 60%.1 Increasing numbers of laparoscopic bariatric surgeries (LBS) are being performed and optimal management strategies including enhanced recovery from anesthesia and surgery (ERAS) protocols have been implemented to optimize care for these patients. We evaluated the effect of a preoperative transversus abdominis plane (TAP) blocks versus local infiltration of port sites as part of an ERAS protocol on outcomes following LBS.

Materials/Methods: IRB approval was obtained. The study was a retrospective review of patients who either received preoperative TAP blocks or intraoperative local anesthetic infiltration (LAI) of port sites between 1 Jan 2017 and 15 Jun 2018. The primary outcome was postoperative opioid analgesia use in mg morphine equivalents (MME). Secondary outcomes were the incidence of severe nausea/vomiting and length of hospitalization (LOS).

Results: 361 cases were analyzed; 144 received a TAP block. There were no differences between the TAP and LAI groups with respect to age, gender, race, ethnicity, smoking, and ASA physical status. Supplemental opioid analgesia was decreased in the TAP block group compared with LAI, difference -10 MME (95% CI of difference -21 to -5, P<0.001), but not overall opioid consumption. Severe postoperative nausea/vomiting, time to meeting dietary milestones, and time to discharge were less in the TAP group. Multi-variable regression identified race, ethnicity, ASA physical status, TAP block and the surgery date (quarter), as preoperative predictors of length of stay. The adjusted difference in LOS with a TAP compared with port instillation was -4.5 h (95% CI -3.5 to -5.8, P<0.001).

Discussion: TAP blocks, as part of an ERAS protocol for LBS, decreased supplemental opioid administration, PONV and LOS. Pain burden and overall opioid use was not different, which may be reflective of round the clock multimodal analgesia per the ERAS protocol. Patients did resume oral intake faster and were discharged earlier. The significant difference in PONV is likely due to the earlier transition to oral intake coupled with less opioid use for breakthrough pain. Our findings support the clinical benefit of TAP blocks as a component of an ERAS protocol for LBS via decreased supplemental opioid administration, PONV, and reduced overall LOS.

References: 1) Batchelder AJ, Williams R, Sutton C, Khanna A. The evolution of minimally invasive bariatric surgery. J Surg Res. 2013; 183:559-6.$$graphic_{BCFED31E-7576-46EC-991D-D7222A1E18BA}$$
Figure 1

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