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Association of the addition of a transversus abdominis plane block to an enhanced recovery program with opioid consumption, postoperative antiemetic use, and discharge time in patients undergoing laparoscopic bariatric surgery: a retrospective study
  1. Robert J McCarthy1,
  2. Katarina G Ivankovich1,
  3. Emily A Ramirez2,
  4. Ashley M Adams1,
  5. Arjun K Ramesh1,
  6. Philip A Omotosho3 and
  7. Asokumar Buvanendran1
  1. 1Anesthesiology, Rush University, Chicago, Illinois, USA
  2. 2Clinical Resource Management, Rush University, Chicago, Illinois, USA
  3. 3Surgery, Rush University, Chicago, Illinois, USA
  1. Correspondence to Dr Robert J McCarthy, Anesthesiology, Rush University, Chicago, IL 60612, USA; Robert_J_McCarthy{at}rush.edu

Abstract

Background Increasing numbers of laparoscopic bariatric surgeries are being performed and enhanced recovery from anesthesia and surgery (ERAS) protocols have been implemented to optimize care for these patients. We evaluated the effects of an anesthesiologist placed preoperative transversus abdominis plane block (TAP) as part of a bariatric surgery ERAS protocol. We hypothesized that an anesthesiologist placed preoperative TAP added to an ERAS protocol following laparoscopic bariatric surgery would reduce total opioid consumption.

Methods A retrospective cohort of consecutive patients between January 1, 2017 and December 31, 2018 at a single large tertiary care center studied. TAP blocks were added to the ERAS protocol beginning in the second quarter of 2017. The primary outcome was total opioid analgesia use in mg oral morphine equivalents. Secondary outcomes were antiemetics administered and length of hospitalization. Data were analyzed using a generalized linear mixed model adjusted for sociodemographic, surgical, and preoperative risk factors that have been associated with opioid and antiemetic use and length of hospitalization.

Results Five hundred and nine cases were analyzed; TAP blocks were performed in 94/144 (65%) laparoscopic Roux-en-Y gastric bypass (LRYGB) and in 172/365 (47%) laparoscopic sleeve gastrectomy (LSG) patients. Mean (95% CI) adjusted total opioid administered was lower by 11% (1% to 19%, p=0.02), antiemetic drug administration was lower by 15% (-2% to 25%, p=0.06) and discharge time lower by 39% (26% to 48%, p<0.01) following LRYGB in the TAP group. Mean (95% CI) adjusted total opioid administered was lower by 9% (2% to 16%, p<0.01), antiemetic drug administration was lower by 11% (3% to 18%, p<0.01) and discharge time lower by 11% (2% to 18%, p=0.02) following LSG in the TAP group.

Conclusions TAP blocks added to a laparoscopic bariatric surgery ERAS protocol were associated with decreased total opioid use, number of antiemetic treatments, and length of stay; however, these changes were not likely clinically important. Our findings do not support widespread clinical benefit of TAP use in ERAS protocols for laparoscopic bariatric surgery.

  • outcomes
  • acute pain
  • surgical outcome
  • truncal blocks
  • postoperative pain
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Footnotes

  • Twitter @Kumar_ASRA

  • Contributors RJM was involved in the conception or design of the study, data analysis and interpretation, drafting the article, critical revision of the article, and final approval of the version to be published. KGI was involved in the acquisition of the data, drafting the article, critical revision of the article, and final approval of the version to be published. EAR was involved in the acquisition of the data and data interpretation, drafting the article, critical revision of the article, and final approval of the version to be published. AMA was involved in the acquisition of the data and data interpretation, drafting the article, critical revision of the article, and final approval of the version to be published. AKR was involved in the acquisition of the data and data interpretation, drafting the article, critical revision of the article, and final approval of the version to be published. PAO was involved in data interpretation, drafting the article, critical revision of the article, and final approval of the version to be published. AB was involved in the conception or design of the study, drafting the article, critical revision of the article, and final approval of the version to be published.

  • Funding The study was funded by Department of Anesthesiology funds.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Deidentified participant data may be available from RJM (ORCID id:0000-0002-0966-5311), the corresponding author, on request and execution of a data use agreement.

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