Effect of transversus abdominis plane block on postoperative outcomes in gynecologic oncology patients managed on an Enhanced Recovery After Surgery pathway

• Published in: Gynecologic oncology 2023-11, Vol.178, p.1-7
• Main Authors: Black, Kristin A., Nelson, Gregg, Goucher, Natalie, Foley, Joshua, Pin, Sophia, Chong, Michael, Ghosh, Sunita, Bisch, Steven P.
• Format: Article
• Language: English
• Subjects: Abdominal Muscles; Alberta; Analgesia; Analgesics, Opioid - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - pharmacology; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Enhanced Recovery After Surgery; Female; Genital Neoplasms, Female - drug therapy; Genital Neoplasms, Female - surgery; Gynecologic cancer; Humans; Opioid-Related Disorders; Opioids; Pain; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Retrospective Studies; Surgery
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2023.09.003

To characterize the effect of transversus abdominis plane (TAP) blocks on post-operative outcomes in patients undergoing laparotomy for gynecologic malignancy. This retrospective cohort study assessed patients undergoing laparotomy in 2016–2017 and 2020 in Alberta, Canada. The primary outcome was opioid consumption in oral morphine milligram equivalent (MME). Secondary outcomes included maximum pain scores, length of stay, and patient-controlled analgesia (PCA) use. Outcomes were compared using t-test with subgroup analysis by NSAID use. Multivariate regression modelling was performed for potential confounders. Data was collected on 956 patients; 828 received a TAP block, 128 did not. Opioid use in the first 24 h was lower in the TAP block group (35.9 mg MME vs 44.5 mg MME, p = 0.0294), without any increase in pain scores, this did not remain significant after regression analysis. Patients with TAP blocks had significant reduced mean length of stay (3.2 days vs. 5.0 days, p