Abstract
Background
Complex abdominal wall reconstruction for ventral and incisional hernias can be quite painful with prolonged length of stay (LOS). There are a variety of options to manage post-operative pain after a ventral hernia repair, including epidural catheters, transversus abdominis plane (TAP) blocks, and intravenous narcotic pain medications (IVPM). We hypothesized that TAP blocks with liposomal bupivacaine decrease the LOS compared to epidurals and IVPM.
Methods
A retrospective review of all patients who underwent an open ventral hernia repair with retromuscular mesh between 2016 and 2020 was conducted. LOS was used as the primary outcome. Secondary outcomes included post-operative pain and 90-day post-operative complications.
Results
An epidural was used in 66 patients, a TAP block with liposomal bupivacaine in 18 patients, and IVPM in 11 patients. The epidural group was noted to have a significantly longer duration of surgery (251.11 vs. 207.94 min; P < 0.05) and larger area of mesh (461.85 vs. 338.17 cm2; P < 0.05) when compared to the TAP block group. Hospital LOS was significantly shorter for the TAP block group compared to the epidural group (4.22 vs. 5.62 days; P < 0.05). There were no differences in post-operative complications between the groups. The epidural group reported significantly lower post-operative day one (POD1) pain scores measured on a 10-point scale, compared to the IVPM and TAP block groups (5.00 vs. 6.91 vs. 7.50; P < 0.05).
Conclusion
Patients who received a TAP block for post-operative pain management had a significantly shorter length of stay compared to those patients who received an epidural. While the TAP block group reported higher POD1 pain scores, they did not have a significant difference in post-operative complications. TAP blocks with liposomal bupivacaine should be considered for post-operative pain control in complex ventral hernia repairs.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Taylor RS, Ullrich K, Regan S, Broussard C, Schwenkglenks M, Taylor RJ, Gordon DB, Zaslansky R, Meissner W, Rothaug J, Langford R, The PAIN-OUT Investigators (2012) The impact of early postoperative pain on health-related quality of life. Pain Pract. https://doi.org/10.1111/papr.12026,Dec23
Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Novitsky YW (2016) Efficacy of transversus abdominis plane block with liposomal bupivacaine during open abdominal wall reconstruction. Am J Surg. https://doi.org/10.1016/j.amjsurg.2015.12.026,Apr12
Petersen PL, Mathiesen O, Torup H, Dahl JB (2010) The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical review. Acta Anaesthesiol Scand. https://doi.org/10.1111/j.1399-6576.2010.02215.x,Feb17
Chesov I, Belîi A (2017) Postoperative analgesic efficiency of transversus abdominis plane block after ventral hernia repair: a prospective, randomized, controlled clinical trial. Rom J Anaesth Intensive Care. https://doi.org/10.21454/rjaic.7518.242.chv,Oct24
Iyer SS, Bavishi H, Mohan CV, Kaur N (2017) Comparison of epidural analgesia with transversus abdominis plane analgesia for postoperative pain relief in patients undergoing lower abdominal surgery: a prospective randomized study. Anesth Essays Res. https://doi.org/10.4103/0259-1162.206856,Jul-Sep
Fields AC, Gonzalez DO, Chin EH, Nguyen SQ, Zhang LP, Divino CM (2015) Laparoscopic-assisted transversus abdominis plane block for postoperative pain control in laparoscopic ventral hernia repair: a randomized controlled trial. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2015.04.007,Apr22
Cho JE, Helm MC, Helm JH, Mier N, Kastenmeier AS, Gould JC, Goldblatt MI (2018) Retro-rectus placement of bio-absorbable mesh improves patient outcomes. Surg Endosc. https://doi.org/10.1007/s00464-018-6560-y,Oct25
Baeriswyl M, Zeiter F, Piubellini D, Kirkham KR, Albrecht E (2018) The analgesic efficacy of transverse abdominis plane block versus epidural analgesia: a systematic review with meta-analysis. Med Baltimore. https://doi.org/10.1097/MD.0000000000011261,Jun
Warren JA, Carbonell AM, Jones LK, Mcguire A, Hand WR, Cancellaro VA, Ewing JA, Cobb WS (2019) Length of stay and opioid dose requirement with transversus abdominis plane block vs epidural analgesia for ventral hernia repair. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2018.12.017,Jan8
Favuzza J, Delaney CP (2013) Outcomes of discharge after elective laparoscopic colorectal surgery with transversus abdominis plane blocks and enhanced recovery pathway. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2013.03.030,Jun28
Torgeson M, Kileny J, Pfeifer C, Narkiewicz L, Obi S (2018) Conventional epidural vs transversus abdominis plane block with liposomal bupivacaine: a randomized trial in colorectal surgery. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2018.04.021,May1
Prabhu AS, Krpata DM, Perez A, Phillips S, Huang LC, Haskins IN, Rosenblatt S, Poulose BK, Rosen MJ (2018) Is it time to reconsider postoperative epidural analgesia in patients undergoing elective ventral hernia repair?: An AHSQC analysis. Ann Surg. https://doi.org/10.1097/SLA.0000000000002214,May
Nishimori M, Ballantyne JC, Low JH (2006) Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005059.pub2,Jul19
Zhou SL, Helm MC, Goldblatt MI (2019) Epidural anesthesia for post-operative pain is associated with a higher incidence of complications following open ventral hernia repair. Surg Endosc. https://doi.org/10.1007/s00464-019-07136-8,Sep25
Felling DR, Jackson MW, Ferraro J, Battaglia MA, Albright JJ, Wu J, Genord CK, Brockhaus KK, Bhave RA, McClure AM, Shanker BA, Cleary RK (2018) Liposomal bupivacaine transversus abdominis plane block versus epidural analgesia in a colon and rectal surgery enhanced recovery pathway: a randomized clinical trial. Dis Colon Rectum. https://doi.org/10.1097/DCR.0000000000001211,Oct
Acknowledgements
None.
Disclosures
Nicole Petcka, Katie Alter-Troilo, Emily Hetzel, Dr. Tammy Kindel, and Dr. Kathleen Lak have no conflicts of interest or financial ties to disclose. Dr. Rana Higgins receives teaching honorarium from WL Gore and Intuitive Surgical. Dr. Jon Gould receives precepting and teaching honorarium from Ethicon/Torax and speaking honorarium from BD. Dr. Andrew Kastenmeier receives teaching honorarium from WL Gore. Dr. Matthew Goldblatt receives research funding from BD, Medtronic, and WL Gore and teaching honorarium from Medtronic and WL Gore.
Funding
This study funded by Medical College of Wisconsin Department of Surgery.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Petcka, N.L., Alter-Troilo, K., Hetzel, E. et al. Transversus abdominis plane blocks for complex abdominal wall reconstruction decrease hospital length of stay compared to epidurals. Surg Endosc 36, 7722–7730 (2022). https://doi.org/10.1007/s00464-022-09095-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-022-09095-z