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Transversus abdominis block utilizing liposomal bupivacaine as a non-opioid analgesic for postoperative pain management

  • 2018 SAGES Oral
  • Published:
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Abstract

Introduction

The use of non-narcotic modalities for postoperative analgesia may decrease exposure to opioids, thereby limiting their deleterious effects. The objective of this study was to determine the effectiveness of a liposomal bupivacaine transverse abdominis plane (TAP) block prior to laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB). The primary outcome was total postoperative morphine equivalents.

Methods

A single-surgeon, IRB-approved retrospective chart review was performed on consecutive patients who underwent LRYGB or LSG from 2010 to 2016. Patients were grouped according to those who received TAP blocks immediately preoperatively with rescue opioids (TAP group) and those who received PCA only (PCA group). Total parenteral morphine equivalents (PME) were calculated. Numerical pain scores were collected immediately following surgery, 12 h postoperatively, and on the day of discharge. Median length of stay (LOS) and 30-day readmissions were also calculated.

Results

There were 440 patients who met inclusion criteria. The TAP group had significantly less opioid use (total PME) than the PCA, irrespective of surgical approach (70.4 ± 2.7 PCA LRYGB and 26.5 ± 1.5 TAP block LRYGB, p value ≤ 0.0001; 60.0 ± 3.5 PCA LSG vs. and 24.1 ± 2.0 TAP block LSG, p value < 0.0001). Median LOS was 2.0 days for both PCA groups, whereas LOS decreased to 1.0 day for both groups of patients receiving TAP blocks (p < 0.0001). Pain scores immediately following and 12 h after surgery were significantly elevated in the TAP LRYGB versus PCA LRYGB (p < 0.05) and immediately following surgery for PCA versus TAP block for LSG (p = 0.0109).

Conclusions

TAP blocks with liposomal bupivacaine lead to significantly less use of parenteral morphine equivalents and decreased LOS compared to PCA alone. Pain scores were higher in the TAP LRYGB group compared to the LRYGB PCA group, with no differences in pain scores noted in the LSG groups.

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Authors and Affiliations

  1. Division of Bariatric Surgery, Carolinas Medical Center, 2630 E 7th St, Charlotte, NC, 28204, USA

    Thomas C. Robertson, Kathryn Hall, Timothy Kuwada & Keith S. Gersin

  2. OhioHealth Physician Group, Riverside Methodist Hospital, Columbus, OH, USA

    Thomas C. Robertson

  3. Clinical Pharmacy Services, Carolinas Medical Center, Charlotte, NC, USA

    Susan Bear

  4. Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    Kyle J. Thompson

Authors
  1. Thomas C. Robertson
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  2. Kathryn Hall
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  5. Timothy Kuwada
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  6. Keith S. Gersin
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Correspondence to Thomas C. Robertson.

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Disclosures

Keith Gersin: Receives personal fees outside the submitted work for being a speaker for WL Gore,GI Dynamics, and Pacira pharmaceuticals. Timothy Kuwada: Receives personal fees outside the submitted work for being a speaker for WL Gore and Bard. Susan Bear: Personal fees from Pacira Pharmaceuticals outside of submitted work. Thomas Robertson, Kyle Thompson, and Kathryn Hall have no conflicts of interest or financial ties to disclose.

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Robertson, T.C., Hall, K., Bear, S. et al. Transversus abdominis block utilizing liposomal bupivacaine as a non-opioid analgesic for postoperative pain management. Surg Endosc 33, 2657–2662 (2019). https://doi.org/10.1007/s00464-018-6543-z

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  • DOI: https://doi.org/10.1007/s00464-018-6543-z

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