Transversus Abdominis Plane Blocks with Single-Dose Liposomal Bupivacaine in Conjunction with a Nonnarcotic Pain Regimen Help Reduce Length of Stay following Abdominally Based Microsurgical Breast Reconstruction

2017 ◽  
Vol 140 (4) ◽  
pp. 868
Keyword(s):  
Single Dose ◽  
Length Of Stay ◽  
Breast Reconstruction ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Liposomal Bupivacaine

scholarly journals Enhanced Recovery With Paravertebral and Transversus Abdominis Plane Blocks in Microvascular Breast Reconstruction

2020 ◽  
Vol 14 ◽  
pp. 117822342096736
Author(s):  
Ryan Guffey ◽  
Grace Keane ◽  
Austin Y Ha ◽  
Rajiv Parikh ◽  
Elizabeth Odom ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Breast Reconstruction ◽  
Regional Anesthesia ◽  
Enhanced Recovery ◽  
Paravertebral Block ◽  
Transversus Abdominis ◽  
Opioid Use ◽  
Transversus Abdominis Plane ◽  
Pain Scores ◽  
Independent Ambulation

Purpose: We have shown previously that a preoperative paravertebral nerve block is associated with improved postoperative recovery in microvascular breast reconstruction. The purpose of this study was to compare the outcomes of a complete enhanced recovery after surgery (ERAS) protocol with complete regional anesthesia coverage to our traditional care with paravertebral block. Patients and methods: This was a retrospective cohort study of 83 patients who underwent autologous breast reconstruction by T.M.M. between May 2014 and February 2018 at a tertiary academic center. Patients in the ERAS group were additionally administered acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentin, a transversus abdominis plane block (liposomal or plain bupivacaine), and primarily oral opioids postoperatively. The patients were mobilized earlier with more rapid diet progression. All patients received a preoperative paravertebral block. Results: Forty-four patients in the ERAS cohort were compared with 39 retrospective controls. The 2 groups were similar with respect to demographics and comorbidities. The ERAS cohort required significantly less opioids (291 vs 707 mg oral morphine equivalent, P < .0001) with unchanged postoperative pain scores and a shorter time to oral only opioid use (16.0 vs 78.2 hours, P < .0001). Median length of stay (3.20 vs 4.62, P < .0001) and time to independent ambulation (1.86 vs 2.88, P < .0001) were also significantly decreased in the ERAS cohort. Liposomal bupivacaine use did not significantly affect the results ( P ⩾ .2). Conclusions: Implementation of a robust enhanced recovery protocol with complete regional anesthesia coverage was associated with significantly decreased opioid use despite unchanged pain scores, with improved markers of recovery including length of stay, time to oral only narcotics, and time to independent ambulation.

scholarly journals The use of bilateral transversus abdominis plane blocks with liposomal bupivacaine on postoperative cesarean delivery patients during COVID-19 pandemic is associated with reduced narcotics use and reduced length of stay

2021 ◽  
Vol 17 ◽  
pp. 174550652110580
Author(s):  
Dennis E Feierman ◽  
Jason Kim ◽  
Aden Bronstein ◽  
Agnes Miller ◽  
Christein Dgheim ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Cesarean Delivery ◽  
Large Scale ◽  
Medical Center ◽  
Transversus Abdominis ◽  
Opioid Use ◽  
Transversus Abdominis Plane ◽  
Liposomal Bupivacaine ◽  
Number Of Patients

Background: The use of transversus abdominis plane blocks has been previously shown in both large-scale studies and our own institution to significantly reduce postoperative pain and opioid use. In addition, the use of bilateral transversus abdominis plane blocks using liposomal bupivacaine in combination with neuraxial morphine significantly reduced post-cesarean-delivery pain and opioid use. During the COVID-19 crisis, our anesthesia department in a collaborative effort with our obstetric colleagues thought that the use of bilateral transversus abdominis plane blocks with liposomal bupivacaine could reduce the use of opioids to treat postoperative pain and might result in decreased length of stay. Methods: After institutional review board approval, a retrospective study of 288 patients who underwent cesarean delivery under spinal or epidural (neuraxial) anesthesia at Maimonides Medical Center in Brooklyn, NY was conducted. Historical controls were from 142 consecutive patients from 1 January 2012 through 12 May 2012. An additional set of controls consisted of 30 consecutive patients from 10 March 2020 through 13 April 2020. The primary outcome data analyzed were the use of opioids and length of stay. Results: Post cesarean delivery, patients who received both bilateral transversus abdominis plane blocks with liposomal bupivacaine and neuraxial morphine was associated with a significant decrease in the number of patients using post operative opioids, 54%–60% decreased to 18% ( p < 0.001), and a decreased length of stay; 3.1 days was reduced to 2.39 ( p < 0.001). Conclusion: Neuraxial opioids combined with liposomal bupivacaine transversus abdominis plane blocks provided significant pain relief for patients post cesarean delivery, required less post operative opioids, and facilitated earlier discharge that may aid in reducing patient exposure and hospital burden secondary to COVID-19.

Factors Associated with a Short (10 Days) Length of Stay after Colectomy: A Multivariate Analysis of over 400 Patients

2016 ◽  
Vol 82 (10) ◽  
pp. 960-963 ◽  
Author(s):  
Kyle G. Cologne ◽  
Sean Byers ◽  
David R. Rosen ◽  
Grace S. Hwang ◽  
Adrian E. Ortega ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Operative Time ◽  
Statistical Significance ◽  
Operative Procedure ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Factors Associated ◽  
Transfusion Requirements ◽  
American Society

A prospectively maintained database of 415 patients undergoing colectomy was evaluated. We performed a logistic regression analysis to identify factors associated with 1) length of stay (LOS) of 2 days or less and 2) LOS of 10 days or more. Investigated variables included demographics, American Society of Anesthesiology (ASA) score, diagnosis, operative procedure, approach and time, transfusion requirements, and occurrence of any complications. Factors associated with a LOS of two days or less included ASA [odds ratio (OR): 0.34, 95% confidence interval (CI): 0.208–0.576], use of transversus abdominis plane block (OR: 5.259, 95% CI: 2.825–9.791), and operative time (OR: 0.98, 95% CI: 0.974–0.986). Age >65 had an OR of 1.73, though this did not reach statistical significance. Factors associated with LOS >10 days included ASA (OR: 2.152, 95% CI: 1.245–3.721), anastomotic leak (OR: 2.163, 95% CI: 1.486–3.148), ileus (OR: 8.790, 95% CI: 4.501–17.165), and surgical site infection (OR: 5.846, 95% CI: 2.764–12.362). Cancer and transfusion status were associated but did not reach statistical significance. Although operative time was longer in left-sided resections, no differences in LOS were observed. In conclusion, numerous factors are associated with short or long LOS and may help stratify resource utilization after colectomy. Further study is needed to confirm our findings.

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