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 Addition of transversus abdominis plane block to patient controlled analgesia for laparoscopic high anterior resection improves analgesia, reduces opioid requirement and expedites recovery of bowel function

2014 ◽  
Vol 96 (8) ◽  
pp. 579-585 ◽  
Author(s):  
F Ris ◽  
JM Findlay ◽  
R Hompes ◽  
A Rashid ◽  
J Warwick ◽  
...  
Keyword(s):  
Anterior Resection ◽  
Enhanced Recovery ◽  
Postoperative Pain Management ◽  
Bowel Function ◽  
Transversus Abdominis ◽  
Opioid Use ◽  
Patient Controlled Analgesia ◽  
Transversus Abdominis Plane ◽  
Pain Scores ◽  
Intravenous Morphine

Introduction Opioid sparing in postoperative pain management appears key in colorectal enhanced recovery. Transversus abdominis plane (TAP) blocks offer such an effect. This study aimed to quantify this effect on pain, opioid use and recovery of bowel function after laparoscopic high anterior resection. Methods This was a retrospective analysis of prospective data on 68 patients. Patients received an epidural (n=24), intravenous morphine patient controlled analgesia (PCA, n=22) or TAP blocks plus PCA (n=22) determined by anaesthetist preference. Outcome measures were numerical pain scores (0–3), cumulative intravenous morphine dose and time to recovery of bowel function (passage of flatus or stool). Results There were no differences in patient characteristics, complications or extraction site. The TAP block group had lower pain scores (0.7 vs 1.36, p<0.001) and morphine requirements (8mg vs 15mg, p=0.01) than the group receiving PCA alone at 12 hours and 24 hours. Earlier passage of flatus (2.0 vs 2.7 vs 3.4 days, p=0.002), stool (3.1 vs 4.1 vs 5.5 days, p=0.04) and earlier discharge (4 vs 5 vs 6 days, p=0.02) were also seen. Conclusions Use of TAP blocks was found to reduce pain and morphine use compared with PCA, expedite recovery of bowel function compared with PCA and epidural, and expedite hospital discharge compared with epidural.

scholarly journals Effect of preoperative versus postoperative use of transversus abdominis plane block with plain 0.25 % bupivacaine on postoperative opioid use: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Richard Kalu ◽  
Peter Boateng ◽  
Lauren Carrier ◽  
Jaime Garzon ◽  
Amy Tang ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Tertiary Care ◽  
Hospital Length ◽  
Transversus Abdominis ◽  
Hospital Length Of Stay ◽  
Tap Block ◽  
Opioid Use ◽  
Transversus Abdominis Plane ◽  
Opioid Medications

Abstract Background Enhanced recovery protocols optimize pain control via multimodal approaches that include transversus abdominis plane (TAP) block. The aim of this study was to evaluate the effect of preoperative vs. postoperative plain 0.25 % bupivacaine TAP block on postoperative opioid use after colorectal surgery. Methods A retrospective cohort study comparing postoperative opioid use in patients who received preoperative (n = 240) vs. postoperative (n = 22) plain 0.25 % bupivacaine TAP blocks. The study was conducted in a single tertiary care institution and included patients who underwent colorectal resections between August 2018 and January 2020. The primary outcome of the study was postoperative opioid use. Secondary outcomes included operative details, length of stay, reoperation, and readmission rates. Results Patients who received postoperative plain 0.25 % bupivacaine TAP blocks were less likely to require postoperative patient-controlled analgesia (PCA) (59.1 % vs. 83.3 %; p = 0.012) and opioid medications on discharge (6.4 % vs. 16.9 %; p = 0.004) relative to patients who received preoperative TAP. When needed, a significantly smaller amount of opioid was prescribed to the postoperative group (84.5 vs. 32.0 mg, p = 0.047). No significant differences were noted in the duration of postoperative PCA use, amount of oral opioid use, and length of stay. Conclusions Plain 0.25 % bupivacaine TAP block administered postoperatively was associated with significantly lower need for postoperative PCA and discharge opioid medications. The overall hospital length of stay was not affected by the timing of TAP block. Because of the limited sample size in this study, conclusions cannot be generalized, and more research will be required.

Enhanced Recovery after Surgery in Breast Reconstruction: A Systematic Review

2019 ◽  
Vol 35 (09) ◽  
pp. 695-704 ◽  
Author(s):  
Carol E. Soteropulos ◽  
Sherry Y.Q. Tang ◽  
Samuel O. Poore
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Breast Reconstruction ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Fluid Management ◽  
Patient Counseling ◽  
Opioid Use ◽  
Full Spectrum ◽  
Alloplastic Breast Reconstruction

Background Enhanced Recovery after Surgery (ERAS) principles have received focused attention in breast reconstruction. Many protocols have been described in the literature for both autologous and alloplastic reconstruction. This systematic review serves to better characterize successful ERAS protocols described in the literature for potential ease of adoption at institutions desiring implementation. Methods A systematic review of ERAS protocols for autologous and alloplastic breast reconstruction was conducted using Medline, the Cochrane Database, and Web of Science. Results Eleven cohort studies evaluating ERAS protocols for autologous (n = 8) and alloplastic (n = 3) breast reconstruction were included for review. The majority compared with a retrospective cohort of traditional perioperative care. All studies described the full spectrum of implemented ERAS protocols including preoperative, intraoperative, and postoperative phases of care. Most frequently reported significant outcomes were reduced length of stay and opioid use with ERAS implementation. No significant change in major complication or readmission rate was demonstrated. Conclusion Based on this systematic review, several core elements that make up a successful perioperative enhanced recovery protocol for breast reconstruction have been identified. Elements include patient counseling and education, limited preoperative fasting, appropriate thromboprophylaxis and antibiotic prophylaxis dependent on reconstructive method, preoperative antiemetics, multimodal analgesia and use of local anesthetic, goal-directed intravenous fluid management, prompt removal of drains and catheters, early diet advancement, and encouragement of ambulation postoperatively. Implementation of ERAS protocols in both autologous and alloplastic breast reconstruction can positively enhance patient experience and improve outcomes by reducing length of stay and opioid use, without compromising successful reconstructive outcomes.

scholarly journals Preoperative Versus Postoperative Use of Transversus Abdominis Plane Block With Nonliposomal Bupivacaine on Postoperative Narcotic Use: A Retrospective Study.

2021 ◽  
Author(s):  
Richard Kalu ◽  
Peter Boateng ◽  
Lauren Carrier ◽  
Jaime Garzon ◽  
Amy Tang ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Tertiary Care ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Readmission Rates ◽  
Recovery Protocols ◽  
Opioid Medications ◽  
Colorectal Resections

Abstract Background: Enhanced recovery protocols optimize pain control via multimodal approaches that include transversus abdominis plane (TAP) block. The aim of this study was to evaluate the effect of preoperative vs postoperative nonliposomal bupivacaine TAP block on postoperative narcotic use after colorectal surgery.Methods: A retrospective cohort study comparing postoperative narcotic use in patients who received preoperative (n = 240) vs postoperative (n = 22) nonliposomal TAP blocks. The study was conducted in a single tertiary care institution and included patients who underwent colorectal resections between August 2018 and January 2020. The study measured narcotics use in the postoperative and follow-up periods, operative details, length of stay, reoperation, and readmission rates.Results: Patients who received postoperative nonliposomal bupivacaine TAP blocks were less likely to require postoperative patient-controlled analgesia (PCA) (59.1% vs 83.3%; p = 0.012) and opioid medications on discharge (6.4% vs 16.9%; p = 0.004) relative to patients who received preoperative TAP. When needed, a significantly smaller amount of opioid was prescribed to the postoperative group (84.5 vs 32.0 mg, p = 0.047). No significant differences were noted in the duration of postoperative PCA use, amount of oral narcotic use, and length of stay.Conclusions: Nonliposomal bupivacaine TAP block administered postoperatively was associated with significantly lower need for postoperative PCA and discharge narcotics. Given the overall short length of stay for the 2 groups, further study is needed to justify the additional cost of liposomal bupivacaine TAP blocks for patients undergoing colorectal resections.

scholarly journals Benefits of Transversus Abdominis Plane Block on Postoperative Analgesia after Bariatric Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 345-358
Keyword(s):  
Bariatric Surgery ◽  
Postoperative Pain ◽  
Length Of Stay ◽  
Multimodal Analgesia ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Hospital Length Of Stay ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Pain Scores

BACKGROUND: Patients undergoing bariatric surgery present unique analgesic challenges, including poorly controlled pain, increased prevalence of obstructive sleep apnea, and opioid-induced respiratory depression. The transversus abdominis plane (TAP) has been demonstrated to be a safe and effective component of multimodal analgesia for a variety of abdominal surgeries. OBJECTIVE: To determine the benefits of the TAP block on postoperative analgesia and recovery in patients undergoing bariatric surgery. STUDY DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized studies. METHODS: We conducted a comprehensive search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to April 2020 for studies using TAP block in bariatric surgeries and reporting postoperative pain, opioid consumption, and recovery-related outcomes. Primary outcomes included postoperative pain scores, opioid consumption, and recovery-related outcomes (e.g., length of stay, time to ambulation). Outcomes were pooled using random effects model and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CI). RESULTS: Twenty-one studies (15 RCTs [n = 1410] and 6 nonrandomized studies [n = 1959]) were included. Among RCTs, the TAP block group required fewer opioid rescues (RR 0.28; 95% CI 0.18 to 0.42, P < 0.001) (moderate quality); reduced total opioid use over 24 hours (MD –8.33; 95% CI –14.78 to –1.89, P = 0.01); decreased time to ambulation (MD –1.12 hours; 95% CI –1.50 to –0.73, P < 0.001) (high quality); and had significantly lower pain scores at 6 hours (MD –1.52; 95% CI –1.90 to –1.13, P < 0.01) and 12 hours (MD –0.95; 95% CI –1.34 to –0.56, P < 0.001) on a 0-10 pain scale (moderate quality). No difference was observed for nausea and vomiting, or hospital length of stay. Meta-analyzed outcomes from observational studies supported these results, suggesting decreased postoperative pain and opioid consumption. LIMITATIONS: Studies varied with respect to type of surgery and components of comparator multimodal analgesia, likely contributing to heterogeneity. Subgroup analyses by type of comparator group were conducted to address these differences. We were unable to extract data from all trials included due to variability in outcomes reporting, such as non-opioid drugs for postoperative pain management or invalid dosages. Pain-related outcomes may be affected by operative differences leading to variation in visceral pain. Observational studies have their inherent limitations, such as confounding due to lack of participant randomization and intervention blinding, potentially affecting subjective outcomes, such as pain scores, as well as provider-dependent outcomes, such as hospital length of stay. Lastly, there was significant variation of TAP block technique across all studies. CONCLUSION: TAP block is an effective, safe modality that can be performed under anesthesia. It decreases pain, opioid use, and time to ambulation after bariatric surgeries and should be considered in multimodal analgesia for enhanced recovery in this high-risk surgical population. KEY WORDS: Analgesia, bariatric surgery, enhanced recovery after surgery, multimodal analgesia, opioid-sparing analgesia, pain, postoperative, regional block, transversus abdominis plane block

Impact of transversus abdominis plane blocks versus non-steroidal anti-inflammatory on post-operative opioid use in ERAS ovarian cancer surgery

2019 ◽  
Vol 29 (9) ◽  
pp. 1372-1376
Author(s):  
Steven Peter Bisch ◽  
Joni Kooy ◽  
Sarah Glaze ◽  
Anna Cameron ◽  
Pamela Chu ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Regression Analysis ◽  
Length Of Stay ◽  
Cytoreductive Surgery ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Opioid Use ◽  
Transversus Abdominis Plane ◽  
Anti Inflammatory

BackgroundTreatment of ovarian cancer often requires extensive surgical resection. The transversus abdominis plane (TAP) block has been utilized in benign gynecologic surgery to decrease post-operative pain and opioid use. We hypothesized that TAP blocks would decrease total opioid use in the first 24 hours and decrease length of stay following staging and cytoreductive surgery for ovarian cancer compared with either no local anesthetic or local wound infiltration alone.MethodsAll patients undergoing surgery for ovarian cancer from November 2016 to June 2017 were included in this retrospective cohort study. Median opioid use at 24, 48, and 72 hours post-operatively, as well as length of stay, were assessed. Multivariate median regression analysis was performed to adjust for potential confounders: post-operative non-steroidal anti-inflammatory drug (NSAID) usage, pre-operative opioid consumption, and extent of cytoreductive surgery. Length of stay was compared using Cox regression analysis.ResultsOne-hundred-and-twenty patients were included in the analysis. Eighty-two patients had a TAP block, while 38 did not. After adjusting for potential confounders there was no difference in median 24 hours opioid consumption (p=0.29) or length of stay (HR 0.95, p=0.78) between patients receiving TAP block compared with those without. After adjusting for potential confounders, patients receiving scheduled NSAIDs had a 2.6-fold greater likelihood of being discharged (p<0.0005) and a significant reduction in median opioid use at 24 hours (23.5 vs 14.5 mg) (p=0.017) compared with those patients without NSAIDs.DiscussionPost-operative administration of NSAIDs, but not TAP block, was associated with a decrease in post-operative opioid use and length of stay following surgery for ovarian cancer. Further investigation into alternative regional anesthetics for Enhanced Recovery after Surgery (ERAS) protocols is warranted.

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.

Transversus abdominis plane block and intrathecal morphine use in cesarean section: a retrospective review

2019 ◽  
Vol 44 (11) ◽  
pp. 1035-1037 ◽  
Author(s):  
Jacob Cole ◽  
Scott Hughey ◽  
Jason Longwell
Keyword(s):  
Postoperative Pain ◽  
Cesarean Section ◽  
Retrospective Review ◽  
Intrathecal Morphine ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Opioid Use ◽  
Transversus Abdominis Plane ◽  
Pain Scores

ObjectivesCesarean delivery is an extremely common surgical procedure practiced worldwide. It is an open abdominal surgery, and is associated with significant postoperative pain. One modality that helps alleviate this pain is the transversus abdominis plane (TAP) block. This analysis sought to evaluate postoperative pain when this block was used in conjunction with intrathecal morphine.MethodsA retrospective review was performed of 142 patients who underwent cesarean section at our institution. Of those, 43 patients had a TAP block performed. The primary outcome for this analysis was the time to first opioid administration following discharge from the operating room. Secondary outcomes included differences in postoperative pain scores, and overall opioid consumption.ResultsThe average time to first opioid use postoperatively decreased in the TAP group when compared with the No-TAP group, 23.3 versus 12.1, respectively (difference of 48.2% (95% CI 74.0% to 24.3%); p<0.001) and opioid consumption was significantly decreased within the first 24 hours following surgery from 4.55 intravenous morphine equivalents (IVME) to 2.67 IVME, respectively (difference of 107.1% (95% CI 145.1% to 69.2%); p=0.006). Visual analog pain scores were significantly decreased in the TAP group versus the No-TAP group up to 36 hours postoperatively.ConclusionsTAP blocks performed in conjunction with intrathecal morphine may decrease opioid use in the first 24 hours and improve pain scores for at least 36 hours following cesarean section. Because of the favorable safety profile, TAP blocks may contribute meaningfully to multimodal anesthesia for cesarean sections.

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