Objective: Although minimally invasive surgery decreases opiate requirements compared to laparotomy, achieving adequate postoperative pain relief continues to be a concern. We aimed to determine the efficacy of transversus abdominis plane block on postoperative opiate use, pain levels, and time of discharge following robotic hysterectomy for surgeries performed by our division of gynecologic oncology. Design: This is a retrospective analysis of patients who underwent robotic hysterectomy. Methods: After induction of general anesthesia, patients received transversus abdominis plane block and underwent robotic hysterectomy. Patients who did not receive the transversus abdominis plane block received local analgesia. A non-narcotic pain control regimen was used pre- and postoperatively and supplemented with narcotic analgesics as needed. Length of stay, pain levels (score of 0-10), and opioid consumption were reviewed and compared between the two groups. Results: Following power calculation, 140 patients were studied: 70 received a transversus abdominis plane block and were matched to 70 patients who received local anesthesia. All patients received our Enhanced Recovery Pathway. After controlling for age, BMI, total surgical time, and number of ports, there were no differences in pain scores at 1 hour (p = 0.13) and at discharge (p = 0.06), time to discharge (p = 0.09), amount of opioids required (p = 0.11), or time to void (p = 0.07). Conclusions: This study demonstrated that when well-established Enhanced Recovery Pathway is utilized, transversus abdominis plane block was equivalent to local anesthesia in reducing postoperative opioid consumption and pain scores.
Improvement of Outcome by Implementation of Enhanced Recovery Pathway in Gynecologic/ Oncology Surgery