Michael Lew, MD, Rachel Lewis, MD, Miles Landry, MD, Brandie Forman, Bruce Ramshaw, MD. University of Tennessee Knoxville
Background: Laparoscopic ventral hernia repair is a commonly performed procedure. Metrics important to both patients and surgeons include pain control and length of stay. Length of stay is associated to increased costs and inversely associated with value. Decreasing opioid usage is part of a national health care initiative.
Methods: In an attempt to measure and improve outcomes, we implemented a clinical quality improvement (CQI) program for ventral hernia patients. From 2012 to 2018, consecutive laparoscopic ventral hernia repair patients from a single hernia program were evaluated. One initiative during this time period was the use of a long acting local anesthetic nerve block.
Results: A total of 112 patients underwent laparoscopic ventral hernia repair. The no block group comprised of 47 patients: 57% were female, mean age was 63, mean BMI was 35.6, and 60% had a recurrent hernia. The long acting local anesthetic block group comprised of 65 patients: 54% were female, mean age was 58, mean BMI was 35, and 51% had a recurrent hernia. The no block group had a larger hernia size (98 to 73 cm2) and mesh size (526 to 477 cm2). The no block group had a longer post anesthesia care unit time (172 to 110 min), and length of stay (4.4 to 2.5 days). Opioid usage was higher in the no block group in the post anesthesia care unit (12 to 7 mg morphine equivalents) and overall (116 to 53 mg morphine equivalents).
Conclusion: Long acting local anesthetic abdominal nerve blocks during laparoscopic ventral hernia repair were associated with decreased post anesthesia care unit time and length of stay. They were also associated with decreased opioid usage overall and in the post anesthesia care unit. Long acting local anesthetic abdominal nerve blocks were used as part of a CQI program to improve outcomes. As with any CQI analysis, other factors may have contributed to these outcomes and these results may be different in another local environment.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95833
Program Number: P581
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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