Ali Mahmood, MD1, Charisma Gajula2. 1Houston Methodist Hospital – Sugar Land; Texas A&M University Health Sciences Center; Baylor College of Medicine, 2Houston Methodist Hospital – Sugar Land
Introduction: Surgery remains the mainstay of management for the majority of colon cancer. Newer surgical techniques aim to improve postoperative pain and recovery process. The purpose of our study was to study two different pharmacologic agents used in Transversus Abdominis Plane (TAP) blocks and evaluate their efficacy is augmenting postoperative pain control.
Methods and Procedures: 20 consecutive patients that had a biopsy proven colon adenoma or adenocarcinoma following colonoscopy were included in our study. The first 10 (cohort 1) successfully underwent laparoscopic segmental colon resections. Their postoperative pain was augmented with a TAP block using On-Q pain pump catheter, administering ropivacaine at 12 cc/hr. The next 10 patients (cohort 2) underwent successful laparoscopic colectomies and had their pain management augmented with Exparel (bupivacaine liposome injectable solution).
Each patient received a PCA (patient controlled analgesia) pump with hydromorphone with identical parameters.
The amount of PCA narcotic administered was measured over the immediate 20 hours post surgery. The number of attempts to self-administer pain medication was also measured. The amount/frequency of breakthrough narcotic medication administered was also recorded. Patient length of stay (LOS) in the hospital was recorded.
Results: There were 20 consecutive patients that were included in our study. Cohort 1 consisted of 10 patients. The average BMI was 31.6 and average length of surgery was 120 minutes. The number of PCA attempts was 437, with an average administration of 6.74 mg of hydromorphone dispensed. The LOS was 4 days. Cohort 2 consisted of 10 patients. The average BMI was 31.8. The average operation lasted 120 minutes. The number of PCA attempts was 468, with an average administration of 6.64 mg of hydromorphone. The average LOS was 3.8 days.
Conclusion: Poor pain management can lead to patients not wanting to get out of bed, perform their incentive spirometry or take an active role in their care. TAP blocks provide yet another method of reducing postoperative pain. From our study, we conclude that there is not any statistical difference in using On-Q versus Exparel techniques. The advantage of On-Q pain pump catheters, it that it does allow for the medication of be given in a bolus form, or titrated to the benefit of the patient. On-Q, however, cannot be given pre-operatively, and it involves two foreign bodies that the patient has placed in their abdomen. Exparel, can be given in the pre-op setting, and involves single time injections, without indwelling catheters.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77639
Program Number: P322
Presentation Session: Poster (Non CME)
Presentation Type: Poster
