Larry M Deppe, MD, FACS1, Christopher A Kasal, MD, FACS1, David R Farley, MD, FACS2. 1Mayo Clinic Health System, 2Mayo Clinic Rochester
Introduction: Data suggests value in using TAP (transversus abdominis plane) neural blockade in abdominal surgical procedures. We deploy TAP blockade using liposomal bupivacaine via ultrasound (US) as part of a narcotic sparing pain management pathway for patients undergoing abdominal surgery in our rural community setting. Our goal was to evaluate adequacy of postoperative discomfort and the success in avoiding narcotic usage.
Methods and Procedures: Records of patients undergoing abdominal surgical procedures performed by one surgeon over an 18 month period were reviewed under IRB approval. Patients taking narcotics prior to the procedure (except for discomfort due to the condition being surgically treated) were excluded from analysis, as were those admitted to the hospital for postoperative treatment. US guided lateral TAP blocks were performed by the surgeon using 266 mg of liposomal bupivacaine and 50 mg of bupivacaine in the OR prior to the incision. Unilateral block was performed for unilateral procedures (e.g. inguinal hernia) and bilateral for laparoscopic or midline procedures. Incisional sites were treated with a field block of 50 mg of bupivacaine. Prescriptions for medications included 1,000 mg of acetaminophen QID and 220 mg of naproxen sodium TID for 7 days. A prescription for tramadol (50 to 100 mg PRN up to 4 times daily; 40 tablets with no refill) was given. Patients were seen in followup two weeks postoperatively.
Results: A total of 47 patients met criteria including 28 males and 19 females (mean age: 46, range: 21-80). Mean BMI was 30.5 (range: 19.0-50.5) and ASA classification was: 1=21%, 2= 69%, and 3=10%. Procedures included both laparoscopic (15 cholecystectomies, 7 appendectomies, and 8 ventral, 5 umbilical, and 2 inguinal hernia repairs with mesh) and open (9 inguinal hernia repairs with mesh and 1 mesenteric mass biopsy) procedures. There was one 30 day complication (port site hematoma treated non-operatively). One patient required narcotics on POD #3 (oxycodone was given); no other patients called with pain complaints. All patients reported adequate pain control during scheduled postoperative clinic visit.
Conclusion: Incorporating a surgeon performed US guided TAP block with an oral narcotic sparing protocol resulted in minimal need for oral narcotic prescriptions in patients undergoing abdominal surgery in a rural community hospital. Analysis of the cost, time away from work, and patient satisfaction with TAP blocks within this pathway will be under further review.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86882
Program Number: P355
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster