Thomas C Robertson, MD1, Kathryn Hall2, Susan Bear, PharmD1, Kyle Thompson, PhD1, Keith Gersin, MD1. 1Carolinas Medical Center, 2Virginia Tech
Introduction: Opioid-related deaths now outnumber vehicle-related deaths in the United States. The trajectory of opioid addiction usually begins with prescription opioid misuse. Identifying non-narcotic means to treat post-op pain is an intervention to limit patient exposure to opioids. The objectives of this study were to compare the effectiveness of a liposomal bupivacaine transverse abdominis plane (TAP) block to opioid-only patient controlled anesthesia (PCA) pain management in respect to total morphine equivalents received, lengths of stay, and post-operative pain scores following bariatric surgery.
Methods and Procedures: A single surgeon retrospective chart review was performed on 440 patients who underwent laparoscopic roux-en-y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (Sleeve) from 2010-2016. Patients were grouped according to those who received TAP blocks immediately pre-operatively and those who received PCA only. Total parenteral morphine equivalents (PME) were calculated for each patient. Pain scores were calculated immediately following surgery, 12 hours post-operatively, and on day of discharge. Median length of stay (LOS) and 30-day readmissions were determined.
Results: Patients with PCA pain management utilized more narcotics following RYGB (70.4±2.7 PME) and Sleeve (60.0±3.5) than those treated with pre-operative TAP block (26.5±1.5 and 24.1±2.0 PME) for RYGB and Sleeve respectively (p < .0001). Median LOS was 2.0 days for both PCA groups whereas LOS decreased to 1.0 day for both groups of patients receiving TAP blocks (p < .0001). 30-day readmissions were 7.5% (RYGB) and 4.9%(Sleeve) for PCA patients versus 6.6% (RYGB) and 0.95% (Sleeve) for TAP block patients (p = .1213). Pain scores immediately after surgery, 12 hours after surgery and prior to discharge were unchanged for PCA versus TAP block for both RYGB and Sleeve patients.
Conclusions: TAP blocks with liposomal bupivacaine lead to significantly less use of parenteral morphine equivalents. Length of stay is significantly less for patients who received a TAP block. Morbidly obese patients receiving liposomal bupivacaine TAP blocks have equivalent pain control and decreased length of stay compared to PCA alone.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85263
Program Number: S089
Presentation Session: Plenary 1 Session
Presentation Type: Podium