Alexandra Argiroff, MD, John-Paul Bellistri, MD, Diego R Camacho, MD. Montefiore Medical Center
Background: The “Opioid Crisis” has taken over headlines with increasing public attention brought to the drastically increasing rates of addiction to prescription narcotics. In 2015, the American Society of Addiction Medicine reported 2 million Americans with an addiction to prescription pain relievers and a four-fold increase in overdose related deaths. In a medical setting, increased opiate use is associated with increased rates of delirium, ileus, urinary retention, and respiratory depression. These risks are increased in the obese/bariatric population. Transversus abdominis plane (TAP) block is a safe and effective approach to achieve optimum pain control. It reduces the use of opiates in patients undergoing major abdominal surgery. However, there is currently no data in the literature examining its use in the bariatric population. Our study examines the use of liposomal bupivacaine for TAP block in patients undergoing laparoscopic sleeve gastrectomy (LSG).
Methods: Sixteen patients undergoing LSG with TAP block were compared with historical cohort of sixteen patients undergoing LSG without TAP block (standard group). The primary outcome measured was post-operative in-hospital opiate use (morphine equivalents). Statistical analysis was performed using Student’s t test for continuous variables and Fisher’s exact test for categorical variables.
Results: Both groups were well matched in regards to BMI, age, and ASA class. There was a significant decrease in the post-operative use of opiates with the use of the TAP block (11.4mg in the TAP block group vs. 43mg in the standard group; p 0.00002). There was no difference in the mean length of stay between the two groups. There was an increase in the mean operative time with use of the TAP block (76 minutes in the TAP block group vs. 58 minutes in the standard group; p < 0.05)
|Value||TAP Block||Standard Care||p-value|
|Opiate Use (mg, SD)||11.43 (8.4)||43.03 (17.8)||0.00002|
|Length of Stay (days, SD)||1.625 (0.62)||1.18 (0.54)||0.54|
|Operative Time (minutes, SD)||75.56 (21.14)||57.62 (16.5)||0.01|
Conclusions: The use liposomal bupivacaine for TAP block provides substantial analgesia, allowing for significant reduction in post-operative opiate use in our bariatric patients. This can be an important adjunct in pain control for the bariatric population and aid in post-operative complication risk reduction.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87519
Program Number: P361
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster