Transversus Abdominus Plane Block Reduces Postoperative Opioid Requirements After Laparoscopic Cholecystectomy
*Kiara Jeffrey, *Angela E Thelen, *Angelina Dreimiller, Kevin M El-Hayek
MetroHealth, Cleveland, OH
OBJECTIVE(S): Evidence demonstrates surgeons directly contribute to the over-prescription of opioids. Alternative postoperative pain management strategies are necessary to reduce opioid dispensation and combat the current opioid epidemic. We set out to examine the effectiveness of a laparoscopic transversus abdominus plane (TAP) block on reducing postoperative opioid requirements after laparoscopic cholecystectomy.
METHODS: In a retrospective cohort analysis, we compared opioid na´ve patients who underwent an outpatient elective laparoscopic cholecystectomy with a TAP block (LC+TAP) to patients who underwent a laparoscopic cholecystectomy alone (LC) between January 2018 - June 2021 at a single institution. Patient demographics, comorbidities, and perioperative pain scores and pain medication requirements were compared between the cohorts.
RESULTS: There were 200 patients included in the study, with 100 patients in the LC+TAP cohort and 100 patients in the LC cohort. Patient demographics, comorbidities, and preoperative pain scores were similar apart from BMI, which was higher in the LC+TAP group (mean=33.1 kg/m2 vs. 30.9 kg/m2, p=0.047). Average initial pain scores in the post-anesthesia care unit (PACU) were equivalent between groups (LC+TAP, 3.39 vs. LC, 4.17, p=0.12), with mean total PACU opioid requirements significantly lower in LC+TAP patients (12.1 oral morphine equivalents (OME) vs. 20.4 OME, p<0.001). As shown in the figure, while LC+TAP patients were prescribed fewer opioids upon discharge (mean 77.5 OME vs. 92.9 OME, p=0.011), at follow-up appointment LC+TAP patients reported using a lower proportion of their opioid prescription (83.2% vs. 100%, p<0.001). Of the LC+TAP patients, 65% reported using over the counter pain medications compared to 82% of LC patients (p<0.001). There were no differences in intraoperative or 30-day postoperative complication rates, 30-day readmissions, or 30-day emergency department visits.
CONCLUSIONS: Performing a TAP block during elective laparoscopic cholecystectomy is a safe and effective strategy to reduce postoperative opioid requirements for the treatment of acute postoperative pain. Future research is warranted to further investigate the potential of a TAP block to reduce postoperative opioid requirements across a broader range of procedures.
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