EP376/#727 The effect of transversus abdominis plane block on postoperative opioid use in gynecologic oncology patients undergoing laparotomy with enhanced recovery after surgery (ERAS). (4th December 2022) - Black, Kristin
Abstract : Objectives: To characterize the effect of transversus abdominis plane (TAP) blocks on opioid use and pain score in the first 48 hours following laparotomy for gynecologic malignancy. Methods: This retrospective cohort study assessed patients who underwent laparotomy by gynecologic oncology service from 2016–2017, and in 2020. Patients on long-acting opioids were excluded. Data were abstracted from the electronic health record and ERAS Interactive Audit System. Opioid consumption was converted to oral morphine equivalent dose (MED) in milligrams. Maximum pain was reported from 0 -10 on visual analogue scale (VAS). Mean opioid use at 12, 24, and 48 hours postoperatively was compared between patients with TAP block to those without using t-test. Stratification by postoperative NSAID use was performed to adjust for confounding. Results: 671 patients were included, 555 had a TAP block, 116 did not. Opioid use was reduced in patients with TAP blocks compared to those patients without TAP blocks at 12 hours (27.7 vs 20.5 mg MED, p=0.006), 12–24 hours (19.3 vs 12.3 mg MED, p=0.0004), and 24–48 hours postoperatively (27.7 vs 15.4 mg MED, p<0.0001). There was no statistically significant difference in max pain score. Stratification demonstrated a reduction in opioid use at 12 hours (20.3 vs 34.8 mg, p=0.017), 12–24 hours (14.5 vs 32.3 mg, p<0.001), and 24–48 hours (18.7 vs 56.0 mg, p<0.001) in patients not receiving NSAIDs (n=99) but not in patients who received NSAIDs (n=572) (p=NS). Conclusions: TAP blocks significantly decreased opioid use in patients not receiving NSAIDs undergoing gynecologic oncology laparotomy on an ERAS protocol.