Purpose: To determine if a transversus abdominis plane (TAP) block with liposomal bupivacaine reduces total postoperative opioid use in the first 72 hrs following laparoscopic or robotic hysterectomy compared to port-site infiltration with 0.25% bupivacaine. Methods: Patients received either a true TAP block procedure with 266 mg liposomal bupivacaine and 50 mg of 0.25% bupivacaine and sham port infiltration or sham TAP block procedure with true port-site infiltration with 100–125 mg of 0.25% bupivacaine. All patients had a standardized, scheduled, non-opioid pain management plan. The primary outcome was total IV morphine equivalents used in the first 72 hrs following surgery. Secondary outcomes included assessment of postoperative pain over the study period and quality of recovery measures. Results: Patients undergoing TAP blockade required fewer total opioid equivalents during the observation period than patients allocated to infiltration (median 21 versus 25 mg IV Morphine equivalents, P=0.03). Opioid use was highest in the first 24 hrs after surgery, with less difference between the groups during days 2 and 3 postoperatively. There were 5 in the TAP group and 0 in the infiltration group were opioid free at 72 hrs. Those in the TAP group had improved quality of recovery (QoR15) with no change in overall benefit of analgesia score. Conclusion: TAP blockade reduced the requirement for opioid pain medication in the first 72 hrs after surgery, had more patients opioid free at 72 hrs, and improved patients’ quality of their recovery.
Bibliographical noteFunding Information:
The authors would like to acknowledge Melissa Cohen (data collection), Britt Erickson (contributing surgeon and study design), Sally Mullany (contributing surgeon and study design), Colleen Rivard (contributing surgeon and study design), and Boris Winterhoff (contributing surgeon and study design) for their contributions to this study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Interim data from this work were presented at the 2017 European Society of Regional Anesthesia meeting on September 13-16, 2017 in Lugano, Switzerland.
© 2019 Hutchins et al.
- Acute pain
- Liposome bupivacaine
- Regional pain
- TAP block