P002: THE EFFICACY OF TRANSVERSUS ABDOMINIS PLANE BLOCK FOR ABDOMINAL HYSTERECTOMY POST-OPERATIVE ANALGESIA
Christina Dai1, Jeffrey Huang, MD2; 1University of Central Florida College of Medicine, 2Anesthesiologists of Greater Orlando
Introduction/Background: Abdominal hysterectomy is an open surgical procedure associated with considerable post-operative pain. Narcotics are often required during recovery but can result in adverse side effects. Transversus abdominis plane block (TAP block) is a regional anesthetic technique found to be an effective post-operative analgesia for many types of abdominal surgeries. However recent literature shows contradicting results regarding its analgesic effect on abdominal hysterectomy recovery. For 3 years, Winnie Palmer Hospital for Women & Babies (WPH) in Orlando, FL has been offering ultrasound-guided bilateral TAP block as an elective procedure to patients undergoing abdominal hysterectomies. This study further examined the role of TAP block in abdominal hysterectomy recovery, specifically its ability to reduce narcotic consumption and improve pain scores.
Methods: A single-center retrospective cohort study was performed on patients who underwent abdominal hysterectomy between 1/1/2015 and 12/31/2015. Exclusion criteria were: received a second surgery within the same hospitalization, experienced an in-hospital mortality event, received hysterectomy for known malignancy, stayed in hospital less than 24 hours, and whose charts contained missing data points
63 patient charts were reviewed in the study. 32 received TAP block and 31 did not. Data collected were: age, weight, height, BMI, length of hospital stay, total narcotic consumption (intra-operation, in the PACU, first 24 h after admittance, entire hospital stay, total PCA quantity, and total oral quantity). All narcotics were converted into parental morphine units for analysis. Numeric Rating Scale (NRS) pain scores at 2,4,8,12,16,20,24 hours after hospital admittance were collected. Two-tailed paired T-test was performed to compare the narcotic consumption and pain scores between the TAP block group and the non-TAP block group.
Results: A significant difference was observed in the PACU with the TAP block group consuming less narcotics than the non-TAP block group (p=0.012). However, no significant difference was observed between the TAP block group’s narcotic consumption and the Non-TAP block group’s consumption during: intra-operation, first 24 hours after admittance, and total hospital stay (p=0.419, p=0.533, p=0.754 respectively). VAS pain scores at all hours (2, 4, 8, 12, 16, 20, and 24) displayed no statistical difference between the two groups. Total patient controlled analgesia (PCA) and total overall oral narcotic usage all showed no statistically significant differences between both groups (p=0.252, 0.669 respectively). All demographics such as weight, height, and BMI were comparable between the two groups except for patient age. Length of hospital stay did not differ between the two groups.
Discussion/Conclusion: The results of this study demonstrated that while TAP block did reduce narcotic requirement in the PACU, it did not have superior analgesic efficacy after discharge from the PACU, nor reduce length of total hospital stay. Possible reasons suggested by the literature is the short effective period of TAP block’s analgesic ability (also reflected in this study), its lack of efficacy on visceral pain, and anatomical variations that prevent the spread of local anesthetics. These results suggest that TAP block may not be an effective strategy in improving the analgesic outcomes of patients undergoing abdominal hysterectomy.