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Ultrasound-guided subcostal transversus abdominis plane block with liposomal bupivacaine compared to bupivacaine infiltration for patients undergoing robotic-assisted and laparoscopic hysterectomy: a prospective randomized study

Authors Hutchins J, Argenta P, Berg A, Habeck J, Kaizer A, Geller MA

Received 8 November 2018

Accepted for publication 25 June 2019

Published 4 July 2019 Volume 2019:12 Pages 2087—2094


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Erica Wegrzyn

Jacob Hutchins,1 Peter Argenta,2 Aaron Berg,1 Jason Habeck,1 Alexander Kaizer,3 Melissa A Geller2

1Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA; 2Department of Obstetrics, Gynecology and Women’s Health, Minneapolis, MN, USA; 3Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA

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.

Keywords: acute pain, regional pain, TAP block, liposome bupivacaine

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