Monica A Solis-Velasco1, Ana S Ore Carranza1, Kathryn A Stackhouse1, Koen Verkoulen2, Ammara A Watkins1, Vimal Akhouri3, Mark P Callery1, Tara S Kent1, A James Moser4. 1. Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA. 2. Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA; Surgery Department, Maastricht University Medical Center, Maastricht, Netherlands. 3. Anesthesiology Department, Beth Israel Deaconess Medical Center, Boston, MA, USA. 4. Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: ajmoser@bidmc.harvard.edu.
Abstract
BACKGROUND: Minimizing pain and disability are key postoperative objectives of robot-assisted distal pancreatectomy (RADP). This study tested effects of bupivacaine transversus abdominis plane (TAP) block on opioid consumption and pain after RADP. METHODS: Retrospective case-control study (June 2012 -Oct 2017) evaluating bilateral intraoperative bupivacaine TAP block as an interrupted time series. Linear regression evaluated opioid consumption in terms of intravenous (IV) morphine milligram equivalents (MME) and controlled for preoperative morbidity. Secondary outcomes included numerical rating scale (NRS) pain scores. RESULTS: 81 RADP patients met eligibility, 48 before and 33 after implementation of TAP. Baseline characteristics were equivalent with a trend toward higher age, Charlson comorbidity, and ASA score among the TAP cohort. TAP patients consumed on average 4.52 fewer IV MME than controls during the first six postoperative hours (p = 0.032) and reported lower mean NRS scores at six (p = 0.009) and 12 h (p = 0.006) but not at 24 h (p = 0.129). Postoperative morbidity and lengths of stay (LOS) were equivalent (5 vs. 6 days, p = 0.428). CONCLUSION: Bupivacaine TAP block was associated with significant reductions in opioid consumption and pain after RADP but did not shorten hospital LOS consistent with bupivacaine's limited half-life.
BACKGROUND: Minimizing pain and disability are key postoperative objectives of robot-assisted distal pancreatectomy (RADP). This study tested effects of bupivacaine transversus abdominis plane (TAP) block on opioid consumption and pain after RADP. METHODS: Retrospective case-control study (June 2012 -Oct 2017) evaluating bilateral intraoperative bupivacaine TAP block as an interrupted time series. Linear regression evaluated opioid consumption in terms of intravenous (IV) morphine milligram equivalents (MME) and controlled for preoperative morbidity. Secondary outcomes included numerical rating scale (NRS) pain scores. RESULTS: 81 RADP patients met eligibility, 48 before and 33 after implementation of TAP. Baseline characteristics were equivalent with a trend toward higher age, Charlson comorbidity, and ASA score among the TAP cohort. TAP patients consumed on average 4.52 fewer IV MME than controls during the first six postoperative hours (p = 0.032) and reported lower mean NRS scores at six (p = 0.009) and 12 h (p = 0.006) but not at 24 h (p = 0.129). Postoperative morbidity and lengths of stay (LOS) were equivalent (5 vs. 6 days, p = 0.428). CONCLUSION:Bupivacaine TAP block was associated with significant reductions in opioid consumption and pain after RADP but did not shorten hospital LOS consistent with bupivacaine's limited half-life.
Authors: Laura Horodyski; Brittany Ball; Clarence Emile; Adriana Rhodes; Feng Miao; Isildinha M Reis; Mara Z Carrasquillo; Joshua Livingstone; Christina Matadial; Chad R Ritch; Leslie A Deane Journal: J Robot Surg Date: 2021-04-15