Postoperative Opioids After Laparoscopic Hysterectomy With Transversus Abdominis Plane Block [2D]

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 133 Suppl 1; no. 1; p. 42S
• Main Authors: Krajick, Kayla Ann, Sullivan, Margaret Hancock
• Format: Journal Article
• Language: English
• Published: by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01-05-2019
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/01.AOG.0000558960.60784.a2

INTRODUCTION:Chronic pelvic pain after hysterectomy affects many women, predisposing them to opioid dependence. The amount of opioids consumed postoperatively can also predispose opioid dependence. Transversus abdominis plane (TAP) block is a non-opioid method to reduce postoperative pain. This study seeks to demonstrate the effectiveness of TAP block for total laparoscopic hysterectomy (TLH) patients in reducing postop pain and opioid consumption.
METHODS:This retrospective cohort study of women undergoing TLH at a single hospital was given exempt status by the Institutional Review Board. Chronic opioid users were excluded. Primary outcomes were opioid consumption within 24 hours postoperatively and amount of opioids prescribed at discharge. Secondary outcomes included pain scores averaged over 6-hour intervals within 24 hours postoperatively. T-test and chi-square analyses were performed.
RESULTS:This study included 49 women with TLH of whom 26 received a TAP block. The two groups were demographically similar. Women who received TAP block needed significantly less opioids within the first 24 hours postop (38.4 vs 65.9 morphine equivalents, P=.02). No significant differences were seen between the two groups in postoperative pain scores at 6-hour intervals, or in the amount of opioids prescribed at discharge.
CONCLUSION:Women undergoing TLH who received a TAP block required approximately half the amount of opioids for pain control within the first postoperative day. TAP block should be considered an effective adjunct for pain control after TLH to decrease the amount of postoperative opioid consumption, ultimately aiding in the prevention of chronic opioid use and opioid dependence.