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

Jacob Hutchins, Peter Argenta, Aaron Berg, Jason Habeck, Alexander Kaizer, Melissa A Geller, Jacob Hutchins, Peter Argenta, Aaron Berg, Jason Habeck, Alexander Kaizer, Melissa A Geller

Abstract

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: TAP block; acute pain; liposome bupivacaine; regional pain.

Conflict of interest statement

J Hutchins is a speaker and consultant for, and has received research funds from Pacira Pharmaceuticals, he is a consultant for and owns stock with Insitu Biologics, he is also a consultant and speaker for Acel RX, a consultant for Worrell and Johnson and Johnson, speaker for Sonosite, and a consultant and speaker for, and has received research funds from Avanos. AB is a consultant for Avnanos and Pacira Pharmaceuticals inc. and reports personal fees from Pacira Pharmaceuticals Inc., Halyard Health, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
CONSORT flow diagram.

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