Impact of liposomal bupivacaine transversus abdominal pain blocks compared to ropivacaine incision site infiltration after discharge: An observational prospective cohort quality improvement study.

BACKGROUND: Transversus abdominis plane(TAP) blocks can be considered as part of a multimodal post-operative pain management strategy. The aim of this study was to evaluate opioid use and pain after discharge in patients who underwent a minimally invasive hysterectomy or myomectomy with or without a TAP block. METHODS: In this prospective cohort quality improvement study from 11/1/2023-5/16/2024, patients who received TAP blocks using liposomal bupivacaine (+TAP) were compared to patients who received incision site infiltration with 0.2 % ropivacaine (no TAP). Patients were surveyed weekly to assess average pain scores, pain score at time of contact, and opioid use until no longer using opioids. RESULTS: 135 patients were included; 118 were contacted successfully. Of these, 89(75.4 %) received and 29(24.6 %) did not receive a TAP block. Average number of opioid pills used after surgery was 6.6(SD 7.1) for + TAP compared to 7.6(SD 6.7) no TAP. Mean pain score over the past week was similar between the two cohorts: 4.8(SD 1.9) + TAP and 4.7(SD 2.3) no TAP. Mean pain score at 1-week post-operative was also similar: 2.8(SD 1.9) + TAP and 2.4(SD 1.7) no TAP. Using a negative binomial regression model, there was no statistically significant association between + TAP block and opioids used, even when adjusting for operating time and a mini-laparotomy extraction site (relative risk = 0.85; 95 % confidence interval = 0.47-1.46). CONCLUSION: Patients who had TAP blocks with liposomal bupivacaine after minimally invasive hysterectomy or myomectomy had similar pain scores and opioid use after discharge as patients who received incision site infiltration with 0.2% ropivacaine.

Duke Scholars

Author Brittany A Davidson Obstetrics and Gynecology, Gynecologic Oncology

Author Craig Joseph Sobolewski Obstetrics and Gynecology, Minimally Invasive Gynecologic Su ...

Author Stephanie Lim Obstetrics and Gynecology, Minimally Invasive Gynecologic Su ...

Author Amy Nicole Broach Obstetrics and Gynecology, Minimally Invasive Gynecologic Su ...