Transversus abdominis block utilizing liposomal bupivacaine as a non-opioid analgesic for postoperative pain management

IntroductionThe use of non-narcotic modalities for postoperative analgesia may decrease exposure to opioids, thereby limiting their deleterious effects. The objective of this study was to determine the effectiveness of a liposomal bupivacaine transverse abdominis plane (TAP) block prior to laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB). The primary outcome was total postoperative morphine equivalents.MethodsA single-surgeon, IRB-approved retrospective chart review was performed on consecutive patients who underwent LRYGB or LSG from 2010 to 2016. Patients were grouped according to those who received TAP blocks immediately preoperatively with rescue opioids (TAP group) and those who received PCA only (PCA group). Total parenteral morphine equivalents (PME) were calculated. Numerical pain scores were collected immediately following surgery, 12h postoperatively, and on the day of discharge. Median length of stay (LOS) and 30-day readmissions were also calculated.ResultsThere were 440 patients who met inclusion criteria. The TAP group had significantly less opioid use (total PME) than the PCA, irrespective of surgical approach (70.42.7 PCA LRYGB and 26.51.5 TAP block LRYGB, p value <= 0.0001; 60.0 +/- 3.5 PCA LSG vs. and 24.1 +/- 2.0 TAP block LSG, p value<0.0001). Median LOS was 2.0 days for both PCA groups, whereas LOS decreased to 1.0day for both groups of patients receiving TAP blocks (p<0.0001). Pain scores immediately following and 12h after surgery were significantly elevated in the TAP LRYGB versus PCA LRYGB (p<0.05) and immediately following surgery for PCA versus TAP block for LSG (p=0.0109).Conclusions TAP blocks with liposomal bupivacaine lead to significantly less use of parenteral morphine equivalents and decreased LOS compared to PCA alone. Pain scores were higher in the TAP LRYGB group compared to the LRYGB PCA group, with no differences in pain scores noted in the LSG groups. [GRAPHICS] .