60. The association of transversus abdominis plane block with length of stay, pain and opioid consumption after anterior or lateral lumbar fusion: A retrospective study

Abstract

<h3>BACKGROUND CONTEXT</h3> Anterior (ALIF) and lateral (LLIF) lumbar interbody fusion is associated with significant postoperative pain, opioid consumption and length of stay (LOS). Transversus abdominis plane (TAP) blocks improve these outcomes in other surgical subtypes but have not been applied to spine surgery. <h3>PURPOSE</h3> To describe associations between TAP block and outcomes after ALIF/LLIF. <h3>STUDY DESIGN/SETTING</h3> A retrospective analysis of patients who underwent primary ALIF or LLIF at an orthopedic specialty hospital. <h3>PATIENT SAMPLE</h3> A total of 250 consecutive patients who underwent primary ALIF or LLIF between January 2016 and December 2019. <h3>OUTCOME MEASURES</h3> LOS, pain scores, opioid consumption and opioid-related side effects <h3>METHODS</h3> The electronic medical records of 129 patients who underwent ALIF or LLIF with TAP block were compared to 121 patients who did not. All patients were cared for under a standardized perioperative care pathway with comprehensive multimodal analgesia. Differences in patent demographics, surgical factors, LOS, opioid consumption, opioid-related side-effects and pain scores were compared in bivariable and multivariable regression analyses. <h3>RESULTS</h3> In bivariable analyses, TAP block was associated with a significantly shorter LOS, less postoperative nausea/vomiting, and lower opioid consumption in the post-anesthesia care unit (PACU). In multivariable analyses, TAP block was associated with significantly shorter LOS (β-12 hours, 95% CI (-22, -2 hours); p=0.021). Preoperative opioid use was a strong predictive factor for higher opioid consumption in the PACU, opioid use in the first 24 hours after surgery, and longer LOS. We did not find significant differences in pain scores at any times between the groups. <h3>CONCLUSIONS</h3> TAP block may represent an effective addition to pain management and opioid reducing strategies and improve outcomes after ALIF/LLIF. Prospective trials are warranted to further explore these associations. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.