7737 Assessment of Interoperative Transverse Abdominis Plane (TAP) Block in Minimally Invasive Gynecologic Surgery

Abstract

<h3>Study Objective</h3> To assess whether an inter-operative transverse abdominis plane (TAP) block to provide analgesia is more effective than local anesthetic injection into trocar insertion sites during robotic gynecologic surgery. <h3>Design</h3> Retrospective chart review of patients undergoing robotic surgery (myomectomy, hysterectomy, and removal of endometriosis) with one surgeon between January and July 2021. <h3>Setting</h3> Academic hospital OR. <h3>Patients or Participants</h3> 109 patients underwent robotic surgery with median age (interquartile range, IQR) of 39 years (11.8) for the following indications: endometriosis (45.9%), fibroid uterus (50.5%), and other (3.6%). <h3>Interventions</h3> Patients undergoing robotic surgery received local injection of anesthetic into trocar insertion sites (control group) or a TAP block. <h3>Measurements and Main Results</h3> Of 109 patients, 54 (49.5%) were in the control and 55 (50.5%) were in the TAP block group. No significant differences in age, BMI, diagnosis, chronic pain status or ASA classification were found between groups. Incision time and length of PACU stay were not statistically different between groups (Table 1). In terms of pain management, the first and maximum pain scores in the PACU were the same in both groups. However, the median (IQR) morphine milligram equivalents used in the PACU for the TAP block group was 17.0 (11.5) compared with 12.5 (8.9) in the control group (p=0.04). <h3>Conclusion</h3> Our analysis demonstrates that performing TAP block in robotic gynecologic surgery cases did not significantly lengthen surgery time or affect patient reported pain scores, however it was associated with greater use of pain medication in the acute postoperative setting.