Cost-efficiency Analysis of USG-guided Transversus Abdominis Plane Blocks

Abstract

Detrimental effects of poorly controlled acute pain after abdominal surgery range from patient suffering, distress, respiratory complications, delirium, myocardial ischaemia, prolonged hospital stay and an increased likelihood of chronic pain. Traditionally, patients undergoing major abdominal surgery have received systemic drugs, such as opioids, ketamine, nonsteroidal anti-inflammatory drugs (NSAIDs), alpha-2 agonists and paracetamol or epidural analgesia as part of their postoperative pain management. Peripheral nerve blockade is an alternative means of providing analgesia, by anesthetising the sensory nerves conveying pain impulses from the incision site to the spinal cord and brain. The purpose of this study is to conduct a cost-effectiveness analysis of ultrasound (US) guidance for postoperative bilateral transversus abdominal plane (TAP) block vs landmark-guided epidural block in elective patients undergoing major gynaecologic oncological surgery. The hypothesis was that US guidance for TAP block is cost-effective compared with continuous epidural infusion in managing postoperative analgesia. Our study is the first health economic evaluation of USG guided TAP block vs landmark guided epidural block for the first 24 hours postoperatively. USG guided bilateral TAP blocks are more cost-effective than continuous epidurals in the first 24 hours postoperatively in patients undergoing midline laparotomy for gynaecologic oncologic surgeries. Thus, in patients with contraindications to epidural blocks can have them as a part of their multimodal analgesia plan.