Effectiveness of transversus abdominis plane block during robotic-assisted endometrial cancer staging in decreasing immediate postoperative pain (557)

Abstract

Objectives: To assess the effectiveness of intraoperative transversus abdominis plane (TAP) block on immediate postoperative pain and morphine milligram equivalent (MME) use relative to local injection in patients undergoing robotic-assisted endometrial cancer staging. Methods: Patients undergoing robotic staging for endometrial cancer from April 1, 2017, to April 1, 2019, were eligible. Patients were excluded if they were converted to laparotomy. Patients received either local anesthesia prior to skin incision and trocar placement with 10 mL of 0.25% bupivacaine hydrochloride or an intraoperative TAP block with 20 mL of 1.3% bupivacaine liposome injectable solution under direct visualization per surgeon preference. Perioperative and patient information was collected from the EMR. Results: During the study period, 188 patients underwent robotic- assisted endometrial cancer staging. TAP block was used in 96 patients and local bupivacaine in 92 patients. The mean morphine milligram equivalent usage in the immediate 24 hours postoperative period (MME) for the TAP block cohort was 9.47 versus 10.52 with local anesthesia (NS). The mean immediate postoperative pain score (on a scale of 0-10) was 2.8 versus 3.8 (p=0.03) in favor of the TAP block. There were no significant demographic differences. Conclusions: Utilization of an intraoperative TAP block was associated with improved postoperative pain scores. There was no difference in the MME of opioid use compared to preoperative local anesthetic. Further evaluation of the cost-efficiency of TAP blocks is warranted. Objectives: To assess the effectiveness of intraoperative transversus abdominis plane (TAP) block on immediate postoperative pain and morphine milligram equivalent (MME) use relative to local injection in patients undergoing robotic-assisted endometrial cancer staging. Methods: Patients undergoing robotic staging for endometrial cancer from April 1, 2017, to April 1, 2019, were eligible. Patients were excluded if they were converted to laparotomy. Patients received either local anesthesia prior to skin incision and trocar placement with 10 mL of 0.25% bupivacaine hydrochloride or an intraoperative TAP block with 20 mL of 1.3% bupivacaine liposome injectable solution under direct visualization per surgeon preference. Perioperative and patient information was collected from the EMR. Results: During the study period, 188 patients underwent robotic- assisted endometrial cancer staging. TAP block was used in 96 patients and local bupivacaine in 92 patients. The mean morphine milligram equivalent usage in the immediate 24 hours postoperative period (MME) for the TAP block cohort was 9.47 versus 10.52 with local anesthesia (NS). The mean immediate postoperative pain score (on a scale of 0-10) was 2.8 versus 3.8 (p=0.03) in favor of the TAP block. There were no significant demographic differences. Conclusions: Utilization of an intraoperative TAP block was associated with improved postoperative pain scores. There was no difference in the MME of opioid use compared to preoperative local anesthetic. Further evaluation of the cost-efficiency of TAP blocks is warranted.