Preoperative transversus abdominis plane block decreases intraoperative opiate use during pancreaticoduodenectomy

Abstract

Presenter: Jorge G Zarate Rodriguez MD | Washington University, St. Louis Background: Due to the adverse effects associated with opioids and the ongoing epidemic of abuse of these medications, there has been an increased interest in decreasing the use of narcotic medication in the perioperative setting. Several adjuncts are routinely used, including preoperative dosing of multimodal analgesics and regional anesthesia with transversus abdominis plane (TAP) block, but the effect of these interventions on intraoperative opiate use is unknown. Of these adjuncts, we hypothesized that preoperative TAP block would be associated with decreased intraoperative opiate use. Methods: A retrospective review of patients undergoing pancreaticoduodenectomy (PD) from June 2018 to January 2021 was performed. Perioperative data, including operative time and medication administration were collected. Intraoperative opiate medications were used to calculate a total morphine equivalent dose (MED) for each patient and adjusted for operative time. Univariate analysis and multivariate linear regression were performed to determine factors affecting intraoperative opiate requirements. Results: 190 patients underwent PD during the study period, 9 patients received methadone intraoperatively and were excluded from analysis. 83 (45.9%) did not receive TAP blocks, 59 (32.6%) received TAP block at the start of surgery, and 39 (21.5%) at the end of surgery. As summarized in Table 1, the univariate analysis showed no statistically significant differences in intraoperative opiate use with preoperative acetaminophen (p = 0.291), celecoxib (p = 0.417), gabapentin (p = 0.392), or intraoperative ketorolac (p = 0.350) administration. Minimally invasive surgical approach compared to open (6.40 MED/hour versus 7.33 MED/hour, p = 0.065) and epidural placement (p = 0.515) also did not significantly affect intraoperative opiate use. While patients receiving preoperative TAP blocks had lower intraoperative opiate use compared to both patients without blocks and with postoperative blocks (5.95, 7.51, 7.89 MED/hour, p = 0.001). Multivariate linear regression demonstrated that preoperative TAP block was the only adjunct significantly associated with decreased intraoperative opiate use (p = 0.002). Conclusion: The use of preoperative TAP block was associated with decreased intraoperative narcotic use during pancreaticoduodenectomy and should be considered for routine use.