Surgeon-Placed Transversus Abdominis Plane Blocks versus Thoracic Epidurals in Open Gynecologic Oncology Cases: A Case-Control Study

Abstract

ObjectiveTo compare time in the operating room (OR) and pain control in patients after laparotomy who had either a surgeon-placed transversus abdominis plane (TAP) block or a thoracic epidural. MethodsThis was a retrospective case-control study. We performed chart review on open surgical patients from January 1, 2019 to October 15, 2021 who had either a surgeon-placed TAP block or thoracic epidural. We matched patients by incision type, pathologic diagnosis, and procedure performed. Thoracic epidurals at our institution are placed in the OR before the surgical case begins. ResultsWe matched 55 patients with a surgeon-placed TAP block (cases) to 55 patients with an epidural (controls). Cases spent less time in the OR before the surgical case started (median 54 vs 77 min, p<0.01), had similar lengths of surgery, and overall spent less total time in the OR (median 250 vs 284 min, p = 0.02). Patients with a TAP block had higher reported pain scores on postoperative day zero but thereafter pain scores were comparable. Total oral and intravenous oral morphine equivalents (OME) used did not differ between cases and controls intra- or postoperatively. Length of hospital stay was shorter for patients who had a TAP block (3 vs 4 days, p = 0.04). ConclusionA TAP block performed by the surgical team is easily performed and led to a reduction in total time spent in the OR, comparable perioperative opioid use, and shorter lengths of stay as compared to thoracic epidurals in our study population.