Timing of perioperative transversus abdominis plane block at the time of radical cystectomy does not affect perioperative outcomes.

Abstract

The transversus abdominis plane (TAP) block has been effective in providing adequate pain control, limiting opioid use, and improving perioperative outcomes in patients undergoing major abdominal surgeries. Little is known regarding the efficacy of preoperative (pre-incisional) versus postoperative TAP block in patients who undergo cystectomy. This is a retrospective study that reviewed all patients who underwent cystectomy between January 2011 and January 2020at a single institution. Patients were stratified into threecohorts: preoperative TAP block, postoperative TAP block, no TAP block. A multivariable linear regression model was constructed that assessed factors associated with total morphine milligram equivalents (MME) per hospital stay. In 463 patients, baseline characteristics were similar. There were 66(14.3%) patients who received a perioperative TAP block, 16 (24.2%) of whom received a preoperative TAP block. There were no significant differences in baseline factors. A TAP block was associated with lower MME used per day (41.8mg vs 53.1mg, p = 0.009) and per hospital stay (232mg vs 320.5mg, p = 0.001). The median MME per hospital stay and per day was lowest in the preoperative TAP cohort (194.0mg, p = 0.011 and 38.0mg, p = 0.042, respectively). On multivariable analysis of a subset of patients who received a TAP block, there was no significant difference in MME use in patients who received a preoperative vs postoperative TAP block (-84.8, p = 0.339). The use of TAP blocks was associated with lower MME use in the entire population; however, there was no difference in MME use when comparing preoperative and postoperative TAP blocks.