Transversus Abdominis Plane Block Versus Local Anesthetic in Postoperative Abdominoplasty Patients on Pain Control

Abstract

The transversus abdominis plane (TAP) block provides analgesia to the parietal peritoneum as well as the skin and muscles of the anterior abdominal wall. These same muscles and skin are operated on during an abdominoplasty. The purpose of this study was to determine whether the use of the TAP block will lead to reduced use of narcotics during the acute postoperative (PO) period (PO day 1 and PO 1 week). The study used a prospective, comparative design. Twenty women between 25 and 65 years of age who underwent abdominoplasty with core liposuction were recruited to participate in this study. All women were given the same PO pain medication Percocet 7.5/325 mg (1-2 tabs by mouth Q4-6 hours PRN pain #20) and Valium 2 mg (1-3 tabs by mouth Q4-6 hours PRN pain #40) at the time of surgery. The women were randomly divided into 2 groups: 10 women received local anesthetic infiltrated along the rectus plication and along the edges of the incision and 10 women received a TAP block (15 cc of 0.25% Bupivacaine with 8 mg of Decadron per side) placed under ultrasound guidance prior to the start of the procedure in conjunction with the local anesthetic along the rectus plication. Each woman was asked to record the number of narcotic pills consumed during the first 24 hours and during the first week. Data from the 2 groups were compared to determine the number of narcotics consumed during the acute PO period. The mean age of participants was 43.8 years (range: 31-63 years) in the treatment group and 38.8 years (range: 26-56 years) in the control group. The mean number of narcotics used during the first 24 hours in the treatment group was 1.95 (1.5) pills, with several women requiring no narcotics within the first 24 hours. The mean number of narcotics used during the first 24 hours in the control group was 4.6 (2.3) pills. The mean number of narcotics used during the first PO week in the treatment group was 7.15 (7.26) pills, with several women requiring no narcotics during the first PO week. The mean number of narcotics used during the first PO week in the control group was 18.7 (7.7), with 1 woman requiring 38 narcotic pills during that first PO week. Statistically significant differences were found between groups ( P = .006) at 24 hours PO and ( P = .01) at 1 week. Our results suggested that receiving a TAP block prior to the start of the procedure significantly reduced the number of narcotics used during the acute PO period.