Transversus abdominis plane blocks with liposomal bupivacaine after open major hepatectomy is associated with reduced early patient-reported pain scores and opioid administration

Matthew C. Hernandez, Jason Panchamia, Eric J. Finnesgard, Jennifer L. Leiting, Bernardo Franssen, Humza Saleem, Michael L. Kendrick, David M. Nagorney, Mark Truty, Rory Smoot

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Opioid overprescription can contribute to suboptimal patient outcomes. Surgeon-performed transversus abdominis plane blocks appear to be associated with pain reduction. We compared the analgesic efficacy of surgeon-performed transversus abdominis plane blocks for major hepatectomy with or without concurrent neuraxial analgesia. Methods: We performed a single-institution review, assessing surgeon-performed transversus abdominis plane blocks for major hepatectomy during 2013–2016. The primary outcome was patient-reported pain (11-point numeric pain-rating scale) and the secondary outcome was opioid consumption. Independent factors predictive of pain control were identified using logistic regression and reported as odds ratios with 95% confidence intervals. Results: A total of 232 patients with a mean (± SD) age of 56.5 (±13.9) years; 51.7% were female. Operative duration, incision type, and American Society of Anesthesiologists score were similar between groups. The 24-hour pain score was decreased substantially in patients who received a transversus abdominis plane block compared with those who did not (3 [2–4] versus 5 [4–6], P =.001) and this decrease in pain sscore persisted at 48 hours (2 [1–2] versus 4 [4–5], P =.001). In patients who received a transversus abdominis plane block, there were decreasess in consumption of oral morphine equivalents at 24 hours (322 [± 18] versus 183 [± 15], P =.0001) and 48 hours (100 [± 11] versus 33 [± 9.4], P =.03) compared with those without transversus abdominis plane block respectively. Conclusion: In patients receiving a transversus abdominis plane block, early patient opioid consumption was decreased and utilization was predictive for improved pain control. Routine transversus abdominis plane block administration should be considered during major hepatectomy as a step toward curbing systematic reliance on opioids for pain management. A prospective study on the utility of transversus abdominis plane block in hepatectomy is warranted.

Original languageEnglish (US)
JournalSurgery (United States)
DOIs
StateAccepted/In press - Jan 1 2018

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Abdominal Muscles
Bupivacaine
Hepatectomy
Opioid Analgesics
Pain
Pain Management
Analgesia
Morphine
Analgesics
Logistic Models
Odds Ratio
Prospective Studies
Confidence Intervals

ASJC Scopus subject areas

  • Surgery

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Transversus abdominis plane blocks with liposomal bupivacaine after open major hepatectomy is associated with reduced early patient-reported pain scores and opioid administration. / Hernandez, Matthew C.; Panchamia, Jason; Finnesgard, Eric J.; Leiting, Jennifer L.; Franssen, Bernardo; Saleem, Humza; Kendrick, Michael L.; Nagorney, David M.; Truty, Mark; Smoot, Rory.

In: Surgery (United States), 01.01.2018.

Research output: Contribution to journalArticle

Hernandez, Matthew C. ; Panchamia, Jason ; Finnesgard, Eric J. ; Leiting, Jennifer L. ; Franssen, Bernardo ; Saleem, Humza ; Kendrick, Michael L. ; Nagorney, David M. ; Truty, Mark ; Smoot, Rory. / Transversus abdominis plane blocks with liposomal bupivacaine after open major hepatectomy is associated with reduced early patient-reported pain scores and opioid administration. In: Surgery (United States). 2018.
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abstract = "Background: Opioid overprescription can contribute to suboptimal patient outcomes. Surgeon-performed transversus abdominis plane blocks appear to be associated with pain reduction. We compared the analgesic efficacy of surgeon-performed transversus abdominis plane blocks for major hepatectomy with or without concurrent neuraxial analgesia. Methods: We performed a single-institution review, assessing surgeon-performed transversus abdominis plane blocks for major hepatectomy during 2013–2016. The primary outcome was patient-reported pain (11-point numeric pain-rating scale) and the secondary outcome was opioid consumption. Independent factors predictive of pain control were identified using logistic regression and reported as odds ratios with 95{\%} confidence intervals. Results: A total of 232 patients with a mean (± SD) age of 56.5 (±13.9) years; 51.7{\%} were female. Operative duration, incision type, and American Society of Anesthesiologists score were similar between groups. The 24-hour pain score was decreased substantially in patients who received a transversus abdominis plane block compared with those who did not (3 [2–4] versus 5 [4–6], P =.001) and this decrease in pain sscore persisted at 48 hours (2 [1–2] versus 4 [4–5], P =.001). In patients who received a transversus abdominis plane block, there were decreasess in consumption of oral morphine equivalents at 24 hours (322 [± 18] versus 183 [± 15], P =.0001) and 48 hours (100 [± 11] versus 33 [± 9.4], P =.03) compared with those without transversus abdominis plane block respectively. Conclusion: In patients receiving a transversus abdominis plane block, early patient opioid consumption was decreased and utilization was predictive for improved pain control. Routine transversus abdominis plane block administration should be considered during major hepatectomy as a step toward curbing systematic reliance on opioids for pain management. A prospective study on the utility of transversus abdominis plane block in hepatectomy is warranted.",
author = "Hernandez, {Matthew C.} and Jason Panchamia and Finnesgard, {Eric J.} and Leiting, {Jennifer L.} and Bernardo Franssen and Humza Saleem and Kendrick, {Michael L.} and Nagorney, {David M.} and Mark Truty and Rory Smoot",
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T1 - Transversus abdominis plane blocks with liposomal bupivacaine after open major hepatectomy is associated with reduced early patient-reported pain scores and opioid administration

AU - Hernandez, Matthew C.

AU - Panchamia, Jason

AU - Finnesgard, Eric J.

AU - Leiting, Jennifer L.

AU - Franssen, Bernardo

AU - Saleem, Humza

AU - Kendrick, Michael L.

AU - Nagorney, David M.

AU - Truty, Mark

AU - Smoot, Rory

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Opioid overprescription can contribute to suboptimal patient outcomes. Surgeon-performed transversus abdominis plane blocks appear to be associated with pain reduction. We compared the analgesic efficacy of surgeon-performed transversus abdominis plane blocks for major hepatectomy with or without concurrent neuraxial analgesia. Methods: We performed a single-institution review, assessing surgeon-performed transversus abdominis plane blocks for major hepatectomy during 2013–2016. The primary outcome was patient-reported pain (11-point numeric pain-rating scale) and the secondary outcome was opioid consumption. Independent factors predictive of pain control were identified using logistic regression and reported as odds ratios with 95% confidence intervals. Results: A total of 232 patients with a mean (± SD) age of 56.5 (±13.9) years; 51.7% were female. Operative duration, incision type, and American Society of Anesthesiologists score were similar between groups. The 24-hour pain score was decreased substantially in patients who received a transversus abdominis plane block compared with those who did not (3 [2–4] versus 5 [4–6], P =.001) and this decrease in pain sscore persisted at 48 hours (2 [1–2] versus 4 [4–5], P =.001). In patients who received a transversus abdominis plane block, there were decreasess in consumption of oral morphine equivalents at 24 hours (322 [± 18] versus 183 [± 15], P =.0001) and 48 hours (100 [± 11] versus 33 [± 9.4], P =.03) compared with those without transversus abdominis plane block respectively. Conclusion: In patients receiving a transversus abdominis plane block, early patient opioid consumption was decreased and utilization was predictive for improved pain control. Routine transversus abdominis plane block administration should be considered during major hepatectomy as a step toward curbing systematic reliance on opioids for pain management. A prospective study on the utility of transversus abdominis plane block in hepatectomy is warranted.

AB - Background: Opioid overprescription can contribute to suboptimal patient outcomes. Surgeon-performed transversus abdominis plane blocks appear to be associated with pain reduction. We compared the analgesic efficacy of surgeon-performed transversus abdominis plane blocks for major hepatectomy with or without concurrent neuraxial analgesia. Methods: We performed a single-institution review, assessing surgeon-performed transversus abdominis plane blocks for major hepatectomy during 2013–2016. The primary outcome was patient-reported pain (11-point numeric pain-rating scale) and the secondary outcome was opioid consumption. Independent factors predictive of pain control were identified using logistic regression and reported as odds ratios with 95% confidence intervals. Results: A total of 232 patients with a mean (± SD) age of 56.5 (±13.9) years; 51.7% were female. Operative duration, incision type, and American Society of Anesthesiologists score were similar between groups. The 24-hour pain score was decreased substantially in patients who received a transversus abdominis plane block compared with those who did not (3 [2–4] versus 5 [4–6], P =.001) and this decrease in pain sscore persisted at 48 hours (2 [1–2] versus 4 [4–5], P =.001). In patients who received a transversus abdominis plane block, there were decreasess in consumption of oral morphine equivalents at 24 hours (322 [± 18] versus 183 [± 15], P =.0001) and 48 hours (100 [± 11] versus 33 [± 9.4], P =.03) compared with those without transversus abdominis plane block respectively. Conclusion: In patients receiving a transversus abdominis plane block, early patient opioid consumption was decreased and utilization was predictive for improved pain control. Routine transversus abdominis plane block administration should be considered during major hepatectomy as a step toward curbing systematic reliance on opioids for pain management. A prospective study on the utility of transversus abdominis plane block in hepatectomy is warranted.

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