Display options
Cite
Stoner K, Preston MA, Mustain WC, et al. The Impact of Transversus Abdominis Plane Block Within an Enhanced Recovery After Surgery Protocol on Length of Stay. Dis Colon Rectum. 2021;64(3):313-318doi: 10.1097/DCR.0000000000001873.
Stoner, K., Preston, M. A., Mustain, W. C., Mizell, J. S., Mehaffey, G., & Laryea, J. A. (2021). The Impact of Transversus Abdominis Plane Block Within an Enhanced Recovery After Surgery Protocol on Length of Stay. Diseases of the colon and rectum, 64(3), 313-318. https://doi.org/10.1097/DCR.0000000000001873
Stoner, Kyle, et al. "The Impact of Transversus Abdominis Plane Block Within an Enhanced Recovery After Surgery Protocol on Length of Stay." Diseases of the colon and rectum vol. 64,3 (2021): 313-318. doi: https://doi.org/10.1097/DCR.0000000000001873
Stoner K, Preston MA, Mustain WC, Mizell JS, Mehaffey G, Laryea JA. The Impact of Transversus Abdominis Plane Block Within an Enhanced Recovery After Surgery Protocol on Length of Stay. Dis Colon Rectum. 2021 Mar 01;64(3):313-318. doi: 10.1097/DCR.0000000000001873. PMID: 33395140.
Copy Download .nbib Format: NLM
Share it on

Dis Colon Rectum. 2021 Mar 01;64(3):313-318. doi: 10.1097/DCR.0000000000001873.

The Impact of Transversus Abdominis Plane Block Within an Enhanced Recovery After Surgery Protocol on Length of Stay.

Diseases of the colon and rectum

Kyle Stoner, Michael A Preston, W Conan Mustain, Jason S Mizell, Gregory Mehaffey, Jonathan A Laryea

Affiliations

  1. Department of Anesthesia, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
  2. Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

PMID: 33395140 DOI: 10.1097/DCR.0000000000001873

Abstract

BACKGROUND: Multimodal, narcotic-sparing analgesic strategies are an important part of enhanced recovery after surgery protocols. Within such protocols, regional anesthetics have proven to be superior to narcotics.

OBJECTIVE: This study aimed to evaluate the impact of the transversus abdominis plane block within an enhanced recovery after surgery protocol on length of stay.

DESIGN: A retrospective analysis of patients who underwent colorectal surgery in 2015 to 2016 was completed. The primary end points for this analysis were total length of stay and total narcotics consumed during hospitalization. Length of stay and total narcotic use were compared for patients who received a transversus abdominis plane block versus those that did not.

DATA SOURCE: The data were obtained from the data warehouse of a university teaching hospital.

SETTINGS: This study took place at a university teaching hospital.

PATIENTS: The patients were 18 years or older.

MAIN OUTCOME MEASURES: The primary outcomes measured were length of stay and the total narcotics used.

RESULTS: A total of 347 patients underwent colorectal procedures under the enhanced recovery protocol. Among these, 186 (54%) received a transversus abdominis plane block. Overall, the mean length of stay was 5.8 days (SD ±5.6), and median length of stay was 4 days. These values compare to a mean length of stay of 9.6 days and median length of stay of 7 days before implementing the enhanced recovery protocol. Patients who received a transversus abdominis plane block had a mean length of stay of 5.1 days compared to 6.6 days for those who did not receive one (p < 0.01). Patients who received a transversus abdominis plane block consumed 736.5 morphine milligram equivalents of opioids compared to 1150.3 morphine milligram equivalents of opioid consumed by those without a transversus abdominis plane block (p < 0.05), a 36% decrease in opioid use. When comparing patients who had a mean length of stay of 4 days with those whose length of stay was >4 days, there was an 80% decrease in opioid use. The readmission rate was 7.8%.

LIMITATIONS: The lack of randomization of patients was a limitation of this study.

CONCLUSION: The use of transversus abdominis plane block in the setting of a well-structured enhanced recovery protocol was associated with a statistically significant decrease in length of stay by 1.5 days and a 36% decrease in narcotic use. See Video Abstract at http://links.lww.com/DCR/B432.

IMPACTO DE LA ANESTESIA DEL PLANO MUSCULAR DE LOS TRANSVERSOS ABDOMINALES EN LA ESTADA DENTRO UN PROTOCOLO ERAS: ANTECEDENTES:La estrategia analgésica multimodal que consume poco medicamento de tipo narcótico es parte importante en los protocolos de recuperación mejorada postoperatoria. Dentro de dichos protocolos, los anestésicos regionales han demostrado ser superiores a la administración de medicamentos narcóticos.OBJETIVO:Estudiar el impacto del bloqueo del plano muscular de los transversos del abdomen sobre la duración de la estadía dentro de un protocolo de recuperación mejorada postoperatoria.DISEÑO:Se realizó un análisis retrospectivo de los pacientes que se sometieron a cirugía colorrectal entre 2015-2016. Los criterios principales de valoración en el presente análisis fueron la duración total de la estadía y el total de medicamentos narcóticos consumidos durante la hospitalización. Se comparó la duración de la estadía y el uso total de narcóticos en los pacientes que recibieron un bloqueo anestésico del plano muscular de los transversos del abdomen con los que no lo recibieron.FUENTE DE DATOS:Banco de datos de un hospital universitario docente.AMBIENTE:Hospital Universitario Docente.PACIENTES:Adultos desde los 18 años o mayores.PRINCIPALES MEDIDAS DE RESULTADO:Duración de la estadía, cantidad total de medicamentos narcóticos administrados.RESULTADOS:Un total de 347 pacientes se sometieron a procedimientos colorrectales bajo el protocolo ERAS. Entre ellos, 186 (54%) recibieron un bloqueo del plano muscular de los transversos del abdomen. En la globalidad, la duración media de la estadía fué de 5,8 días (DE ± 5,6) y la duración media de la estadía fué de 4 días. Estos resultados fueron comparados con la estadía media de 9,6 días y una estadía media de 7 días antes de implementar el protocolo ERAS. Los pacientes que recibieron un bloqueo del plano muscular de los transversos del abdomen tuvieron una estadía media de 5,1 días en comparación con los 6,6 días de los que no recibieron el mencionado bloqueo (p <0,01). Los pacientes que recibieron el bloqueo del plano muscular consumieron 736,5 miligramos de morfina o su equivalente en opioides, comparados con los 1150,3 de aquellos sin bloqueo del plano muscular (p <0,05) lo que significó una disminución del 36% en la administración de opioides. Al comparar los pacientes que tuvieron una estadía media de 4 días con aquellos cuya estadía fue mayor a 4 días, se evidenció una disminución en el 80% de la administración de opioides. La tasa de reingreso fue del 7,8%.LIMITACIONES:Estudio sin sin aleatorización de pacientes.CONCLUSIÓN:El bloqueo anestésico del plano muscular de los transversos del abdomen dentro un contexto protocolar tipo ERAS o de recuperación mejorada bien estructurada, se asoció con la disminución estadísticamente significativa de la duración de la estadía en 1,5 días y una disminución del 36% en la administración de medicamentos narcóticos. Consulte Video Resumen en http://links.lww.com/DCR/B432.

Copyright © The ASCRS 2020.

References

  1. Tanious MK, Ljungqvist O, Urman RD. Enhanced recovery after surgery: history, evolution, guidelines, and future directions. Int Anesthesiol Clin. 2017; 55:1–11 - PubMed
  2. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017; 152:292–298 - PubMed
  3. Nelson G, Kiyang LN, Crumley ET, et al. Implementation of enhanced recovery after surgery (ERAS) across a provincial healthcare system: the ERAS Alberta Colorectal Surgery Experience. World J Surg. 2016; 40:1092–1103 - PubMed
  4. Camilleri M, Lembo A, Katzka DA. Opioids in gastroenterology: treating adverse effects and creating therapeutic benefits. Clin Gastroenterol Hepatol. 2017; 15:1338–1349 - PubMed
  5. Shafi S, Collinsworth AW, Copeland LA, et al. Association of opioid-related adverse drug events with clinical and cost outcomes among surgical patients in a large integrated health care delivery system. JAMA Surg. 2018; 153:757–763 - PubMed
  6. Cho JS, Kim HI, Lee KY, et al. Comparison of the effects of patient-controlled epidural and intravenous analgesia on postoperative bowel function after laparoscopic gastrectomy: a prospective randomized study. Surg Endosc. 2017; 31:4688–4696 - PubMed
  7. Johns N, O’Neill S, Ventham NT, Barron F, Brady RR, Daniel T. Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: a systematic review and meta-analysis. Colorectal Dis. 2012; 14:e635–e642 - PubMed
  8. Kim AJ, Yong RJ, Urman RD. The role of transversus abdominis plane blocks in enhanced recovery after surgery pathways for open and laparoscopic colorectal surgery. J Laparoendosc Adv Surg Tech A. 2017; 27:909–914 - PubMed
  9. Miller TE, Thacker JK, White WD, et al.; Enhanced Recovery Study Group. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg. 2014; 118:1052–1061 - PubMed
  10. Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014; 38:1531–1541 - PubMed
  11. Rao Kadam V, Van Wijk RM, Moran JI, Miller D. Epidural versus continuous transversus abdominis plane catheter technique for postoperative analgesia after abdominal surgery. Anaesth Intensive Care. 2013; 41:476–481 - PubMed
  12. Weiss E, Jolly C, Dumoulin JL, et al. Convulsions in 2 patients after bilateral ultrasound-guided transversus abdominis plane blocks for cesarean analgesia. Reg Anesth Pain Med. 2014; 39:248–251 - PubMed
  13. Shirozu K, Kuramoto S, Kido S, Hayamizu K, Karashima Y, Hoka S. Hematoma after transversus abdominis plane block in a patient with HELLP syndrome: a case report. A A Case Rep. 2017; 8:257–260 - PubMed
  14. New alert promotes safe use of opioids in hospitals. Jt Comm Perspect. 2012; 32:11–15 - PubMed
  15. Oderda GM, Gan TJ, Johnson BH, Robinson SB. Effect of opioid-related adverse events on outcomes in selected surgical patients. J Pain Palliat Care Pharmacother. 2013; 27:62–70 - PubMed

Substances

MeSH terms

Publication Types