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P022: EQUIVALENT OUTCOMES FOR SURGEON-PERFORMED TRANSVERSUS ABDOMINIS PLANE BLOCKS FOLLOWING RETRORECTUS OR TRANSVERSUS ABDOMINIS RELEASE OPEN VENTRAL HERNIA REPAIRS
David J Morrell, MD; Justin A Doble, MD; Eric M Pauli, MD; Penn State Health Milton S. Hershey Medical Center
Introduction: Recovery protocols aim to limit narcotic administration following open ventral hernia repair (oVHR). One component of these protocols is transversus abdominis plane blocks (TAP-block). Intraoperative, surgeon-performed TAP-blocks provide superior analgesia to other locoregional modalities. It is unknown, however, if this method provides equivalent outcomes following oVHR with retrorectus (RR), unilateral transversus abdominis (uTAR), or bilateral transversus abdominis (bTAR) releases.
Objectives: Compare outcomes for surgeon-performed TAP-blocks following RR, uTAR, and bTAR oVHR.
Methods: Data prospectively collected between 2012-2019 was retrospectively analyzed. All patients undergoing oVHR with posterior component separation receiving bilateral surgeon-performed TAP-blocks with 266mg liposomal bupivacaine (Exparel, Pacira Biosciences, Inc.) were included. Patients were stratified by RR, uTAR, or bTAR oVHR. Correct TAP infiltration was confirmed by visualizing posterior bulging of the transversus abdominis muscle during injection. Outcome measures included pain scores, opioid requirements (converted to morphine milligram equivalents (MME)), length of stay (LOS), and 30-day morbidity.
Results: Ninety-nine patients met inclusion criteria (20 RR, 12 uTAR, 67 bTAR). There were no differences in demographics or comorbidities. LOS was similar between the groups (4.7 days RR, 3.7 days uTAR, 4.7 days bTAR; p=0.1053). Average patient-reported pain scores throughout LOS were equivalent (3.4 RR, 4.4 uTAR, 3.3 bTAR; p=0.1254) as was average MME per 24-hour period (107.7 RR, 126.0 uTAR, 145.3 bTAR; p=0.3802). There were no differences in 30-day morbidity, surgical site infection, or surgical site occurrence rates.
Conclusion: Despite accessing the TAP via differently visualized anatomic landmarks, surgeon-performed TAP-blocks result in equivalent outcomes following RR, uTAR, and bTAR oVHR. Patients report similar analgesia while using similar amounts of narcotic.
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