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P045: PREDICTORS OF POST-OPERATIVE PAIN AND NARCOTIC CONSUMPTION IN ROBOTIC-ASSISTED VENTRAL HERNIA REPAIR
Dane Thompson, MD1; Carina Zhang, BS2; David Lin, BS2; Samuel Abecassis, BA3; Siavash Bolourani, MD4; Gianosuke Sugiyama, MD5; 1Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Feinstein Institutes for Medical Research, North Shore University Hospital Department of Surgery; 2Donald and Barbara Zucker School of Medicine at Hofstra Northwell; 3North Shore University Hospital Department of Surgery; 4Feinstein Institutes for Medical Research; 5Donald and Barbara Zucker School of Medicine at Hofstra Northwell, North Shore University Hospital Department of Surgery
Introduction: Ventral hernia repair is a common procedure, traditionally performed open or laparoscopic, but robotic repairs are becoming more common. With the opioid crisis, reduction in pain medications needed postoperatively has become of paramount importance among surgeons. Multiple studies have shown peripheral nerve blocks to be effective in decreasing narcotic use in open and laparoscopic methods, but there is a lack of data regarding their effectiveness in robotic repairs. We aimed to determine whether perioperative peripheral nerve blocks correlate with reduced pain and narcotic requirements.
Methods: All patients undergoing robotic ventral hernia repair between January 2017 and February 2019 were compiled. Patients less than 18 years old, patients that underwent primary repair without mesh, and operations that were converted to open were excluded. 44 inpatient and 37 outpatient repairs were performed among the 81 total patients. Patient charts were retrospectively reviewed for demographic data, comorbidities, hernia type, anesthesia time, cut-to-close time, operating room time, PACU time, performance of lysis of adhesions and diastasis plication, mesh size, performance of peripheral nerve block and bupivacaine equivalents used, length of stay, pain, and milligram morphine equivalents (MME) required. Fisher’s exact testing and Mann-Whitney U test for continuous variables were used. Further statistics were performed with correlation matrix-based hierarchical clustering (CMBHC).
Results: There were no differences in demographics or comorbidities between the block and non-block groups when analyzed as all patient, inpatient, or outpatient cohorts. There was also no difference in pain at discharge from PACU, average pain, MME on the day of surgery, average MME per day, or total MME. Utilization of correlation-matrix-based hierarchical clustering (CMBHC) revealed the positive effects of peripheral nerve blocks. Specifically, the rectus sheath block was associated with lower average pain in two groups, all patients and all block patients. Also, the amount of bupivacaine administered was associated with fewer MME required in all patients groups. Total narcotic use was positively correlated with lysis of adhesions, mesh size, operative time, and total midline hernia. Additionally, average pain correlated positively with operative time within the cluster of inpatient procedures.
Conclusion: Performance of peripheral nerve block, specifically rectus sheath block, was associated with lower average pain in robotic ventral hernia repair. Decreased requirement of post-operative narcotics was correlated with increasing amounts of bupivacaine administered. Prospectively randomized controlled studies will be needed to determine the true efficacy of nerve blocks.
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