title: Ultrasound guided subcostal transversus abdominis plane (TAP) infiltration with liposomal bupivacaine for patients undergoing robotic assisted hysterectomy: A prospective randomized controlled study.
abstract: BACKGROUND
  Optimal pain control after major surgery contributes to a patient's recovery and satisfaction. The use of liposomal bupivacaine in subcostal transversus abdominis plane (TAP) blocks for postoperative pain control after robot assisted abdominal surgery has yet to be studied.
  
  
  METHODS
  We conducted a prospective randomized controlled observer-blinded study comparing bilateral subcostal TAP blocks with bupivacaine to bilateral subcostal TAP blocks with liposomal bupivacaine. These were performed prior to the patient undergoing robot assisted hysterectomy. The patients' pain scores, opioid use, side effects, and satisfaction were followed for 72h after injection.
  
  
  RESULTS
  Total opioid use in the first 72h after injection was significantly decreased in the group that received liposomal bupivacaine compared to bupivacaine. Patients in the liposomal bupivacaine group had significantly lower maximal pain scores at all time periods studied as well as decreased incidence of nausea/vomiting. There was a trend toward decreased length of stay in the liposomal bupivacaine group.
  
  
  CONCLUSIONS
  Subcostal TAP blocks with liposomal bupivacaine decreased the total opioid requirement for the first 72h after robot assisted hysterectomy when compared to subcostal TAP blocks with bupivacaine.
authors.affiliation: Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Hutchins
authors.affiliation: Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Delaney
authors.affiliation: Masonic Cancer Center Biostatistics and Bioinformatics, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Rachel Isaksson
authors.initials: RI
authors.lastname: Vogel
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Rahel G
authors.initials: RG
authors.lastname: Ghebre
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Levi S
authors.initials: LS
authors.lastname: Downs
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Carson
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Mullany
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Teoh
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA. Electronic address: gelle005@umn.edu.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Geller
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008081:Liposomes / Q000008:administration & dosage; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine
keywords: Acute pain; Hysterectomy; Liposomal bupivacaine; Post-operative pain; Robotic; Transversus abdominis plane