title: Efficacy of transversus abdominis plane block with liposomal bupivacaine during open abdominal wall reconstruction.
abstract: BACKGROUND
  Transversus abdominis plane block (TAPb) is an analgesic adjunct used for abdominal surgical procedures. Liposomal bupivacaine (LB) demonstrates prolonged analgesic effects, up to 72 hours. We evaluated the analgesic efficacy of TAPb using LB for patients undergoing open abdominal wall reconstruction (AWR).
  
  
  METHODS
  Fifty patients undergoing AWR with TAPb using LB (TAP-group) were compared with a matched historical cohort undergoing AWR without TAPb (control group). Outcome measures included postoperative utilization of morphine equivalents, numerical rating scale pain scores, time to oral narcotics, and length of stay (LOS).
  
  
  RESULTS
  Cohorts were matched demographically. No complications were associated with TAPb or LB. TAP-group evidenced significantly reduced narcotic requirements on operative day (9.5 mg vs 16.5 mg, P = .004), postoperative day (POD) 1 (26.7 mg vs 39.5 mg, P = .01) and POD2 (29.6 mg vs 40.7 mg, P = .047) and pain scores on operative day (5.1 vs 7.0, P <.001), POD1 (4.2 vs 5.5, P = .002), and POD2 (3.9 vs 4.8, P = .04). In addition, TAP-group demonstrated significantly shorter time to oral narcotics (2.7 days vs 4.0 days, P <.001) and median LOS (5.2 days vs 6.8 days, P = .004).
  
  
  CONCLUSIONS
  TAPb with LB demonstrated significant reductions in narcotic consumption and improved pain control. TAPb allowed for earlier discontinuation of intravenous narcotics and shorter LOS. Intraoperative TAPb with LB appears to be an effective adjunct for perioperative analgesia in patients undergoing open AWR.
authors.affiliation: Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Fayezizadeh
authors.affiliation: Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Arnab
authors.initials: A
authors.lastname: Majumder
authors.affiliation: Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Ruel
authors.initials: R
authors.lastname: Neupane
authors.affiliation: Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Elliott
authors.affiliation: Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA. Electronic address: yuri.novitsky@uhhospitals.org.
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation* / Q000601:surgery; D061645:Abdominoplasty / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine
keywords: Abdominal wall reconstruction; Hernia repair; Liposomal bupivacaine; Narcotic consumption; Pain reduction; Transversus abdominis plane block