Key result
Postoperative administration of nonliposomal bupivacaine TAP block significantly reduced the need for postoperative PCA (59.1% vs 83.3%; p=0.012) compared to preoperative administration.
Why the study?
Enhanced recovery protocols optimize pain control via multimodal approaches including transversus abdominis plane blocks, but the effect of preoperative versus postoperative timing on narcotic use after colorectal surgery needed evaluation.
Does postoperative nonliposomal bupivacaine TAP block reduce postoperative narcotic use compared to preoperative TAP block in patients undergoing colorectal surgery?
Cohort (n=262)
No
Does postoperative nonliposomal bupivacaine TAP block reduce postoperative narcotic use compared to preoperative TAP block in patients undergoing colorectal surgery?
Absolute Event Rate: 59.1% vs 83.3%
p-value: p=0.012
Postoperative administration of nonliposomal bupivacaine TAP block is associated with significantly lower need for postoperative PCA and discharge narcotics compared to preoperative administration in colorectal surgery patients.
Postoperative TAP block was associated with lower PCA and discharge opioid needs; leaves open optimal timing for colorectal ERAS pending RCTs.
Background: Enhanced recovery protocols optimize pain control via multimodal approaches that include transversus abdominis plane (TAP) block. The aim of this study was to evaluate the effect of preoperative vs postoperative nonliposomal bupivacaine TAP block on postoperative narcotic use after colorectal surgery.Methods: A retrospective cohort study comparing postoperative narcotic use in patients who received preoperative (n = 240) vs postoperative (n = 22) nonliposomal TAP blocks. The study was conducted in a single tertiary care institution and included patients who underwent colorectal resections between August 2018 and January 2020. The study measured narcotics use in the postoperative and follow-up periods, operative details, length of stay, reoperation, and readmission rates.Results: Patients who received postoperative nonliposomal bupivacaine TAP blocks were less likely to require postoperative patient-controlled analgesia (PCA) (59.1% vs 83.3%; p = 0.012) and opioid medications on discharge (6.4% vs 16.9%; p = 0.004) relative to patients who received preoperative TAP. When needed, a significantly smaller amount of opioid was prescribed to the postoperative group (84.5 vs 32.0 mg, p = 0.047). No significant differences were noted in the duration of postoperative PCA use, amount of oral narcotic use, and length of stay.Conclusions: Nonliposomal bupivacaine TAP block administered postoperatively was associated with significantly lower need for postoperative PCA and discharge narcotics. Given the overall short length of stay for the 2 groups, further study is needed to justify the additional cost of liposomal bupivacaine TAP blocks for patients undergoing colorectal resections.
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Kalu et al. (2021) conducted a cohort in Postoperative pain after colorectal surgery (n=262). Postoperative nonliposomal bupivacaine TAP block vs. Preoperative nonliposomal bupivacaine TAP block was evaluated on Incidence of postoperative patient-controlled analgesia (PCA) use (p=0.012). Postoperative administration of nonliposomal bupivacaine TAP block significantly reduced the need for postoperative PCA (59.1% vs 83.3%; p=0.012) compared to preoperative administration.
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