Mp92-03 transversus abdominis plane blockade as part of a multimodal postoperative analgesia plan is associated with improved postoperative outcomes in radical cystectomy patients

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II1 Apr 2017MP92-03 TRANSVERSUS ABDOMINIS PLANE BLOCKADE AS PART OF A MULTIMODAL POSTOPERATIVE ANALGESIA PLAN IS ASSOCIATED WITH IMPROVED POSTOPERATIVE OUTCOMES IN RADICAL CYSTECTOMY PATIENTS Richard Matulewicz, Mehul Patel, Jacqueline Morano, Brendan Frainey, Yasin Bhanji, Anton Nader, Shilajit Kundu, and Joshua Meeks Richard MatulewiczRichard Matulewicz More articles by this author , Mehul PatelMehul Patel More articles by this author , Jacqueline MoranoJacqueline Morano More articles by this author , Brendan FraineyBrendan Frainey More articles by this author , Yasin BhanjiYasin Bhanji More articles by this author , Anton NaderAnton Nader More articles by this author , Shilajit KunduShilajit Kundu More articles by this author , and Joshua MeeksJoshua Meeks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2864AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Enhanced recovery protocols (ERP) after radical cystectomy (RC) focus heavily on GI recovery since prolonged postoperative ileus is associated with an increased risk of complications and longer length of stay (LOS). Recently, novel multimodal pain management plans have been used in conjunction with ERPs to either reduce the use of narcotics postoperatively or prevent their side effects. We examine the benefits of continuous transversus abdominis plane (TAP) blockade with a local anesthetic as part of a post-RC pain regiment. METHODS A retrospective comparison of consecutive patients undergoing RC over a 4-year period was conducted. Patients were designated as having RC during either the pre-TAP or TAP era. Patient demographics, operative details, and perioperative outcomes were compared between the two cohorts. Median days to flatus, bowel movement (BM), LOS, and narcotic usage (converted to milligrams of morphine equivalents) were compared using the Mann-Whitney Test. RESULTS In total, 171 patients were included: 100 pre-TAP and 71 TAP. There were no differences in age, smoking status, operative approach (robot vs. open), or urinary diversion type between the two cohorts. The TAP group had fewer men (69% vs. 83%, p=0.03) and more patients who received neoadjuvant chemotherapy (38% vs. 21%, p=0.015). The TAP cohort had significantly better GI recovery with shorter days to flatus (3 vs 4, p<0.001) and days to BM (4 vs. 5, p<0.001). There were no differences in need for NG tube or reoperation (Table 1). Overall, early (POD0-3), and daily narcotic use was significantly lower in the TAP patients: 62 vs. 297mg (p<0.001), 44 vs. 194mg (p=0.001), and 9.7 vs 30.9mg (p=0.001), respectively. Median LOS was significantly shorter in the TAP group (7 vs. 8.5d, p=0.002). CONCLUSIONS TAP blockade as part of a multimodal postoperative pain plan is safely associated with low narcotic usage, and significant improvement in time to flatus, BM, and LOS compared to traditional post-RC management. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1226-e1227 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Richard Matulewicz More articles by this author Mehul Patel More articles by this author Jacqueline Morano More articles by this author Brendan Frainey More articles by this author Yasin Bhanji More articles by this author Anton Nader More articles by this author Shilajit Kundu More articles by this author Joshua Meeks More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...