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OUTCOMES OF PAIN AND DISCHARGE COURSE FOLLOWING ULTRASOUND (US)- GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR PATIENTS UNDERGOING ABDOMINAL MYOMECTOMY
Abstract   Peer reviewed

OUTCOMES OF PAIN AND DISCHARGE COURSE FOLLOWING ULTRASOUND (US)- GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR PATIENTS UNDERGOING ABDOMINAL MYOMECTOMY

Prapti Singh, Haley Steffen, Karen M. Summers, Anita Chazhikattu, Rakesh Sondekoppam and Abey Eapen
Fertility and sterility, Vol.122(4 Supplement), pp.e396-e397
10/2024
DOI: 10.1016/j.fertnstert.2024.08.208

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Abstract

OBJECTIVE Transversus abdominis plane (TAP) block for gynecological surgeries has some proven efficacy, yet use of TAP medications with abdominal myomectomy has limited data (1-3). Therefore, we decided to compare outcomes of pain and discharge course following abdominal myomectomy with and without TAP block. MATERIALS AND METHODS We performed a retrospective case-control study in our institution (IRB approval - #20200328) with data from Apr 2022 to Feb 2024. Eligible patients were screened using ICD diagnoses code(s). TAP blocks were performed by regional anesthesia providers under US guidance using ropivacaine-0.25% 40 ml or 0.25%-bupivacaine 20 ml mixed with 20 ml of exparel (266 mg). Demographic data, operation duration(min), incision type, post-operative pain scores using the numerical rating scale (NRS 0-10) and medications given, complications, and hospital stay in days (d) were collected. Primary outcomes were median pain score on postoperative day 1 (POD#1) and duration of hospital stay. Secondary outcomes included total nausea or/and vomiting (N/V) events and rate of complications. Independent student t-test compared means (SD), and we utilized Chi-square or Fisher’s exact test for categorical factors and Mann Whitney U test for median values (IQR) for pain scores. RESULTS Of 67 eligible patients, 43 patients did not undergo TAP block, TAP (-), and 24 patients underwent TAP block, TAP (+). There was no difference in demographic data. Most patients self-reported Black race. There was no reduction in median pain scores between the two groups on POD#1 (p=.90). The duration of hospital stay was 2 d (p=.35). More dilaudid was used in the TAP (+) group (p=.03). There was no difference in postoperative N/V events or complications between groups (p=.745, p=.836, respectively, Table 1). CONCLUSIONS Our findings suggest that TAP block at the time of abdominal myomectomy does not reduce the post operative pain or duration of hospital stay. IMPACT STATEMENT Contrary to limited evidence showing improvement in pain, TAP block does not show significant benefits for recovery outcomes following abdominal myomectomy. Further prospective studies are warranted.

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