(440) Association of transversus abdominus plane block and postoperative opioid consumption following planned cesarean hysterectomy

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Brittany M. Hood, MD

Resident
Baylor Scott and White Health
Temple, Texas, United States

Coauthor(s)

JE

Jessica C. Ehrig, MD

Maternal Medical and Maternal Transport Director and Co-director of Labor & Delivery
Baylor Scott and White Health
Temple, Texas, United States
MH

Michael Hofkamp, MD

Baylor Scott and White Health
Temple, Texas, United States

Objective: The rate of placenta accreta spectrum is 1 in 272. To combat the opioid epidemic, alternative pain management strategies including multimodal analgesia have been investigated. We hypothesized that patients who underwent planned cesarean hysterectomy (C-HYST) who received a transversus abdominus plane (TAP) block would have lower 24-hour postoperative opioid consumption compared to patients who did not.

Study Design: Our IRB approved the study and waived informed consent. Patients with C-HYST who did not require postoperative mechanical ventilation at our hospital from July 1, 2014 to December 31, 2022 were eligible for inclusion. Our primary outcome was 24-hour postoperative opioid consumption. We converted opioid use to morphine milligram equivalents (MME). For p</span>atients with patient-controlled analgesia (PCA), the closest documented entry to 24 hours was used to calculate opioid consumption. Demographic, physical, and clinical data were recorded.

Results: Demographic and physical characteristics of patients with TAP block following C-HYST with (n=23) and without TAP block (n=26) were no different. Patients with TAP block following C-HYST had a 24-hour opioid consumption of 30.8 + 29.8 mg compared to 80.4 + 59.4 mg for patients without a TAP block (p< 0.001). Patients with PCA (n=12) had an average deviation in documentation from the 24-hour period of 41 minutes. For patients with TAP block, the average time from wound closure to TAP block was 69 minutes.

Conclusion: Patients with TAP block following C-HYST had statistically significant reductions in 24-hour opioid consumption compared to patients without TAP block. A limitation of this study was that patients without TAP block had statistically significant lower acetaminophen consumption compared to patients with TAP block. Increased acetaminophen administration may explain a modest decrease in opioid consumption but is unlikely to fully explain the magnitude of reduction observed in our study. Another limitation was imprecise data for patients with intravenous PCA. TAP blocks should be considered for patients who undergo C-HYST procedures.