Impact of transversus abdominis plane blocks versus non-steroidal anti-inflammatory on post-operative opioid use in ERAS ovarian cancer surgery
Autor: | Garrett M. Fitzmaurice, S.P. Bisch, Joni Kooy, Jill Nation, Pamela Chu, Prafull Ghatage, Sarah Glaze, Anna Cameron, Gregg Nelson |
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Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
medicine.drug_class Cohort Studies 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Transversus Abdominis Plane Block Humans Medicine Transversus abdominis Abdominal Muscles Retrospective Studies Ovarian Neoplasms Pain Postoperative business.industry Local anesthetic Proportional hazards model Opioid use Anti-Inflammatory Agents Non-Steroidal Confounding Obstetrics and Gynecology Nerve Block Retrospective cohort study Cytoreduction Surgical Procedures Middle Aged medicine.disease Surgery Analgesics Opioid Oncology 030220 oncology & carcinogenesis Female Enhanced Recovery After Surgery business Ovarian cancer |
Zdroj: | International Journal of Gynecologic Cancer. 29:1372-1376 |
ISSN: | 1525-1438 1048-891X |
DOI: | 10.1136/ijgc-2019-000724 |
Popis: | BackgroundTreatment of ovarian cancer often requires extensive surgical resection. The transversus abdominis plane (TAP) block has been utilized in benign gynecologic surgery to decrease post-operative pain and opioid use. We hypothesized that TAP blocks would decrease total opioid use in the first 24 hours and decrease length of stay following staging and cytoreductive surgery for ovarian cancer compared with either no local anesthetic or local wound infiltration alone.MethodsAll patients undergoing surgery for ovarian cancer from November 2016 to June 2017 were included in this retrospective cohort study. Median opioid use at 24, 48, and 72 hours post-operatively, as well as length of stay, were assessed. Multivariate median regression analysis was performed to adjust for potential confounders: post-operative non-steroidal anti-inflammatory drug (NSAID) usage, pre-operative opioid consumption, and extent of cytoreductive surgery. Length of stay was compared using Cox regression analysis.ResultsOne-hundred-and-twenty patients were included in the analysis. Eighty-two patients had a TAP block, while 38 did not. After adjusting for potential confounders there was no difference in median 24 hours opioid consumption (p=0.29) or length of stay (HR 0.95, p=0.78) between patients receiving TAP block compared with those without. After adjusting for potential confounders, patients receiving scheduled NSAIDs had a 2.6-fold greater likelihood of being discharged (pDiscussionPost-operative administration of NSAIDs, but not TAP block, was associated with a decrease in post-operative opioid use and length of stay following surgery for ovarian cancer. Further investigation into alternative regional anesthetics for Enhanced Recovery after Surgery (ERAS) protocols is warranted. |
Databáze: | OpenAIRE |
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