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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 1/2020

01-01-2020 | Ileus | Original Article

Implementation of liposomal bupivacaine transversus abdominis plane blocks into the colorectal enhanced recovery after surgery protocol: a natural experiment

Authors: Adam C. Fields, Scott G. Weiner, Luisa J Maldonado, Paul M. Cavallaro, Nelya Melnitchouk, Joel Goldberg, Matthias F. Stopfkuchen-Evans, Olesya Baker, Liliana G. Bordeianou, Ronald Bleday

Published in: International Journal of Colorectal Disease | Issue 1/2020

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Abstract

Background

Enhanced recovery after surgery (ERAS) programs are now standard of care for colorectal surgery. Efforts have been aimed at decreasing postoperative opioid consumption. The goal of this study is to evaluate the effect of liposomal bupivacaine transversus abdominis plane (TAP) blocks on opioid use and its downstream effect on rates of ileus and hospital length of stay (LOS).

Methods

We performed a retrospective pre- and postintervention time-trend analysis (2016–2018) of ERAS patients undergoing laparoscopic colorectal surgery at two academic medical centers within the same hospital system. The intervention was liposomal bupivacaine TAP blocks versus standard local infiltration with bupivacaine with a primary outcome of total morphine milligram equivalents (MME) administered within 72 h of surgery. Secondary outcomes included hospital LOS and rate of postoperative ileus.

Results

There were 556 patients included at the control hospital, and 384 patients were included at the treatment hospital. Patients at both hospitals were similar with regard to age, body mass index, comorbidities, and surgical indication. In an adjusted time-trend analysis, the treatment hospital was associated with a significant decrease in MME administered (– 15.9 mg, p = 0.04) and hospital LOS (– 0.8 days, p < 0.001). There was no significant decrease in the rate of ileus at the treatment hospital (– 6.9%, p = 0.08).

Conclusions

In a time-trend analysis, the addition of liposomal bupivacaine TAP blocks into the ERAS protocol resulted in significantly reduced opioid use and shorter hospital LOS for patients undergoing surgery at the treatment hospital. Liposomal bupivacaine TAP blocks should be considered for inclusion in the standard ERAS protocol.
Literature
1.
Ren L, Zhu D, Wei Y, Pan X, Liang L, Xu J, Zhong Y, Xue Z, Jin L, Zhan S, Niu W, Qin X, Wu Z, Wu Z (2012) Enhanced recovery after surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: A prospective randomized controlled trial. World J Surg 36:407–414CrossRef
2.
Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF et al (2001) Laparoscopy in combination with fast track multimodal management is the best strategy in patients undergoing colonic surgery. A randomized clinical trial (LAFA-study). Ann Surg 254(6):868–875CrossRef
3.
Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38:1531–1541CrossRef
4.
Varadhan KK, Neal KR, Dejong CHC, Fearon K, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29:434–440CrossRef
5.
Adamina M, Kehlet H, Tomlinson GA (2014) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149:830–840CrossRef
6.
Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46:851–859CrossRef
7.
Gustafsson UO, Scott MJ, Nygren HJ, Demartines N, Francis N, Rockall TA et al (2019) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS) society recommendations: 2018. World J Surg 43:659–695CrossRef
8.
Wilmore DW, Kehlet H (2001) Recent advances. Management of patients in fast track surgery. Clinical review. Br J Surg 322:473–476
9.
Wind J, Polle SW, Jin FK, Dejong CHC, Meyenfeldt MF, Ubbink DT et al (2006) Systemic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809CrossRef
10.
Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, Bohnert ASB, Kheterpal S, Nallamothu BK (2017) New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 152(6):e170504CrossRef
11.
Hanna MH, Jafari MD, Jafari F, Phelan MJ, Rinehart J, Sun C, Carmichael JC, Mills SD, Stamos MJ, Pigazzi A (2017) Randomized clinical trial of epidural compared with conventional analgesia after minimally invasive colorectal surgery. J Am Coll Surg 225:622–630CrossRef
12.
Pricolo VE, Fei P, Crowley S, Camisa V, Bonvini M (2018) A novel enhanced recovery protocol, combining multimodal analgesia with liposomal bupivacaine and pharmacologic intervention, reduces parenteral opioid use and hospital length of stay after colectomy – a cohort study. Int J Surg Open 13:24–28CrossRef
13.
Felling DR, Jackson MW, Ferraro J, Battaglia MA, Albright JJ, Wu J et al (2018) Liposomal bupivacaine transversus abdominis plane block versus epidural analgesia in a colon and rectal surgery enhanced recovery pathway: a randomized clinical trial. Dis Colon Rectum 61(10):1196–1204CrossRef
14.
Knudson RA, Dunlavy PW, Franko J, Raman SR, Kraemer SR (2016) Effectiveness of liposomal bupivacaine in colorectal surgery: A pragmatic nonsponsored prospective randomized double blinded trial in a community hospital. Dis Colon Rectum 59(9):862–869CrossRef
15.
Torgeson M, Kileny J, Pfeifer C, Narkiewicz L, Obi S (2018) Conventional epidural vs transversus abdominis plane block with liposomal bupivacaine: A randomized trial in colorectal surgery. J Am Coll Surg 227(1):78–83CrossRef
16.
Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L et al (2017) Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surg Endosc 31:3412e3436CrossRef
17.
Stokes AL, Adhikary SD, Quintili A, Puleo F, Choi CS, Hollenbeak CS, Messaris E (2017) Liposomal bupivacaine use in transversus abdominis plane blocks reduces pain and postoperative intravenous opioid requirement after colorectal surgery. Dis Colon Rectum 60:170–177CrossRef
18.
Oh TK, Lee SJ, Do SH, Song IA (2018) Transversus abdominis plane block using a short-acting local anesthetic for postoperative pain after laparoscopic colorectal surgery: a systematic review and meta-analysis. Surg Endosc 32:545–552CrossRef
19.
Keller DS, Ermlich BO, Schiltz N, Champagne BJ, Reynolds HL, Stein SL et al (2014) The effect of transversus abdominis plane blocks on postoperative pain in laparoscopic colorectal surgery: a prospective, randomized, double-blind trial. Dis Colon Rectum 57:1290–1297CrossRef
20.
Pedrazzani C, Menestrina N, Moro M, Brazzo G, Mantovani G, Polati E, Guglielmi A (2016) Local wound infiltration plus transversus abdominis plane (TAP) block versus local wound infiltration in laparoscopic colorectal surgery and ERAS program. Surg Endosc 30:5117–5125CrossRef
21.
Walter CJ, Maxwell-Armstrong C, Pinkney TD, Conaghan PJ, Bedforth N, Gornall CB, Acheson AG (2013) A randomized controlled trial of the efficacy of ultrasound-guided transversus abdominis plane (TAP) block in laparoscopic colorectal surgery. Surg Endosc 27:2366–2372CrossRef
22.
Keller DS, Ermlich BO, Delaney CP (2014) Demonstrating the benefits of transversus abdominis plane blocks on patient outcomes in laparoscopic colorectal surgery: review of 200 consecutive cases. J Am Coll Surg 219:1143–1148CrossRef
23.
Favuzza J, Brady K, Delaney CP (2013) Transversus abdominis plane blocks and enhanced recovery pathways: making the 23-h hospital stay a realistic goal after laparoscopic colorectal surgery. Surg Endosc 27:2481–2486CrossRef
24.
Conaghan P, Maxwell-Armstrong C, Bedforth N, Gornall C, Baxendale B, Hong L, Carty HM, Acheson AG (2010) Efficacy of transversus abdominis plane blocks in laparoscopic colorectal resections. Surg Endosc 24:2480–2484CrossRef
25.
Park JS, Choi GS, Kwak KH, Jung H, Jeon Y, Park S et al (2015) Effect of local wound infiltration and transversus abdominis plane block on morphine use after laparoscopic colectomy: a nonrandomized, single-blind prospective study. J Surg Res 195:61–66CrossRef
26.
Niraj G, Kelkar A, Hart E, Horst C, Malik D, Yeow C, Singh B, Chaudhri S (2014) Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, noninferiority trial. Anaesthesia 69:348–355CrossRef
Metadata
Title
Implementation of liposomal bupivacaine transversus abdominis plane blocks into the colorectal enhanced recovery after surgery protocol: a natural experiment
Authors
Adam C. Fields
Scott G. Weiner
Luisa J Maldonado
Paul M. Cavallaro
Nelya Melnitchouk
Joel Goldberg
Matthias F. Stopfkuchen-Evans
Olesya Baker
Liliana G. Bordeianou
Ronald Bleday
Publication date
01-01-2020
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 1/2020
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-019-03457-1

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