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European Spine Journal
Published in: European Spine Journal 9/2019

01-09-2019 | Opioids | Original Article

Effects of a multimodal analgesic pathway with transversus abdominis plane block for lumbar spine fusion: a prospective feasibility trial

Authors: Ellen M. Soffin, Carrie Freeman, Alexander P. Hughes, Douglas S. Wetmore, Stavros G. Memtsoudis, Federico P. Girardi, Haoyan Zhong, James D. Beckman

Published in: European Spine Journal | Issue 9/2019

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Abstract

Purpose

Lumbar spine fusion with anterior (ALIF) or lateral (LLIF) approach is a moderately painful procedure associated with significant length of hospital stay (LoS) and opioid requirements. We developed an opioid-sparing analgesic pathway of care for ALIF and LLIF, featuring transversus abdominis plane (TAP) block. In this study, we assessed the feasibility of performing the TAP block as an analgesic adjunct for ALIF or LLIF.

Methods

This is a prospective feasibility study of 32 patients. All patients received pre-incisional TAP block, regularly scheduled non-opioid analgesics (gabapentin, acetaminophen, ketorolac), and oral tramadol, as needed. The primary feasibility outcomes were rates of recruitment, adherence and adverse events associated with the TAP block. Secondary outcomes included assessment of TAP block efficacy and duration, numeric rating scale (NRS) pain scores, LoS and opioid consumption.

Results

Thirty-three patients were approached for the study, and all were enrolled. One patient did not have surgery. All patients received the intervention. There were no block-related adverse events. PACU NRS scores were significantly lower (1.9 ± 3.0) than at postoperative day 1 (POD1; 3.3 ± 2.5). The TAP block was effective in 31/32 patients, with 1 failed block. Median LoS was 26.8 h (IQR 22.8–49.5 h). Median opioid consumption was 57.5 oral morphine equivalents (IQR 30–74.38). One patient required opioid iv patient-controlled analgesia.

Conclusions

Applying TAP block to spine surgery is a novel pain management strategy. This study demonstrates high patient acceptance and the general safety of the technique. Although lacking a control arm, these results also provide preliminary data supporting efficacy.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.
Appendix
Available only for authorised users
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Metadata
Title
Effects of a multimodal analgesic pathway with transversus abdominis plane block for lumbar spine fusion: a prospective feasibility trial
Authors
Ellen M. Soffin
Carrie Freeman
Alexander P. Hughes
Douglas S. Wetmore
Stavros G. Memtsoudis
Federico P. Girardi
Haoyan Zhong
James D. Beckman
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 9/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-019-06081-3

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