LAUSR

Study Objective To determine if liposomal bupivacaine TAP blocks affected perioperative opioid requirements and self-reported pain scores. Design Retrospective cohort study. Setting Academic tertiary care hospital. Patients or Participants Women undergoing laparoscopic hysterectomy for uteri >250g with contained tissue extraction via a 3-to 4cm umbilical incision. Interventions 70 laparoscopic hysterectomies over 250g were identified between July 1,2017 and February 15,2019; 30 were excluded. 40 were analyzed for outcomes (21control, 19 liposomal bupivacaine TAP). Measurements and Main Results Demographics including age, race, body mass index, preoperative diagnosis, procedure, complication rate, and pathology were similar between groups. Median estimated blood loss was 250cc for the control group and 300cc for the TAP group (p=0.85). Median uterine weight was 881g versus 781g (p=0.33). More than 50% of patients were discharged on day of surgery (13control, 9TAP). All opioids were converted to intravenous milligram morphine equivalents (MME). Median intraoperative opioid requirements were 24.02MME for the control group and 20.36MME for the TAP group (p=0.24). Median post-anesthesia care unit (PACU) requirements were 4.67MME versus 5.5MME (p=0.28). Among admitted patients, median inpatient requirements were 10.43MME versus 15MME (p=0.35), and median total hospital requirements were 40.7MME versus 37.95MME (p=0.93). Median opioids prescribed were 46.67MME versus 60MME (p=0.12), and zero patients in either group required a refill prescription. No difference was seen in pain scores between groups (maximum PACU, first inpatient, maximum inpatient, average inpatient, and last prior to discharge). Conclusion Conflicting evidence exists regarding efficacy of short acting anesthetic TAPs at laparoscopic hysterectomy. To the authors’ knowledge, only one prior study examined liposomal bupivacaine TAPs and no prior study assessed TAPs for contained tissue extraction via an extended umbilical incision. Liposomal bupivacaine TAPs do not appear to reduce perioperative opioid consumption nor improve postoperative pain scores. Its use should be weighed against operative time and increased cost.