Increased Same Day Discharge Rate After Laparoscopic Guided 4-Point Transversus Abdominis Plane Block for Robotic Assisted Gynecologic Procedures

Abstract

Study Objective To compare rates of same day discharge between four-point and two-point, laparoscopically guided transversus abdominis plane (TAP) blocks, for robotic-assisted gynecologic procedures. Design We performed a retrospective chart review from October 2017 to March 2019. All information from the surgical admission as well as postoperative follow up was reviewed. Data was compared to a similar cohort of patients who had received two-point TAP blocks. Setting All procedures were performed at one academic hospital. Patients or Participants 116 patients who underwent robotic-assisted gynecologic surgery, with administration of a four-point TAP block were included. Interventions A four-point TAP block was performed under laparoscopic visualization by the same surgeon after induction of anesthesia and immediately following placement of the laparoscope. 20 mL of Liposomal bupivacaine and 20 mL of 0.5% bupivacaine mixed with saline were used as the injectate for both groups. Measurements and Main Results 116 patients were included with a mean age of 40.6 (19-80) and a mean body mass index of 30.6 (17.2-53.3). 70.7 % of patients were discharged to home on the day of surgery. Of the 29.3% of patients who were admitted 20.6 % were due to pain control. Those who were admitted for pain control comprised 6.0% of all study participants. In the cohort who received the two-point TAP block, only 33.7% of patients were discharged home on the day of surgery which was significantly lower than the four-point cohort with a p value of Conclusion A surgeon performed TAP block, under laparoscopic visualization, is a safe and efficacious intervention to reduce postoperative pain thereby increasing same day discharge rate. In this study, patients who received a four-point TAP block had a higher rate of same-day discharge than those in the group who received the two-point TAP.