Transversus Abdominis Plane Block Improves Perioperative Outcome After Esophagectomy Versus Epidural

Gal Levy, Mark A. Cordes, Alexander S. Farivar, Ralph W. Aye, Brian E. Louie

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Pain control is challenging during esophagectomy. An epidural is commonly used, but the sympathetic blockade can have unintended consequences such as hypotension or delayed return of bowel function. A transversus abdominis plane (TAP) block has the potential to control upper abdominal pain without these adverse consequences. We aimed to compare bilateral TAP blocks with patient-controlled analgesia (PCA) for immediate management after esophagectomy with a cohort using a thoracic (T5 to T8) epidural. Methods This was a retrospective review of patients undergoing esophagectomy between 2012 and 2016. Primary outcomes were pain scores (0 to 10) assessed at 24, 48, and 72 hours for adequacy of pain control. Secondary outcomes were volume resuscitation at 72 hours, hypotension (systolic blood pressure <90 mm Hg), length of stay (LOS), return of bowel function, and complications. Results Sixty-one patients underwent esophagectomy using bilateral TAP block and PCA (n = 32) or thoracic (T5 to T8) epidural (n = 29). Overall pain scores were not statistically different between the TAP group and the epidural group averaged over 72 hours (4.98 versus 4.39, p = 0.09). During the initial 72 hours after operation, hypotension was less prevalent in the TAP group (25% versus 76%, p < 0.05) with lower crystalloid resuscitation needs. The LOS in the intensive care unit (3.2 days versus 4.6 days, p < 0.05) and return of bowel function (5 days versus 6.7 days, p < 0.05) were considerably shorter in the TAP group. Pulmonary complications were similar. Conclusions TAP blocks with a PCA is an alternative option for pain control in patients undergoing esophagectomy and may reduce hypotension and need for volume resuscitation with similar pulmonary complications.

Original languageEnglish (US)
Pages (from-to)406-412
Number of pages7
JournalAnnals of Thoracic Surgery
Volume105
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Fingerprint

Abdominal Muscles
Esophagectomy
Patient-Controlled Analgesia
Hypotension
Pain
Resuscitation
Length of Stay
Thorax
Blood Pressure
Lung
Abdominal Pain
Intensive Care Units

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Transversus Abdominis Plane Block Improves Perioperative Outcome After Esophagectomy Versus Epidural. / Levy, Gal; Cordes, Mark A.; Farivar, Alexander S.; Aye, Ralph W.; Louie, Brian E.

In: Annals of Thoracic Surgery, Vol. 105, No. 2, 01.02.2018, p. 406-412.

Research output: Contribution to journalArticle

Levy, Gal ; Cordes, Mark A. ; Farivar, Alexander S. ; Aye, Ralph W. ; Louie, Brian E. / Transversus Abdominis Plane Block Improves Perioperative Outcome After Esophagectomy Versus Epidural. In: Annals of Thoracic Surgery. 2018 ; Vol. 105, No. 2. pp. 406-412.
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N2 - Background Pain control is challenging during esophagectomy. An epidural is commonly used, but the sympathetic blockade can have unintended consequences such as hypotension or delayed return of bowel function. A transversus abdominis plane (TAP) block has the potential to control upper abdominal pain without these adverse consequences. We aimed to compare bilateral TAP blocks with patient-controlled analgesia (PCA) for immediate management after esophagectomy with a cohort using a thoracic (T5 to T8) epidural. Methods This was a retrospective review of patients undergoing esophagectomy between 2012 and 2016. Primary outcomes were pain scores (0 to 10) assessed at 24, 48, and 72 hours for adequacy of pain control. Secondary outcomes were volume resuscitation at 72 hours, hypotension (systolic blood pressure <90 mm Hg), length of stay (LOS), return of bowel function, and complications. Results Sixty-one patients underwent esophagectomy using bilateral TAP block and PCA (n = 32) or thoracic (T5 to T8) epidural (n = 29). Overall pain scores were not statistically different between the TAP group and the epidural group averaged over 72 hours (4.98 versus 4.39, p = 0.09). During the initial 72 hours after operation, hypotension was less prevalent in the TAP group (25% versus 76%, p < 0.05) with lower crystalloid resuscitation needs. The LOS in the intensive care unit (3.2 days versus 4.6 days, p < 0.05) and return of bowel function (5 days versus 6.7 days, p < 0.05) were considerably shorter in the TAP group. Pulmonary complications were similar. Conclusions TAP blocks with a PCA is an alternative option for pain control in patients undergoing esophagectomy and may reduce hypotension and need for volume resuscitation with similar pulmonary complications.

AB - Background Pain control is challenging during esophagectomy. An epidural is commonly used, but the sympathetic blockade can have unintended consequences such as hypotension or delayed return of bowel function. A transversus abdominis plane (TAP) block has the potential to control upper abdominal pain without these adverse consequences. We aimed to compare bilateral TAP blocks with patient-controlled analgesia (PCA) for immediate management after esophagectomy with a cohort using a thoracic (T5 to T8) epidural. Methods This was a retrospective review of patients undergoing esophagectomy between 2012 and 2016. Primary outcomes were pain scores (0 to 10) assessed at 24, 48, and 72 hours for adequacy of pain control. Secondary outcomes were volume resuscitation at 72 hours, hypotension (systolic blood pressure <90 mm Hg), length of stay (LOS), return of bowel function, and complications. Results Sixty-one patients underwent esophagectomy using bilateral TAP block and PCA (n = 32) or thoracic (T5 to T8) epidural (n = 29). Overall pain scores were not statistically different between the TAP group and the epidural group averaged over 72 hours (4.98 versus 4.39, p = 0.09). During the initial 72 hours after operation, hypotension was less prevalent in the TAP group (25% versus 76%, p < 0.05) with lower crystalloid resuscitation needs. The LOS in the intensive care unit (3.2 days versus 4.6 days, p < 0.05) and return of bowel function (5 days versus 6.7 days, p < 0.05) were considerably shorter in the TAP group. Pulmonary complications were similar. Conclusions TAP blocks with a PCA is an alternative option for pain control in patients undergoing esophagectomy and may reduce hypotension and need for volume resuscitation with similar pulmonary complications.

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