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Comparative effectiveness of surgeon-performed transversus abdominis plane blocks and epidural catheters following open hernia repair with transversus abdominis release

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Abstract

Purpose

Recovery protocols aim to limit narcotic administration following ventral hernia repair (VHR). However, little is known about the contribution of a protocol’s individual components on patient outcomes. We previously reported that surgeon-performed transversus abdominis plane block (TAP-block) is more effective than ultrasound-guided TAP-block following VHR. This study evaluates the effectiveness of two postoperative analgesia modalities: epidural catheter and surgeon-performed TAP-block following VHR performed with transversus abdominis release (TAR).

Methods

A retrospective analysis was performed on data prospectively collected between 2012 and 2019. All patients undergoing open VHR with TAR performed by a single surgeon were identified. Parastomal hernia repairs and any patients receiving ultrasound-guided TAP blocks or paraspinal blocks were excluded. Primary outcome was length of stay (LOS) with secondary outcomes including pain scores, opioid requirements, and 30-day morbidity. Linear regression was used to model LOS.

Results

One hundred thirty-five patients met inclusion criteria (63 epidural, 72 TAP-block). The majority (67.4%) of patients were modified ventral hernia working group grade 2. The only statistically significant difference in postoperative pain scores between the groups was on postoperative day 2 (TAP block 3.19 versus epidural 4.11, p = 0.0126). LOS was significantly shorter in the TAP block group (4.7 versus 6.2 days, p = 0.0023) as was time to regular diet (3.2 versus 4.7 days, p < 0.0001). After controlling for confounders, epidural was associated with increased LOS by 1.3 days (p = 0.0004).

Conclusion

Epidural use following VHR with TAR is associated with increased LOS and increased time to regular diet without reducing pain or opioid use when compared to surgeon-performed TAP block.

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Data availability

Data for this study is available upon request.

Code availability

Code for the statistical analysis of this study are available upon request.

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Acknowledgements

The authors have no acknowledgements to make.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA

    D. J. Morrell, J. A. Doble, B. S. Hendriksen, C. M. Horne & E. M. Pauli

  2. Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA

    C. S. Hollenbeak

Authors
  1. D. J. Morrell
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  2. J. A. Doble
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  3. B. S. Hendriksen
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  4. C. M. Horne
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  5. C. S. Hollenbeak
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  6. E. M. Pauli
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Contributions

DM and EP contributed to the study conception and design. Acquisition of data was performed by DM and JD. Analysis and interpretation of the data was performed by DM, BH, CH, CH, and EP. The first draft of the manuscript was written by DM and EP, CH, and CH commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to E. M. Pauli.

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Conflict of interest

Eric Pauli reports teaching honoraria, research support, and Data and Safety Monitoring Board membership for Beckton, Dickinson and Company (BD), teaching honoraria and consultant fees from Boston Scientific Corp., teaching honoraria from Cook Biotech, Inc., royalties from Springer, royalties from UpToDate, Inc., consulting fees from Wells Fargo & Company, teaching honoraria from Medtronic, PLC, consulting fees from CMR Surgical, Ltd., consulting fees from Ovesco Endoscopy, AG and consulting fees from Baxter International, Inc. unrelated to this report. Charlotte Horne reports teaching honoraria for Medtronic, PLC unrelated to this report. David Morrell, Justin Doble, Brandon Hendriksen, and Christopher Hollenbeak declare that they have no conflict of interest.

Ethics approval

Ethical approval was waived by the local Institutional Review Board of Penn State Health in view of the retrospective nature of the study and all the procedures being performed were part of routine care.

Human and animal rights

The study including human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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Informed consent was waived by the institutional review board given the retrospective nature of this study.

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No additional informed consent was necessary given that no identifying information was included in this article.

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Morrell, D.J., Doble, J.A., Hendriksen, B.S. et al. Comparative effectiveness of surgeon-performed transversus abdominis plane blocks and epidural catheters following open hernia repair with transversus abdominis release. Hernia 25, 1611–1620 (2021). https://doi.org/10.1007/s10029-021-02454-0

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  • DOI: https://doi.org/10.1007/s10029-021-02454-0

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