Implementation of liposomal bupivacaine transversus abdominis plane blocks into the colorectal enhanced recovery after surgery protocol: a natural experiment

Fields, Adam C.; Weiner, Scott G.; Maldonado, L.; Cavallaro, Paul; Goldberg, Joel; Stopfkuchen-Evans, Matthias; Baker, Olesya; Bordeianou, Liliana; Bleday, Ronald

doi:10.1007/s00384-019-03457-1

Cited by 14 publications

(13 citation statements)

References 28 publications

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“…One of the most common alternatives to epidural catheters nowadays is the TAP block where a long-lasting local anesthetic (i.e., liposomal bupivacaine) is injected or a catheter is placed (for continuous application) between the internal oblique and transverse abdominis muscle layers guided by ultrasound providing a regional anesthesia [63]. As this technique is relatively new and was first introduced in 2001 [64], data regarding POI are sparse. There are results demonstrating reduced length of stay and opioid consumption as well as improved bowel function compared to traditional regimes after MIS [32].…”

Section: Transverse Abdominis Plane (Tap) Blockmentioning

confidence: 99%

State-of-the-art colorectal disease: postoperative ileus

Sommer

Schneider

Wehner

et al. 2021

Int J Colorectal Dis

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Purpose Postoperative Ileus (POI) remains an important complication for patients after abdominal surgery with an incidence of 10–27% representing an everyday issue for abdominal surgeons. It accounts for patients’ discomfort, increased morbidity, prolonged hospital stays, and a high economic burden. This review outlines the current understanding of POI pathophysiology and focuses on preventive treatments that have proven to be effective or at least show promising effects. Methods Pathophysiology and recommendations for POI treatment are summarized on the basis of a selective literature review. Results While a lot of therapies have been researched over the past decades, many of them failed to prove successful in meta-analyses. To date, there is no evidence-based treatment once POI has manifested. In the era of enhanced recovery after surgery or fast track regimes, a few approaches show a beneficial effect in preventing POI: multimodal, opioid-sparing analgesia with placement of epidural catheters or transverse abdominis plane block; μ-opioid-receptor antagonists; and goal-directed fluid therapy and in general the use of minimally invasive surgery. Conclusion The results of different studies are often contradictory, as a concise definition of POI and reliable surrogate endpoints are still absent. These will be needed to advance POI research and provide clinicians with consistent data to improve the treatment strategies.

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Section: Transverse Abdominis Plane (Tap) Blockmentioning

confidence: 99%

State-of-the-art colorectal disease: postoperative ileus

Sommer

Schneider

Wehner

et al. 2021

Int J Colorectal Dis

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“…[34,35] Fields et al used liposomal bupivacaine for TAP blocks in patients undergoing colorectal surgeries in the ERAS program and found that there was reduced opioid use and lesser hospital stay. [36] These blocks should be used as a component of the ERAS pathway based on the skills and resources available. These blocks could be single-shot or in the form of continuous infusion via indwelling catheters.…”

Section: Available Evidence Regarding Implementation Of Ra In Erasmentioning

confidence: 99%

Regional Anaesthesia in Enhanced Recovery After Surgery Pathways – A Quintessential Component

Nair¹,

Diwan²

2021

IJRA

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Enhanced recovery after surgery (ERAS) is a multimodal, perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. [1] Initially described by Henry Kehlet in 1995 for colonic surgeries, the enhanced recovery pathways have now evolved and are now validated for more than 30 different types of surgery which include but are not limited to emergency laparotomy, neonatal surgeries, and lower segment cesarean sections. [2] Not only is the patient benefited from this by having an enhanced recovery and early discharge from the hospital, the cost of treatment is reduced and also leads to more turnover of patients thereby reducing the waiting list of patients scheduled for various surgeries. [3]

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“…The selection process is summarized in a PRISMA flow diagram (Figure 1). Study characteristics are summarized in Table 1 [32][33][34][35][36][37][38][39]. In nine of 12 studies (75%), patients were enrolled in a standardized ERAS programme across study arms.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

“…TAP, transversus abdominis plane block; Local, local infiltration; LB, liposomal bupivacaine; NLB, non-liposomal bupivacaine; Standard, standard analgesia surgery similarly led to lower morphine consumption and shorter length of stay compared to nerve blocks with conventional bupivacaine[42]. Positive findings from other fields have generated considerable interest in integrating LB into colorectal ERAS protocols[29,35].…”

mentioning

confidence: 99%

Effect of liposomal bupivacaine on opioid requirements and length of stay in colorectal enhanced recovery pathways: A systematic review and network meta‐analysis

2020

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Aim: Reducing postoperative opioid consumption is a key aim of enhanced recovery after colorectal surgery protocols. Potential solutions include anaesthetic techniques such as local infiltration of anaesthetic agents or transversus abdominis plane (TAP) blocks. This study aimed to assess the efficacy of liposomal bupivacaine (LB) for colorectal resections, across a variety of anaesthetic techniques. Methods: PubMed, Scopus and Embase databases were searched for relevant studies assessing LB, administered by any anaesthetic technique. The primary outcome was postoperative morphine consumed (milligrams) and the secondary outcome was length of stay (days). A Bayesian network meta-analysis comparing LB versus non-LB analgesia was performed alongside meta-regression for different surgical approaches. Results: Twelve trials were included, with a total of 2512 patients. LB-based wound infiltration was most likely to reduce length of stay followed by TAP block with LB (sum under the cumulative ranking [SUCRA] 85.55 and 70.26, respectively). TAP block with LB was most likely to reduce morphine requirements, followed by wound infiltration with LB (SUCRA 83.94 and 75.73, respectively). Compared to standard analgesia, LB-based wound infiltration reduced morphine usage (mean difference 36.64 mg, 95% credibility interval 15.64-59.20) and length of stay (mean difference 1.79 days, 95% credibility interval 0.59-3.81). On meta-regression, the findings held for minimally invasive surgery only. Conclusion: Although LB-based interventions were associated with reduced postoperative morphine requirements and length of stay in this network meta-analysis, the confidence in these estimates was graded as very low. Further well-executed trials are required before LB can be recommended as a first-line agent.

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Implementation of liposomal bupivacaine transversus abdominis plane blocks into the colorectal enhanced recovery after surgery protocol: a natural experiment

Cited by 14 publications

References 28 publications

State-of-the-art colorectal disease: postoperative ileus

State-of-the-art colorectal disease: postoperative ileus

Regional Anaesthesia in Enhanced Recovery After Surgery Pathways – A Quintessential Component

Effect of liposomal bupivacaine on opioid requirements and length of stay in colorectal enhanced recovery pathways: A systematic review and network meta‐analysis

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