Utility of transversus abdominis plane block in trauma and emergency general surgery laparotomy: A quality improvement project.

Abstract

Transversus abdominis plane (TAP) blocks reduce opioid use and improve outcomes in elective surgeries, but their benefit in acute care surgery has not been demonstrated. Our program recently developed a quality improvement project to implement a pain management protocol including TAP blocks for emergency laparotomy. The purpose of this study is to evaluate the impact of TAP blocks on opioid use and hospital outcomes. As part of a hospital quality improvement initiative, we conducted a retrospective cohort study (2022-2024) including patients (18 years or older) who underwent an emergency laparotomy. Patients were divided into TAP block and no TAP block cohorts. Univariate and multivariate analyses were performed to assess the association between the use of TAP blocks and study outcomes including postoperative morphine milligram equivalents (MME), hospital length of stay, and postoperative complications. Among 219 patients (TAP block, 110; no TAP block, 109), those receiving TAP blocks required significantly less total MME (64 vs. 118, p = 0.009) and daily MME (9 vs. 15, p < 0.001) and were less likely to require ≥20 MME/day (22.7% vs. 45.9%, p < 0.001). No significant differences were observed in postoperative complications or hospital length of stay. Multivariate analysis showed the use of TAP blocks was associated with decreased odds of requiring ≥20 MME/day (adjusted odds ratio, 0.363; 95% confidence interval, 0.195-0.675; p = 0.001), and less MME per day ( β = -14.52; 95% confidence interval, -27.50 to -1.53; p = 0.029). Our results suggest that the use of TAP blocks was significantly associated with reduced opioid use in trauma and emergency general surgery patients. While further research is warranted, TAP blocks should be considered for postoperative pain management in acute care surgery patients undergoing emergency laparotomy. Therapeutic/Care Management Study; Level III.