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TO BLOCK OR NOT TO BLOCK
Dylan S. Goto
*, Divyaam Satija, Savannah Renshaw, Stefanie C. Rohde, William T. Head, Sidhant Kalsotra, Benjamin Poulose
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
Introduction
Transversus abdominis plane (TAP) blocks utilize local anesthetic injections to anesthetize the abdominal wall. These sensory nerves originate from the spine and travel horizontally along the plane between the transverse abdominis and internal oblique muscles. Prior studies have shown that TAP blocks reduce the need for postoperative opioid use and result in improved pain control. We aimed to assess whether TAP blocks result in post-operative pain control and early post-operative complications.
Methods
This was a retrospective study utilizing data from the Abdominal Core Health Quality Collaborative (2014-2023). All adult patients undergoing ventral hernia repair (VHR) were included. The cohort was stratified by preoperative TAP block use. Propensity score matching was performed using nearest neighbor matching with a 1:1 ratio and a caliper of 0.20, incorporating demographic, clinical, and operative variables. Covariate balance was assessed with standardized mean differences. Primary outcomes included length of stay (LOS) and post-operative pain at 1-, 3-, 6-, and 12 months. Secondary outcomes included 30-day rates of ileus, deep venous thrombosis, pneumonia, and intubations. Chi-square tests were used to compare categorical variables. QQ plots were used to assess normality for continuous variables, where T-tests were used for parametric variables while Mann-Whitney U tests were used for non-parametric variables. Significance was set at p<0.05.
Results
30,732 patients undergoing VHR were included. 2,362 (7.7%) received TAP blocks. In unadjusted analyses, the LOS was lower in the TAP block group (median 1 day [IQR 0-3] vs 1 [0-4], p<0.001) but the 30-day rate of ileus was higher (72.3% vs 59.7%, p=0.03); there were no other significant differences in the primary or secondary outcomes, including no differences in binary pain scores at any follow-up interval. After matching, there were 2293 patients in both groups with all SMD values less than 0.10, indicating a well-balanced match. No statistically significant differences were noted in pain scores and rates of ileus, DVT, pneumonia, and intubation.
Conclusion
TAP blocks were not found to have any benefit in post-operative pain control for patients with ventral hernias. They were additionally found to show increased rates of ileus within 30 days within the unadjusted analysis. This questions the utility of performing TAP blocks within the ventral hernia population and their efficacy in improving early post-operative complications.
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