Chang-Patel et al.
Effect of TAP Block Timing in Patients Undergoing MIH
consumption than postoperative TAP blocks [24]. This dif-
ference in analgesic effect of preoperative versus postopera-
tive TAP block was also seen in a 2011 randomized study
of patients undergoing elective total abdominal hysterecto-
mies [15]. Our study thus sought to explore, through a retro-
spective study, if the timing of TAP blocks in patients
undergoing minimally invasive total hysterectomy had an
impact on opioid requirements or pain scores postopera-
tively and would warrant further investigation.
Our study included a large sample size and patients with
comorbidities that are often excluded from randomized trial
data. Although subject to selection bias inherent to any ret-
rospective study, our results reflect a real-world practice
population.
This study has several limitations. Due to the retrospec-
tive and nonrandomized nature of the data, there were sig-
nificant differences in baseline characteristics between
groups, with the postoperative TAP block group being sig-
nificantly smaller in number compared to the preoperative
or no TAP block groups. As such, there may have been var-
iables outside of the TAP block that impacted postoperative
outcomes in this population and timing and selection for
TAP block administration may have been similarly
impacted by confounding factors. Specifically, we were
unable to assess which patients received other aspects of
multimodal analgesia or other components of the ERAS
protocol that would have impacted the effect of a TAP
block. Similarly, there was no standardized TAP block
technique or anesthetic composition, which was unable to
be accounted for in our study. Additionally, the data encom-
passed patients undergoing hysterectomy for a wide range
of indications, with data collection unable to account for
concurrent endometriosis-related procedures or adnexal
surgeries that may have influenced patient outcomes.
Patients were also identified using CPT codes, and coding
misclassifications or omissions may have impacted the
results. Finally, pain scores were analyzed at a single time-
point for each patient due to variability in documentation.
Thus, results may have failed to detect a difference in the
amount of time spent at different pain levels.
Conclusion
Our study sought to evaluate the effect of TAP block
timing on postoperative opioid consumption and pain
scores. When comparing preoperative to postoperative TAP
block recipients undergoing minimally invasive total hys-
terectomy, preoperative TAP blocks were only associated
with a shorter time to discharge without an impact on maxi-
mum pain scores or opioid consumption postoperatively.
Receipt of a TAP block at any point was also associated
with a decreased opioid requirement postoperatively and a
shortened time to discharge than no TAP block. Our study
is limited by the retrospective nature of our data but sug-
gests that additional future randomized studies may be
worthwhile to further examine the impact of TAP block
5
timing on postoperative factors in minimally invasive hys-
terectomy patients.
Acknowledgements
The authors thank John Collins for his invaluable assis-
tance with data collection. The authors also thank Drs.
Blake Osmundsen and Amanda Ecker for their support with
project development and analysis assistance.
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