ELSEVIER
JMIG
The Journal of
Minimally Invasive
Gynecology
AGL
ELEVATING GYNECOLOGIC SURGERY WORLDWIDE
Original Article
The Effect of Transversus Abdominis Plane Block Timing on
Milliequivalents of Opioid Use and Immediate Postoperative Pain
Scores in Patients Undergoing Minimally Invasive Hysterectomy: a
Retrospective Cohort Study
Erica J. Chang-Patel, MD, Jacqueline M.K. Wong, MD, Claire H. Gould, MD, and
Shaban Demirel, OD, PhD
From the Department of Obstetrics and Gynecology, Division of Gynecology (Drs Chang-Patel and Gould), Legacy Research Institute (Dr Demirel), Legacy
Health, and Department of Obstetrics and Gynecology, Oregon Health and Science University (Dr Wong), Portland, Oregon.
ABSTRACT Study Objective: To examine the effect of transversus abdominis plane (TAP) block timing (preoperative or postoperative)
on postoperative opioid use (quantified via morphine milligram equivalents; MME) and pain scores in patients undergoing
minimally invasive hysterectomy for benign indications.
Keywords:
Design: Retrospective, single-institution cohort study
Setting: Academic-affiliated community hospital
Patients: A total of 2982 patients were included who underwent a minimally invasive total hysterectomy between January
2018 and December 2022, excluding patients with a malignancy diagnosis, concurrent urogynecological procedure, vaginal
hysterectomy, supracervical hysterectomy, or those with baseline narcotic use (opioid use within the 3 months before sur-
gery). Patients were separated into 3 groups: no TAP blocks (n = 1966, 65.9%), preoperative TAP blocks (854, 28.6%), and
postoperative TAP blocks (162, 5.4%).
Interventions: Summary statistics and mixed-effects regression methods were used for data analysis.
Measurements and Main Results: There was a statistically significant lower mean use of opioids (MME 43.2 vs 53.9,
p = .002) among patients who received a TAP block (either pre or postoperatively) than those who did not receive a block.
However, when comparing preoperative vs postoperative patients with TAP block, there was no statistically significant dif-
ference in mean opioid use (MME 43.4 vs 42.1, p = .752). There were no differences in postoperative pain scores between
patients with and without a TAP block, however, more opioids were required in patients who did not receive a TAP block
to achieve the same pain scores as those who did receive a TAP block. There was a statistically significant shorter time to
discharge for TAP versus patients without TAP block(median 5.5 vs 6.3 hours, p < .001) as well as preoperative versus post-
operative patients with TAP block (median 5.3 vs 6.2 hours, p = .001).
Conclusion: While TAP block use at the time of minimally invasive hysterectomy reduced use of postoperative opioids, the
timing of TAP block, either preoperatively or postoperatively, did not significantly affect opioid use. Preoperative compared
with postoperative TAP block administration significantly shortened the time to discharge. Journal of Minimally Invasive
Gynecology (2023) 00, 1–6. © 2023 AAGL. All rights reserved.
Anesthesia; Benign; Laparoscopic; Robotic
Funding support, financial disclosure, conflict of interest: none
IRB number and date: FWA00001280, January 20, 2023
Abstract of the study was submitted to the 52nd American Association for
Gynecologic Laparoscopy Global Congress on Minimally Invasive Gyne-
cologic Surgery
Data availability statement: The derived data that support the findings of
this study are available on request from the corresponding author. The data
is not publicly available due to patient privacy.
1553-4650/$
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see front matter © 2023 AAGL. All rights reserved.
https://doi.org/10.1016/j.jmig.2023.12.013
Corresponding author: Erica J. Chang-Patel, Legacy Health, Advanced
Gynecology, 4406 NE 20th Ave, Vancouver, WA, 98686.
E-mail: erica.j.chang@kp.org
Submitted July 17, 2023, Revised December 17, 2023, Accepted for publica-
tion December 22, 2023.
Available at www.sciencedirect.com and www.jmig.org