Login to Access Video or Poster Abstract: MP92-03
Sources of Funding: The Alumnae of Northwestern Grant

Introduction

Enhanced recovery protocols (ERP) after radical cystectomy (RC) focus heavily on GI recovery since prolonged postoperative ileus is associated with an increased risk of complications and longer length of stay (LOS). Recently, novel multimodal pain management plans have been used in conjunction with ERPs to either reduce the use of narcotics postoperatively or prevent their side effects. We examine the benefits of continuous transversus abdominis plane (TAP) blockade with a local anesthetic as part of a post-RC pain regiment.

Methods

A retrospective comparison of consecutive patients undergoing RC over a 4-year period was conducted. Patients were designated as having RC during either the pre-TAP or TAP era. Patient demographics, operative details, and perioperative outcomes were compared between the two cohorts. Median days to flatus, bowel movement (BM), LOS, and narcotic usage (converted to milligrams of morphine equivalents) were compared using the Mann-Whitney Test.

Results

In total, 171 patients were included: 100 pre-TAP and 71 TAP. There were no differences in age, smoking status, operative approach (robot vs. open), or urinary diversion type between the two cohorts. The TAP group had fewer men (69% vs. 83%, p=0.03) and more patients who received neoadjuvant chemotherapy (38% vs. 21%, p=0.015). The TAP cohort had significantly better GI recovery with shorter days to flatus (3 vs 4, p<0.001) and days to BM (4 vs. 5, p<0.001). There were no differences in need for NG tube or reoperation (Table 1). Overall, early (POD0-3), and daily narcotic use was significantly lower in the TAP patients: 62 vs. 297mg (p<0.001), 44 vs. 194mg (p=0.001), and 9.7 vs 30.9mg (p=0.001), respectively. Median LOS was significantly shorter in the TAP group (7 vs. 8.5d, p=0.002).

Conclusions

TAP blockade as part of a multimodal postoperative pain plan is safely associated with low narcotic usage, and significant improvement in time to flatus, BM, and LOS compared to traditional post-RC management.

Funding

The Alumnae of Northwestern Grant