Comparison of transversus abdominis plane catheters with thoracic epidurals for cost and length of stay in open colorectal surgeries: a cohort study

BMC Anesthesiology

David Miller¹  Erin Macbeth²  Divya Cherukupalli²  Peter Andriakos²  Dilip Sidhu²  Farzana Afroze²  Igor Galay²  A. David Chismark³  Edward Lee³  Jonathan Canete³  Justin VanBacker³  Brian Valerian³ 

[1] Albany Medical College, 43 New Scotland Avenue, Albany, NY, USA;Department of Anesthesiology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA;Department of Anesthesiology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA;Department of Surgery, Albany Medical Center, 43 New Scotland Avenue, Albany, USA;

关键词: Enhanced recovery after surgery;    Transversus abdominis plane catheter;    Epidural catheter;    peri-operative pain control;   

DOI  :  10.1186/s12871-021-01359-w

来源: Springer

【 摘 要 】

BackgroundThoracic epidural analgesia has long been a common method of postoperative analgesia for major open abdominal surgeries and is frequently used within enhanced recovery after surgery programs. An alternative postoperative analgesia method is the single shot transversus abdominis plane block, which has shown promising outcomes with respect to total length of stay, cost, pain scores, and decreased opioid usage. However, far less is known regarding continuous transversus abdominis plane analgesia using catheters. We evaluated the total cost-effectiveness of transversus abdominis plane catheter analgesia compared to thoracic epidural analgesia for patients undergoing open colorectal surgeries within the enhanced recovery after surgery program at our institution.MethodsThis cohort study included patients booked under the colorectal surgery enhanced recovery after surgery program from November 2016 through March 2018 who received either bilateral transversus abdominis plane catheters (n = 52) or thoracic epidural analgesia (n = 24).ResultsThere was no difference in total direct cost (p = 0.660) and indirect cost (p = 0.220), and median length of stay (p = 0.664) in the transversus abdominis plane catheter group compared to the thoracic epidural group. Additionally, the transversus abdominis plane catheter group received significantly less morphine equivalents compared to the thoracic epidural group (p = 0.008) and had a lower mean body mass index (p = 0.019). There was no significant difference between the two groups for age (p = 0.820), or sex (p = 0.330).ConclusionsTransversus abdominis plane catheter analgesia is not associated with increased cost or longer hospital stays when compared to thoracic epidural analgesia in patients undergoing open colorectal surgery within an enhanced recovery after surgery program. Furthermore, transversus abdominis plane catheter analgesia led to decreased opioid consumption while maintaining similar pain scores, suggesting similar pain control between the two modalities.

【 授权许可】

CC BY