Transversus Abdominis Plane Block as Part of a Multimodal Analgesic Regimen in Patients Undergoing Anterior Lumbar Interbody Fusion: A Retrospective Cohort Study

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Figure 1
(A) Patient is placed supine for the transversus abdominis plane (TAP) procedure. Skin is marked for level of rib cage (RC) and iliac crest (IC). (B) TAP procedure performed with ultrasound guidance through the lateral abdominal wall using a 21G × 100-mm needle. (C) Lateral abdominal wall layers demonstrated with ultrasound image. Layers are labeled from superficial (superior) to deep (inferior).
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Figure 2
Preoperative and postoperative lumbar x-ray images of a 56-year-old patient who underwent an anterior lumbar interbody fusion. (A) Preoperative anterior-posterior (AP), (B) preoperative lateral, (C) postoperative AP, and (D) postoperative lateral views.

Table 1

Summary of patient characteristics.

Characteristic	Transversus Abdominis Plane (n = 47)	Control (n = 52)	P Value
Age	58.0 (46.0–68.0)	64.0 (52.5–69.0)	0.099
Body mass index	30.5 ± 5.4	30.5 ± 5.8	0.977
Sex
Men	23 (48.9%)	31 (59.6%)	0.287
Women	24 (51.1%)	21 (40.4%)	0.287
Diabetes	8 (17.0%)	9 (17.3%)	0.970
Tobacco history	17 (36.2%)	23 (44.2%)	0.414
Drug abuse history	2 (4.3%)	6 (11.5%)	0.274
Previous pain management	19 (40.4%)	27 (51.9%)	0.252
No. of levels (rows)	1.0 (1.0–2.0)	1.0 (1.0–2.0)	0.864
Surgery type
ALIF	17 (36.2%)	20 (38.5%)	0.814
ALIF/PLIF	30 (63.8%)	32 (61.5%)

Abbreviations: ALIF, anterior lumbar interbody fusion; PLIF, posterior lumbar interbody fusion.
Note: Data are presented as number (%), mean ± SD, or median (interquartile range).

Table 2

Postoperative day opioid consumption and hospital length of stay.

Outcome Measure	Transversus Abdominis Plane (n = 47)	Control (n = 52)	P Value
MME consumption
POD 0 MME	19.0 (11.0–36.0)	32.5 (21.3–42.8)	0.004^{^a}
POD 1 MME	58.7 (36.0–75.0)	61.5 (45.1–79.3)	0.129
POD 2 MME	45.0 (23.5–75.0)	60.0 (35.3–81.1)	0.147
POD 3 MME	42.5 (12.0–60.0)	45.0 (17.1–75.0)	0.476
POD 4 MME	0.0 (0.0–46.0)	9.6 (0.0–63.0)	0.459
POD 5 MME	0.0 (0.0–27.5)	0.0 (0.0–32.5)	0.268
Length of stay, d	4.0 (3.0–5.0)	4.0 (3.0–5.0)	0.811
Total MME days
0–2	124.0 (86.4–173.0)	151.1 (113.0–196.2)	0.036^a
0–5	190.0 (115.0–262.0)	240.7 (157.7–345.6)	0.050^a

Table 3

Postoperative day visual analog scale scores.

Abbreviations: POD, postoperative day; TAP, transversus abdominis plane; VAS, visual analog scale.
Note: Data presented as n (%) or median (interquartile range).
↵a Statistically significant difference (P < 0.05).

Table 4

Anterior lumbar interbody fusion subgroup patient characteristics.

Characteristic	Transversus Abdominis Plane (n = 17)	Control (n = 20)	P Value
Age, y	54.8 ± 13.6	59.7 ± 12.1	0.258
Body mass index	27.5 ± 4.0	29.2 ± 4.8	0.303
Sex
Men	5 (29.4%)	12 (60.0%)	0.063
Women	12 (70.6%)	8 (40.0%)	0.063
Tobacco history	6 (35.5%)	9 (45.0%)	0.549
Drug abuse history	1 (5.9%)	3 (15.0%)	0.609
Previous pain management	9 (52.9%)	10 (50.0%)	0.858
No. of levels (rows)	1.0 (1.0–2.0)	1.0 (1.0–1.0)	0.052

Table 5

Anterior lumbar interbody fusion subgroup analysis postoperative day opioid consumption and hospital length of stay.

Opioid Measure	Transversus Abdominis Plane (n = 17)	Control (n = 20)	P Value
MME consumption
POD 0	14.7 (6.7–44.3)	33.7 (21.3–47.1)	0.060
POD 1	46.0 (30.0–62.0)	67.6 (47.6–85.2)	0.024^{^a}
POD 2	30.0 (17.5–75.0)	53.6 (35.3–89.2)	0.187
POD 3	33.0 (4.0–60.0)	45.0 (5.6–79.6)	0.442
POD 4	15.0 (0.0–53.0)	0.0 (0.0–56.2)	0.478
POD 5	0.0 (0.0–27.2)	0.0 (0.0–27.2)	0.964
Total MME days 0–2	99.2 (62.2–182.2)	152.5 (112.0–211.5)	0.026^a
Total MME days 0–5	176.4 (100.3–273.7)	234.3 (139.3–406.4)	0.125
Length of stay, d	4.0 (2.5–7.5)	3.0 (3.0–5.0)	0.257

Table 6

Multiple regression results for logarithmic postoperative day 0 to 2 opioid consumption.

Variable/Factor	Unstandardized Coefficients		95% CI for B		β	P Value
Variable/Factor	B	Standard Error	Lower Bound	Upper Bound	β	P Value
(Constant)	5.986	0.410	5.172	6.800		<0.001
Age	−1.9%	0.004	−2.8%	−1.1%	−0.439	<0.001^{^a}
Transversus abdominis plane	−29.9%	0.102	−42.7%	−14.2%	−0.325	0.001^{^a}
Sex (men)	31.4%	0.107	6.2%	62.6%	0.250	0.012^{^a}
Drug abuse	−28.9%	0.191	−51.3%	3.8%	−0.172	0.077
Diabetes	6.2%	0.135	−18.7%	39.0%	0.043	0.652
Previous pain management	4.1%	0.103	−15.2%	27.8%	0.037	0.696
Body mass index	0.2%	0.009	−1.5%	2.1%	0.030	0.750
Smoking	−2.7%	0.104	−20.9%	19.6%	−0.025	0.788