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The association of transversus abdominis plane block with length of stay, pain and opioid consumption after anterior or lateral lumbar fusion: a retrospective study

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Abstract

Purpose

Anterior (ALIF) and lateral (LLIF) lumbar interbody fusion is associated with significant postoperative pain, opioid consumption and length of stay. Transversus abdominis plane (TAP) blocks improve these outcomes in other surgical subtypes but have not been applied to spine surgery. A retrospective study of 250 patients was performed to describe associations between TAP block and outcomes after ALIF/LLIF.

Methods

The electronic medical records of 129 patients who underwent ALIF or LLIF with TAP block were compared to 121 patients who did not. All patients were cared for under a standardized perioperative care pathway with comprehensive multimodal analgesia. Differences in patent demographics, surgical factors, length of stay (LOS), opioid consumption, opioid-related side effects and pain scores were compared in bivariable and multivariable regression analyses.

Results

In bivariable analyses, TAP block was associated with a significantly shorter LOS, less postoperative nausea/vomiting and lower opioid consumption in the post-anesthesia care unit (PACU). In multivariable analyses, TAP block was associated with significantly shorter LOS (β − 12 h, 95% CI (− 22, − 2 h); p = 0.021). Preoperative opioid use was a strong predictive factor for higher opioid consumption in the PACU, opioid use in the first 24 h after surgery and longer LOS. We did not find significant differences in pain scores at any times between the groups.

Conclusion

TAP block may represent an effective addition to pain management and opioid-reducing strategies and improve outcomes after ALIF/LLIF. Prospective trials are warranted to further explore these associations.

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Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The Authors do not have any relevant financial sources of support to declare.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Spine Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Marie-Jacqueline Reisener, Alexander P. Hughes, Ichiro Okano, Shuting Lu, Stephan N. Salzmann, Jennifer Shue, Andrew A. Sama, Frank P. Cammisa & Federico P. Girardi

  2. Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Ellen M. Soffin

  3. Department of Epidemiology and Biostatistics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Jiaqi Zhu

Authors
  1. Marie-Jacqueline Reisener
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  2. Alexander P. Hughes
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  3. Ichiro Okano
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  4. Jiaqi Zhu
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  5. Shuting Lu
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  6. Stephan N. Salzmann
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  7. Jennifer Shue
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  8. Andrew A. Sama
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  9. Frank P. Cammisa
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  10. Federico P. Girardi
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  11. Ellen M. Soffin
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Contributions

EMS, APH, M-JR helped in conception and study design. EMS and M-JR drafted the work. EMS, APH, IO, M-JR, JZ, SL, SNS, JS contributed to analysis and interpretation of data, revised the work critically for important intellectual content. All authors revised the work critically for important intellectual content, approved the final version to be published and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ellen M. Soffin.

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Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

IRB Approval

This study was approved by the Hospital for Special Surgery Institutional Review Board (HSS IRB #2020-1877).

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Cite this article

Reisener, MJ., Hughes, A.P., Okano, I. et al. The association of transversus abdominis plane block with length of stay, pain and opioid consumption after anterior or lateral lumbar fusion: a retrospective study. Eur Spine J 30, 3738–3745 (2021). https://doi.org/10.1007/s00586-021-06855-8

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  • DOI: https://doi.org/10.1007/s00586-021-06855-8

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