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2022-RA-993-ESGO Comparing thoracic epidural analgesia to surgeon-administered continuous transversus abdominus plane blocks in gynaecologic oncology patients: a retrospective cohort study
  1. Vishaal Gupta1,
  2. Ann-Rebecca Drolet2,
  3. Emad Matanes1,
  4. Joanne Power3,
  5. Eva Suarthana4,
  6. Lucy Gilbert3,
  7. Shuk On Annie Leung3 and
  8. Xing Zeng3
  1. 1Gynecologic Oncology, McGill University, MONTREAL, QC, Canada
  2. 2Medical School, McGill University, MONTREAL, QC, Canada
  3. 3Gynecologic Oncology, McGill University Health Centre, MONTREAL, QC, Canada
  4. 4Obstetrics and Gynecology, McGill University Health Centre, MONTREAL, QC, Canada


Introduction/Background Post-operative analgesia comprises of a thoracic epidural (TEA) with multimodal adjuncts. Literature has shown transversus abdominus plane blocks (TAP) offer equivalent analgesia with potential secondary benefits. Our study assessed whether surgeon-administered continuous TAP blocks (cTAP) provided equivalent post-operative analgesia in Gynecologic Oncology patients undergoing abdominal surgery.

Methodology A retrospective cohort study of patients undergoing abdominal surgery at McGill University Health Centre from January 2018–2022 was completed. During the CoVID-19 pandemic, an institutional practice change was made in January 2020 to offer a cTAP with IV rescue patient-controlled analgesia. Patients in the TEA group were treated per standardized Department of Anesthesia protocols. Patients in the cTAP group received a surgeon-administered TAP catheter insertion prior to fascial closure with infiltration of bupivicaine 2–2.5 mg/kg 0.5% diluted 1:1 NS + 10 mg dexamethasone divided bilaterally followed by an infusion of 5–10 cc/hour. Our primary outcome was self-reported pain (numerical rating scale (NRS 0–10)) at 24 h; secondary outcomes included NRS at 1 h, first flatus and bowel movement, vomiting, hospitalization length, and analgesia-related complications. Univariate and multivariate analyses were completed, adjusting for age, body mass index, estimated blood loss, and operative time.

Results Two-hundred forty-four patients met study inclusion criteria: 135 and 109 patients received a TEA and cTAP, respectively. There was no difference in pain scores at 24 h between groups unadjusted (p=0.668) and adjusted (p=0.795). The cTAP group had significantly earlier flatus (-0.3 days, p<0.05), bowel movement (-0.7 days, p<0.05), hospital discharge (-1.4 days, p≤0.05), less vomiting events (OR 0.5 p >0.05), and higher NRS at 1 h (1.3, p<0.05). The TEA group had more adverse events, hypotension, and inadequate pain control (p<0.05).

Abstract 2022-RA-993-ESGO Table 1

Baseline demographic and clinical characteristics by types of anesthesia

Abstract 2022-RA-993-ESGO Table 2

Unadjusted and adjusted for Age, BMI, EBL and OR time Primary Outcome and Secondary Outcomes

Conclusion Our study offers a unique comparison of surgeon-administered cTAP blocks, showing similar analgesic effects with secondary benefits. Further prospective studies are needed to assess utilization of the cTAP block as routine post-operative analgesia.

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