@article {GuptaA198, author = {Vishaal Gupta and Ann-Rebecca Drolet and Emad Matanes and Joanne Power and Eva Suarthana and Lucy Gilbert and Shuk On Annie Leung and Xing Zeng}, title = {2022-RA-993-ESGO Comparing thoracic epidural analgesia to surgeon-administered continuous transversus abdominus plane blocks in gynaecologic oncology patients: a retrospective cohort study}, volume = {32}, number = {Suppl 2}, pages = {A198--A199}, year = {2022}, doi = {10.1136/ijgc-2022-ESGO.423}, publisher = {BMJ Specialist Journals}, abstract = {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{\textendash}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{\textendash}2.5 mg/kg 0.5\% diluted 1:1 NS + 10 mg dexamethasone divided bilaterally followed by an infusion of 5{\textendash}10 cc/hour. Our primary outcome was self-reported pain (numerical rating scale (NRS 0{\textendash}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).View this table:Abstract 2022-RA-993-ESGO Table 1 Baseline demographic and clinical characteristics by types of anesthesiaView this table:Abstract 2022-RA-993-ESGO Table 2 Unadjusted and adjusted for Age, BMI, EBL and OR time Primary Outcome and Secondary OutcomesConclusion 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.}, issn = {1048-891X}, URL = {https://ijgc.bmj.com/content/32/Suppl_2/A198}, eprint = {https://ijgc.bmj.com/content/32/Suppl_2/A198.full.pdf}, journal = {International Journal of Gynecologic Cancer} }