Transverse Abdominis Plane Blocks to Decrease Pain in Gynecological Oncology Surgical Patients
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Fowler, Alex
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Abstract
Problem: In the general operating room of a medium sized community hospital, Gynecological Oncology (Gyn-Onc) surgical patients experienced more pain compared to other patient populations who underwent similar open abdominal surgical procedures. Increased pain and higher use of narcotics leads to greater adverse effects such as nausea, vomiting, constipation, and a prolonged length of stay in the hospital. A chart audit showed less than a third of Gyn-Onc patients received Transverse Abdominis Plane (TAP) blocks for pain control, which are shown to reduce narcotic usage by 50% in the post-operative period. Purpose: The purpose of this quality improvement project was to decrease opioid requirements among Gyn-Onc patients who underwent open abdominal surgeries in the perioperative setting at this community hospital by implementing a protocol for the use of TAP blocks and measuring compliance with the performance of TAP blocks, an evidence-based, research supported practice change. Methods: Education was provided to the anesthesia department on how to safely administer TAP blocks. The anesthesia team agreed to implement TAP block consent as a standard for these cases and to include its administration as part of their intraoperative pain control plan. Stakeholders, such as surgeons, have approved the project and will request a TAP block as part of the surgical postings, which served as a reminder to the anesthesia staff to provide one at the conclusion of the surgery. The Enhanced Recovery After Surgery (ERAS) committee was consulted, and approval was obtained for TAP blocks to serve as the beginning of an ERAS protocol for GYN-ONC procedures. This project impacted 2-3 patients per week, the average number of weekly open abdominal Gyn-Onc procedures. Results: Of the 36 eligible patients, 23 patients were consented for TAP blocks (63.89%) and 21 patients received a TAP block (58.3%). Conclusions: Despite a conflicting quality improvement project which led to the low compliance at the beginning of the implementation period, TAP blocks were highly welcomed by the anesthesia staff. Patients who received a TAP block experienced less pain and required fewer narcotics after surgery. The creation of an ERAS protocol will ensure the project’s sustainability.