A. J. Scholer1, A. Hashemi2,3, Z. C. Sifri1, M. Gajewski2 3University Of Miami,Anesthesia,Miami, FL, USA 1New Jersey Medical School,Surgery,Newark, NJ, USA 2New Jersey Medical School,Anesthesiology,Newark, NJ, USA
Introduction
Advances in technology have allowed innovation and rapid deployment of these discoveries to spread throughout the developed world. In low to middle income countries (LMICs) a dearth of resources prevents a similar advancement of medical progress. Resources such as opioid medications are difficult to obtain and make pain control one of the many difficult aspects of surgical care in LMICs. To provide adequate pain control in these countries, surgical teams must implement alternate modes of analgesia, and often their ingenuity, to make surgery a possibility. During short term surgical missions (STSMs), implementation of the transverse abdominal plane (TAP) block was used as an adjuvant to control pain in lieu of narcotics. The primary objective of our study was to determine the TAP block’s safety, feasibility and effectiveness in decreasing opioid use and controlling postoperative pain in LMICs.
Methods
A retrospective chart review was conducted of patients who underwent a hysterectomy (23 patients) during STSMs from 2008 to 2015. Patients were divided into two groups, general anesthesia (GETA) and spinal anesthesia (5 patients, control group) vs. GETA and spinal anesthesia with a TAP block (5 patients). The primary endpoints of our study included Visual Analog Scale (VAS) pain scores at rest (30 minutes – 2 hours postop); intravenous (IV) narcotic doses administered, and complications from TAP block. Secondary endpoints included hospital length of stay (LOS); time to rescue medication, and initial pain score in the PACU. Baseline characteristics were identified and included age, comorbidities, and the American Society of Anesthesiologists (ASA) class.
Results
Mean pain scores significantly increased at each time interval in TAP group than the control group (Table 1) while the mean dose of postoperative narcotics given was similiar in both groups (17 μg fentanyl [0 – 40 μg], control vs. 15 μg fentanyl [5 – 30ug], TAP). The total dose of intraoperative narcotics was lower in the TAP group compared to the control group (95 μg fentanyl [5 – 230 μg] vs. 237 μg fentanyl [0 – 440 μg], respectively, p-value = not significant). No complications from the TAP block were reported.
Conclusion
This study demonstrated that a TAP block is a safe opioid alternative, however, resulting in higher initial VAS pain scores post-hysterectomy in LMICs. Availability of TAP blocks is dependent on trained anesthesia staff and availability of ultrasound equipment which may be limited during STSMS. In conclusion, if narcotics are scarce during a STSM and trained anesthesia staff is available, TAP blocks are safe and effective in preventing escalation of pain postoperatively in LMICs.