Regional Nerve Blocks and Opiate Usage in Patients Undergoing Laparoscopic Hysterectomy.

Objective: Regional blocks in open abdominal surgery reduce postoperative opioid use. Use in minimally invasive gynecologic surgery has had inconsistent results regarding postoperative pain and narcotic use. Effects on intraoperative opioid requirements are unknown. This study examined intraoperative and immediate postoperative effects of 2 regional anesthetic techniques. Materials and Methods: Of 394 patients, 79 had transverse abdominis plane (TAP) block, 207 had quadratus lumborum (QL) block, and 108 had no block (NB). Intraoperative opioids were converted to morphine-equivalent doses (MEDs) and divided by surgical minutes to control for operative time. Univariate analysis examined differences in opioid needs and secondary outcomes. Results: Average intraoperative MED/minute per cohort was 0.21 for QL, 0.25 for TAP, and 0.25 for NB (p = 0.002). QL used fewer intraoperative opioids than TAP (p = 0.01) and NB (p < 0.001). There was no difference in intraoperative MED use between TAP and NB (p = 0.47). Subgroup analysis showed increased intraoperative MED in individuals under age 40, and no difference by American Society of Anesthesiologists classification, robotic surgery use, or presence of endometriosis. Postoperative MED use was 17, 23.8, and 24.2 for QL, TAP, and NB respectively (p = 0.001). There was no difference in mean incidence of nausea (p = 0.88) or vomiting (p = 0.29) among groups. Time to postoperative anesthesia unit (PACU) discharge was 108 minutes for QL, 112 minutes for TAP, and 125 minutes for NB (p = 0.007). Conclusions: Preoperative QL blockade is associated with decreased narcotic use and a quicker time to discharge. While statistically significant, this difference of 18 MED and 12-minute quicker discharge has minimal clinical significance and is not cost-effective, given the exponential cost of liposomal bupivacaine, compared to standard bupivicaine. (J GYNECOL SURG 20XX:000 [ABSTRACT FROM AUTHOR]