Adoption of enhanced recovery after surgery and intraoperative transverse abdominis plane block decreases opioid use and length of stay in very large open ventral hernia repairs.

Background: The effect of an enhanced recovery after surgery (ERAS) pathway including liposomal bupivacaine transversus abdominus plane (TAP)-blocks for abdominal wall reconstruction (AWR) on opioids use is not clear.
Methods: A prospective, tertiary hernia center database of patients undergoing AWR before and after ERAS and operative TAP-blocks was matched in large ventral hernias.
Results: In 106 patients, non-TAP-block and TAP-block groups were comparable in mean BMI (p = 0.694), hernia defect size (p = 0.424), components separation (p = 0.610), complete fascial closure (p = 1.0), and panniculectomy (p = 1.0). The total morphine milligram equivalents (MME) used during hospitalization was reduced by 3-fold in the TAP-block group (p < 0.001), and opioid usage decreased by 35%-71% during days 1-5. Length of stay (LOS) was shorter in the TAP-block group by average of 1 day (p = 0.011).
Conclusion: ERAS and TAP-block in AWR leads to a decrease in mean opioid usage by 65% and decreased LOS by an average of 1 day.
Competing Interests: Declaration of competing interest Dr. Heniford has been awarded surgical research and education grants and received honoraria from W.L. Gore and Allergan. Dr. Augenstein has received honoraria for speaking for Medtronic, Allergan, Intuitive, Acelity, and W.L. Gore. Dr. Colavita is a consultant for design of a research protocol for Becton Dickinson. Dr. Shao, Dr. Deerenberg, Ms. Tanu Prasad, and Ms. Colleen Dunphy have no potential conflicts or disclosures relevant to this work.
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