Abstract

Transversus abdominis plane (TAP) blocks are utilized as an opioid-sparing anesthetic regimen and are incorporated into Enhanced Recovery After Surgery (ERAS) programs to promote higher quality care for all surgical patients. Transversus abdominis plane blocks decrease pain scores, nausea and vomiting, respiratory depression, the time until ambulation and return of bowel mobility, and length of hospital stay. Transversus abdominis plane blocks have been shown to be superior to the current “gold standard,” thoracic epidural analgesia (TEA), for multimodal analgesia in an ERAS pathway. An ultrasound guided TAP block was performed after induction in a case involving a 41-year-old female with a body mass index BMI of 52.9 kg/m2 who presented for robotic Roux-en-Y gastric bypass surgery. The needle was placed in the correct position between the internal oblique and transversus abdominis. The local anesthetic mixture utilized for the TAP block included ropivacaine 75 mg diluted with 5 ml, so 20 ml was injected on each side. Fentanyl, a total of 150 mcg IV, was administered throughout the case for pain management based on the patient’s hemodynamics. Emergence was uneventful, and the patient was successfully transported to PACU awake and not in any pain. Forty-five minutes after arrival to the PACU, the patient reported having a 3/10 pain level but refused any pain medication and denied any nausea. The plan was to have the patient walking by the end of the day and going home the next day.

Author Details

Monicka Roden, DNP (c); Nancy Ann Westbrook, DNP, MSNA, CRNA, FNP-BC, Col (Ret) USAF; Lisa Herbinger, DNP, CRNA

Sigma Membership

Non-member

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

N/A

Research Approach

N/A

Keywords:

Transversus Abdominis Plane Block, Enhanced Recovery After Surgery, Postoperative, Multimodal Analgesia

Advisor

Westbrook, Nancy Ann

Second Advisor

Herbinger, Lisa

Degree

DNP

Degree Grantor

Samford University

Degree Year

2021

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2021-03-24

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