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Introduction <p>This study evaluated whether a perioperative opioid-sparing multimodal pain regimen with intraoperative transversus abdominis plane (TAP) block reduces opioid use after laparoscopic paraesophageal hernia (PEH) repair while maintaining pain control.</p> Methods <p>A retrospective chart review identified patients who underwent laparoscopic PEH repair at our institution from January 2010 to April 2025. Patients were grouped before and after implementation of a multimodal regimen with TAP block (July 2017). The regimen included scheduled acetaminophen and celecoxib. Outcomes included inpatient and follow-up pain scores (0–10), inpatient morphine milligram equivalents (MME), and opioid prescriptions at discharge or within 30&#xa0;days. Statistical analysis included chi-squared, <i>t</i> tests, nonparametric tests, and multivariate analysis.</p> Results <p>A total of 2539 patients were included (813 pre-regimen, 1726 post-regimen). Inpatient opioid use decreased from 86% to 67.6% (<i>p</i> &lt; 0.001), and inpatient oral MME was significantly lower post-regimen (<i>p</i> &lt; 0.001). Opioid prescriptions at discharge declined from 94.7% to 20.6% (<i>p</i> &lt; 0.001). Median inpatient and follow-up pain scores were lower in the multimodal group (<i>p</i> &lt; 0.0001 and <i>p</i> = 0.015). After adjusting for demographics, maximum inpatient pain score, and additional procedures at time of surgery, the post-regimen group remained associated with reduced inpatient opioid use (OR 0.36, <i>p</i> &lt; 0.001). Median length of stay decreased from 2 to 1&#xa0;day (<i>p</i> &lt; 0.001). 30-day ED visits and readmissions were not significantly different (<i>p</i> = 0.116 and <i>p</i> = 0.404).</p> Conclusion <p>Implementation of a multimodal opioid-sparing regimen with intraoperative TAP block reduced inpatient and post-discharge opioid use after laparoscopic PEH repair, with lower pain scores and shorter hospital stays without increased ED visits or readmissions.</p>

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Opioid-sparing multimodal pain regimen in combination with intraoperative transversus abdominis plane block reduces opioid use after laparoscopic paraesophageal hernia repair

  • 期刊论文

  • 发表日期：

    2026年7月24日

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  • Sophie Lipson,
  • Nicolas Cassata,
  • Sundarachalam Pindicura,
  • Joseph Chronowski,
  • Vladan Obradovic,
  • Osama Shaheen,
  • Ryan Horsley,
  • Alexandra Falvo,
  • Mark Mahan,
  • Anthony T. Petrick,
  • David M. Parker

摘要

Introduction

This study evaluated whether a perioperative opioid-sparing multimodal pain regimen with intraoperative transversus abdominis plane (TAP) block reduces opioid use after laparoscopic paraesophageal hernia (PEH) repair while maintaining pain control.

Methods

A retrospective chart review identified patients who underwent laparoscopic PEH repair at our institution from January 2010 to April 2025. Patients were grouped before and after implementation of a multimodal regimen with TAP block (July 2017). The regimen included scheduled acetaminophen and celecoxib. Outcomes included inpatient and follow-up pain scores (0–10), inpatient morphine milligram equivalents (MME), and opioid prescriptions at discharge or within 30 days. Statistical analysis included chi-squared, t tests, nonparametric tests, and multivariate analysis.

Results

A total of 2539 patients were included (813 pre-regimen, 1726 post-regimen). Inpatient opioid use decreased from 86% to 67.6% (p < 0.001), and inpatient oral MME was significantly lower post-regimen (p < 0.001). Opioid prescriptions at discharge declined from 94.7% to 20.6% (p < 0.001). Median inpatient and follow-up pain scores were lower in the multimodal group (p < 0.0001 and p = 0.015). After adjusting for demographics, maximum inpatient pain score, and additional procedures at time of surgery, the post-regimen group remained associated with reduced inpatient opioid use (OR 0.36, p < 0.001). Median length of stay decreased from 2 to 1 day (p < 0.001). 30-day ED visits and readmissions were not significantly different (p = 0.116 and p = 0.404).

Conclusion

Implementation of a multimodal opioid-sparing regimen with intraoperative TAP block reduced inpatient and post-discharge opioid use after laparoscopic PEH repair, with lower pain scores and shorter hospital stays without increased ED visits or readmissions.