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

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.