The Efficacy and Safety of Transversus Abdominis Plane Blocks After Open Cholecystectomy in Low- and Middle-Income Countries Amtul Mansoor, MD, a,b Stephen Ellwood, MD, a,b Gary Hoffman, BS, a,b, * Anthony Scholer, MD, c,d Amy Gore, MD, a,b Dennis Grech, MD, a,b Bradley Patrick, DNP, MBA, MS, CRNA, b and Ziad Sifri, MD, FACS a,b a Department of Surgery, New Jersey Medical School, Newark, New Jersey b International Surgical Health Initiative, Jersey City, New Jersey c John Wayne Cancer Institute at Providence St. John’s Health Center, Santa Monica, California d Department of Surgical Oncology, Prisma Health Greenville Memorial Medical Campus, Greenville, South Carolina article info Article history: Received 9 December 2019 Received in revised form 8 May 2020 Accepted 16 June 2020 Available online xxx Keywords: Transversus abdominis plane block Open cholecystectomy Short-term surgical missions Low- and middle-income countries Safety Opioids abstract Background: Postoperative pain management is challenging in low- and middle-income countries (LMICs). This study assesses the safety and efficacy of transversus abdominis plane (TAP) blocks as an adjunct for postoperative pain control after an open cholecys- tectomy in LMICs during short-term surgical missions (STSMs). TAP block is a regional anesthesia technique that has been shown to be effective in providing supplementary analgesia to the anterolateral wall post abdominal surgery. Methods: A retrospective chart review of patients undergoing open cholecystectomy during STSMs was performed. STSMs took place in Guatemala, the Philippines, and Peru from 2009 to 2019. Measured outcomes including pain scores, presence of postoperative nausea or vomiting, and opioid consumption were compared between TAP block and non-TAP block groups. Results: Of the 48 patients analyzed, 28 underwent TAP block (58%). Non-TAP block patients received, on average, 8 mg of oral morphine equivalents more than the TAP patients (P ¼ 0.035). No significant difference was noted in pain scores, which were taken imme- diately after surgery, 2 h after surgery, and at multiple times between these time points to calculate an average. Of the patients who received a TAP block, 11% reported nausea or vomiting compared with 45% in the standard group (P < 0.01). There were no reported procedure-related complications. Conclusions: TAP blocks are safe and effective adjuncts for postoperative pain management on STSMs to LMICs. Additional studies are needed to investigate the potential advantages and disadvantages of more widespread use of TAP blocks in LMICs. ª 2020 Elsevier Inc. All rights reserved. * Corresponding author. Rutgers New Jersey Medical School, 150 Bergen Street Room M228, Newark, NJ 07103. Tel.: þ1 9084 632 722; fax: þ1 9739 727 441. E-mail address: gary.hoffman95@gmail.com (G. Hoffman). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  december 2020 (256) 136 e142 0022-4804/$ e see front matter ª 2020 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jss.2020.06.020