ACUTE PAIN & PERIOPERATIVE PAIN SECTION Original Research Article Continuous Transversus Abdominis Plane (TAP) Blocks for Postoperative Pain Control after Hernia Surgery: A Randomized, Triple-Masked, Placebo-Controlled Study Justin W. Heil, MD,* Ken A. Nakanote, BA, † Sarah J. Madison, MD,* Vanessa J. Loland, MD,* Edward R. Mariano, MD, MAS,* NavParkash S. Sandhu, MD, MS,* Michael L. Bishop, MD,* Rishi R. Agarwal, MD,* James A. Proudfoot, MSc, ‡ Eliza J. Ferguson, BS,* Anya C. Morgan, MA, CCRC,* and Brian M. Ilfeld, MD, MS (Clinical Investigation)* Departments of *Anesthesiology and ‡ Biostatistics, and † School of Medicine, University of California San Diego, San Diego, California, USA Reprint requests to: Brian M. Ilfeld, MD, MS (Clinical Investigation), Department of Anesthesiology, 200 West Arbor Drive, MC 8990, San Diego, CA 92130, USA. Tel: (858) 657-7030; Fax: (858) 683-2003; E-mail: bilfeld@ucsd.edu. Disclosure: The contributions of Drs. Heil, 1 Loland, 4 and Mariano 5 occurred while working at the University of California San Diego, San Diego, California. These investigators subsequently moved to Naval Medical Center San Diego (San Diego, California), 1 the University of Washington (Seattle, Washington), 3 and Stanford University (Stanford, California), 4 respectively. I-Flow Corporation (Lake Forest, CA, USA) provided funding for the current study. This company also provided the portable infusion pumps used in this investigation, and had no input into any aspect of study conceptualization, design, and implementation; data collection, analysis and interpretation; or manuscript preparation. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the funding entities. Conflict of Interest: During the period of subject enrollment, Drs. Ilfeld and Mariano taught workshops on continuous peripheral nerve blocks, receiving honoraria from I-Flow Corporation. Dr. Ilfeld had no financial relationship with this company during data analysis and manuscript preparation. Dr. Mariano taught workshops during data analysis and manuscript preparation. Submitted, in part, as a scientific abstract for the annual meeting of the American Society of Anesthesiologists, New Orleans, Louisiana, October 11–15, 2014. Abstract Background. Single-injection transversus abdo- minis plane (TAP) block provides postoperative analgesia and decreases supplemental analgesic requirements. However, there is currently no evi- dence from randomized, controlled studies investi- gating the possible benefits of continuous TAP blocks. Therefore, the aim of this randomized, triple-masked, placebo-controlled study was to determine if benefits are afforded by adding a multiple-day, ambulatory, continuous ropivacaine TAP block to a single-injection block following hernia surgery. Methods. Preoperatively, subjects undergoing uni- lateral inguinal (N = 19) or peri-umbilical (N = 1) hernia surgery received unilateral or bilateral TAP perineural catheter(s), respectively. All received a ropivacaine 0.5% (20 mL) bolus via the catheter(s). Subjects were randomized to either postoperative perineural ropivacaine 0.2% or normal saline using portable infusion pump(s). Subjects were dis- charged home where the catheter(s) were removed the evening of postoperative day (POD) 2. Subjects were contacted on POD 0–3. The primary endpoint was average pain with movement (scale: 0–10) queried on POD 1. Results. Twenty subjects of a target 30 were enrolled due to the primary surgeon’s unanticipated departure from the institution. Average pain queried on POD 1 for subjects receiving ropivacaine (N = 10) bs_bs_banner Pain Medicine 2014; 15: 1957–1964 Wiley Periodicals, Inc. 1957 Downloaded from https://academic.oup.com/painmedicine/article-abstract/15/11/1957/1836254 by guest on 20 June 2020