Proceedings in Obstetrics and Gynecology
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Association of ultrasound-guided transversus abdominis plane block on pain scores and length of stay for patients who underwent abdominal myomectomy
No full textoai:pog:id:35036Background: TAP blocks are often used in the setting of abdominal myomectomy yet with insufficient evidence of its efficacy. Our aim was to compare outcomes of postoperative pain and length of hospital stay following abdominal myomectomy with and without transversus abdominis plane (TAP) block.
Methods: A retrospective cohort study was performed with patients from a single academic institution who underwent abdominal myomectomy with or without TAP block with 10 ml of 0.5% bupivacaine mixed with 10 ml of 1.33% liposomal bupivacaine (Exparel™) between April 2022 and February 2024. The primary outcomes were median pain score on postoperative day 1 (POD#1) and duration of hospital stay. Secondary outcomes included pain medications administered on POD#1, total nausea or/and vomiting (N/V) events, and rate of postoperative complications.
Results: After initially identifying 109 patients, 67 patients met the inclusion criteria of undergoing abdominal myomectomy between April 2022 and February 2024. Most patients self-identified as Black race (no Tap-48%, TAP-45%), and underwent a Pfannenstiel incision (no TAP-70% and TAP-71%). There were no statistically significant differences in patient characteristics between groups. The median pain score reported as numerical rating scale (NRS 1-10) [Interquartile range-IQR] on POD#1 was similar between groups (NRS– No TAP- 4 [3 – 5], TAP-3.5 [3 – 5.5], p=0.90). Length of stay was two days [IQR)] (no TAP-2 [1 – 2], TAP-2 [1 – 3], p=0.35). Nausea and/or vomiting events were comparable (no TAP-0 [0 – 3], TAP-0.5 [0 – 2.0] events, p=0.75). Complication rate was similar between groups (no TAP- 35%, TAP-29%, p=0.84) with no difference in type of complication. Ketorolac was administered to more patients in the TAP group (no TAP-35%, TAP-67%, p=0.03), yet the total mean dose given to patients who received Ketorolac did not differ between groups (no TAP- 46.00 ± 18.34, TAP-57.19 ± 16.63 mg, p=0.09). Additionally, the total dose of opioids +/- SD based on total morphine oral dosing (morphine equivalent dosing-MED) was similar between groups (no TAP-37.14 ± 53.55, TAP-32.56 ± 53.55, p=0.71).
Conclusion: Compared to women with no TAP block, there was no improvement in postoperative pain scores, or reduction in length hospital stay for those who had TAP block for abdominal myomectomy
Association between differences in body-weight based dose versus actual propofol dosages administered for oocyte retrieval on hemodynamic parameters and reproductive outcomes
Full text linkObjective: To evaluate the dose-dependent effect of propofol in hemodynamic parameters and reproductive outcomes following In-Vitro Fertilization (IVF) oocyte retrieval (OR)Design: Retrospective cohort studySubjects: 1575 women who underwent their first OR under monitored anesthesia care (MAC) and subsequent fresh embryo transfer (ET) between January 2016 through December 2022Exposure: Women in the study were categorized into five cohorts (cohorts A – E) based on increasing dose of total propofol in μg/kg/min.Main Outcome Measures: Primary outcomes were mean differences in ideal dose of propofol based on body weight vs. actual dose administered and the live birth rate (LBR) following a fresh ET. Secondary outcomes included changes in hemodynamic parameters following anesthesia. ANOVA with Tukey post-hoc tests were used to compare means (SD) between the study groups. Paired T-tests assessed the difference between ideal and actual propofol dosing within each groupResults: 1564 women [mean (SD) age (years), 32.77 (4.25) and mean (SD) weight (Kg), 79.49 (20.70)] were included in the final analysis. The live birth rate (LBR) was 815/1564 (52.1%). There was a statistically significant difference in the ideal total dose of propofol and the actual dose administered, mean [(95% CI, P value)] 196.83 [(190.85 – 202.82), <0.001)]. Although not statistically significant, the LBR improved with increasing dose of propofol; 50.2% (cohort A) to 55.4% (cohort E). The adjusted Risk Ratio (aRR), (95% CI) of LBR with an additional mg of propofol/kg/min was 1.25 (0.75 – 2.09). Similar, non-significant improvements were observed in clinical pregnancy rate; 60.1% (cohort A) to 65.7% (cohort E); aRR (95% CI) = 1.25 (0.80 – 1.96). Compared to the start of procedure, there was a statistically significant reduction in mean +/- SD in heart rate (bpm), -8.08 ± 13.01 and mean +/- SD (mm/Hg) systolic BP [-17.44 ± 16.28], diastolic BP [-12.76 ± 13.62] and mean arterial pressure [-14.04 ± 13.16] at the end of the procedure.Conclusion: Despite the statistically significant higher dose of propofol administered during IVF oocyte retrieval and the associated significant changes in hemodynamic parameters; there was a trend of increasing LBR and clinical pregnancy rate with higher doses of propofol
Unique Considerations for OB/Gyn Care in Special Populations
Full text linkUniversity of Iowa Obstetrics and Gynecology Postgraduate Conference. Hilton Garden Inn, Iowa City, IA.November 3, 2023. Poster Presentations
Not all operative time is created equal: operative time in relation to 30-day complications in benign laparoscopic hysterectomies
Full text linkSTUDY OBJECTIVE: To assess the relationship between operative time and specific 30-day postoperative complications across different intervals of operation duration in total laparoscopic hysterectomies (TLHs).DESIGN: A retrospective cohort study.SETTING: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2020.PATIENTS: 131,146 TLH cases.INTERVENTIONS: Eligible cases included benign laparoscopic hysterectomies with operative times between 20 and 499 min. We excluded cases involving disseminated cancer, emergency surgery, supracervical approaches, or concomitant procedures.MEASUREMENTS: Multivariable logistic regression analysis was used to evaluate the relationship between specific postoperative complications and operative time. Spline regression was used to analyze differences in the association between postoperative complications and operative time across different tertiles of operative duration.MAIN RESULTS: Multivariable logistic regression analysis demonstrated a significant association between operative time and complication occurrence for each complication type investigated, including unplanned readmission, urinary tract infections, superficial surgical site infections, blood transfusion administration, return to the operating room, and deep organ space infections. Multivariable logistic spline regression demonstrated that operative time contributed more strongly to the odds of a complication for shorter procedures than longer procedures. This relationship was more pronounced for major complications than minor complications.CONCLUSION: Operative time is a stronger risk factor for developing complications for shorter duration procedures than longer procedures. This is especially evident in major complications such as return to the operating room and deep organ space infections. Our results suggest that longer procedure duration may not affect the likelihood of a complication as much as previously thought, and operative times should not be a primary factor in deciding to convert to laparotomy or alter post-operative management
Surgical management of cornual heterotopic using intraoperative sonography depth resection guidance: case report
Full text linkHeterotopic pregnancy is an uncommon phenomenon in which an ectopic and intrauterine pregnancy coexist. This condition can be life-threatening and poses a significant therapeutic challenge. Here we describe management of a heterotopic pregnancy with the ectopic pregnancy located in the right cornua. Resection of the ectopic pregnancy was performed via open laparotomy with intraoperative sonography. A sonography guided approach may optimize resection depth while secondarily allowing monitoring of the intrauterine pregnancy and prevention of disruption in cases in which the gestational sacs are in close proximity. After resection, the course of the pregnancy was uncomplicated, and a healthy baby was delivered via planned cesarean delivery at 36 weeks. While the optimal management of heterotopic pregnancies is often individualized, prompt diagnosis and treatment can result in favorable outcomes. The use of ultrasound intraoperatively allows for more precise resection depth, and which may lead to improved outcomes including increased intrauterine fetal survival rates and decreased myometrial scarring
