TAP blocks - yay or nay?

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PpfSuxTube said:
No blocks for anything laparoscopic small incision type stuff. So unless this robot is huge hole forget it.

Anyone trying to say there's benefits is probably a liberal
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we had a regional fellowship trained guy at my old practice…and he had just finished his fellowship and was setting up a “regional program” at the hospital

hospital recruited him to run the regional program even though most docs were already very experienced and had been doing blocks and providing standard care for appropriate surgeries

he’d basically send nasty emails to anyone about professionalism if they didn’t do tap blocks for basic laparoscopic cases…appy and chole…lol thinking about it makes me cringe…
thank god i left that toxic place

turns out he had cut a deal with the hospital on % of all block reimbursement with the facility for all docs in exchange to run the program…

didn’t sit well with too many people once they found out…he left shortly after
 
AKMD_1984 said:
turns out he had cut a deal with the hospital on % of all block reimbursement with the facility for all docs in exchange to run the program…

didn’t sit well with too many people once they found out…he left shortly after
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Sounds about right.
 
AKMD_1984 said:
we had a regional fellowship trained guy at my old practice…and he had just finished his fellowship and was setting up a “regional program” at the hospital

hospital recruited him to run the regional program even though most docs were already very experienced and had been doing blocks and providing standard care for appropriate surgeries

he’d basically send nasty emails to anyone about professionalism if they didn’t do tap blocks for basic laparoscopic cases…appy and chole…lol thinking about it makes me cringe…
thank god i left that toxic place

turns out he had cut a deal with the hospital on % of all block reimbursement with the facility for all docs in exchange to run the program…

didn’t sit well with too many people once they found out…he left shortly after
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That's too bad. They work well for lap appy.

Probably should have listened to him



 
UscGhost said:
That's too bad. They work well for lap appy.

Probably should have listened to him



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So no change in opioids use… What were the actual pain scores from the groups?

Just because something is statistically significant doesn’t automatically mean it is clinically significant.
 
CopaceticOne said:
So no change in opioids use… What were the actual pain scores from the groups?

Just because something is statistically significant doesn’t automatically mean it is clinically significant.
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A good question.

But its risk vs reward for me.

Its a procedure thats extremely low risk, works well in my personal experience, studies support it and it takes 3 minutes to do.

I dont see any significant downsides
 
CopaceticOne said:
So no change in opioids use… What were the actual pain scores from the groups?

Just because something is statistically significant doesn’t automatically mean it is clinically significant.
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i don’t think that study is that convincing…there’s no difference in length of stay or opioid use…
 
AKMD_1984 said:
i don’t think that study is that convincing…there’s no difference in length of stay or opioid use…
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Thats fine.

Nobody ever argued that it was a game changing procedure. Its a very simple procedure, takes 3 mins to do, with virtually zero complications and helps with pain.

So the risk reward favors doing it.

I am not impressed with the types, concentration or amount of local used by most surgeons..so that may be the patients that benefit most. If you have surgeons that are very generous, and inject well, then it may be less of a difference maker
 
zaitoun said:
can't you just do rectus sheath block for more coverage?
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Rectus sheath just covers a narrow midline dermatome of the abdomen. Generally aren't placed above the umbilicus. The external oblique intercostal is a new block that covers the upper quadrants very well. I am a long-time practitioner of TAPs and rectus sheath. This new block covers the dermatomes missing from those other 2.
 
CopaceticOne said:
So no change in opioids use… What were the actual pain scores from the groups?

Just because something is statistically significant doesn’t automatically mean it is clinically significant.
Click to expand...
This. Its a lap appy. 20 min procedure these days for these superfast lap surgeons. Patient gone home a few hours later. There is nothing clinically significant about adding a tap block here...


Maybe if these were cancer cases or something more important
 
PpfSuxTube said:
This. Its a lap appy. 20 min procedure these days for these superfast lap surgeons. Patient gone home a few hours later. There is nothing clinically significant about adding a tap block here...


Maybe if these were cancer cases or something more important
Click to expand...
I wish our appys took 20 mins...
 
UscGhost said:
Thats fine.

Nobody ever argued that it was a game changing procedure. Its a very simple procedure, takes 3 mins to do, with virtually zero complications and helps with pain.

So the risk reward favors doing it.

I am not impressed with the types, concentration or amount of local used by most surgeons..so that may be the patients that benefit most. If you have surgeons that are very generous, and inject well, then it may be less of a difference maker
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This is actually really important. In my prior practice, surgeons' use of local seemed non-existent. In my current practice, the opposite is consistently true. As much as I like my TAP blocks, I think the amount of local the surgeons use makes a huge difference.
 
cchoukal said:
This is actually really important. In my prior practice, surgeons' use of local seemed non-existent. In my current practice, the opposite is consistently true. As much as I like my TAP blocks, I think the amount of local the surgeons use makes a huge difference.
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Yea, my surgeons often just inject random amounts, random concentrations.

Every once in awhile you get a surgeon who is invested in multi modal..they do a better job
 
UscGhost said:
Yea, my surgeons often just inject random amounts, random concentrations.

Every once in awhile you get a surgeon who is invested in multi modal..they do a better job
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Some of the faster surgeons I work with inject a mix of lido & bupi. Seems to work quite well.

They are the same ones that have no issues with patients getting ketorolac.
 
UscGhost said:
That's too bad. They work well for lap appy.

Probably should have listened to him



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Holy moly. That is nauseating. Both describe lap-assisted "TAP" blocks, not even ultrasound-guided. Mostly blind preperitoneal injections at the end of the case. Very little local is actually in the TA plane. Garbage studies with garbage results.

Criminal research. As is doing TAP blocks for lap appys.
 
Maz777 said:
Holy moly. That is nauseating. Both describe lap-assisted "TAP" blocks, not even ultrasound-guided. Mostly blind preperitoneal injections at the end of the case. Very little local is actually in the TA plane. Garbage studies with garbage results.

Criminal research. As is doing TAP blocks for lap appys.
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Of course

Couple more for ya

Comparison of ultrasound-guided bilateral subcostal transversus abdominis plane block and port-site infiltration with bupivacaine in laparoscopic cholecystectomy - PMC

Many patients experience moderate-to-severe pain after laparoscopic cholecystectomy. We aimed to compare the efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane (TAP) block with port-site infiltration for post-operative ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov



All garbage I'm sure. I usually encounter such resistance amongst the older docs who dont know how to use an ultrasound...
 
UscGhost said:
Of course

Couple more for ya

Comparison of ultrasound-guided bilateral subcostal transversus abdominis plane block and port-site infiltration with bupivacaine in laparoscopic cholecystectomy - PMC

Many patients experience moderate-to-severe pain after laparoscopic cholecystectomy. We aimed to compare the efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane (TAP) block with port-site infiltration for post-operative ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov



All garbage I'm sure. I usually encounter such resistance amongst the older docs who dont know how to use an ultrasound...
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Garbage., tap blocks are garbage. Sometime in next 3 years insurance will stop paying for them. Hopefully cataracts after that., adapt or get left behind

And no I’m not old. Can do tap blocks in less than 2 minutes.

They don’t do anything compared to surgeon local if they just take the time and do it

As a specialty we need to quit finding things to justify our existence that really don’t as data doesn’t support or are such a basic skill it takes an srna 3 attempts do do. Or both as is the case here.
 
Howard888 said:
Garbage., tap blocks are garbage. Sometime in next 3 years insurance will stop paying for them. Hopefully cataracts after that., adapt or get left behind

And no I’m not old. Can do tap blocks in less than 2 minutes.

They don’t do anything compared to surgeon local if they just take the time and do it

As a specialty we need to quit finding things to justify our existence that really don’t as data doesn’t support or are such a basic skill it takes an srna 3 attempts do do. Or both as is the case here.
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The studies showing promise..a joke. Tap blocks a joke
 
Howard888 said:
Garbage., tap blocks are garbage. Sometime in next 3 years insurance will stop paying for them. Hopefully cataracts after that., adapt or get left behind

And no I’m not old. Can do tap blocks in less than 2 minutes.

They don’t do anything compared to surgeon local if they just take the time and do it

As a specialty we need to quit finding things to justify our existence that really don’t as data doesn’t support or are such a basic skill it takes an srna 3 attempts do do. Or both as is the case here.
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Seems like a lot of studies disagree with you.
 
Maybe a different way to look at it: specialty bodies were tasked with coming up with the five most wasteful/least impactful things they do and bill for. Not sure what the ASA come up with, but don’t think TAP blocks should be on that list?
 
cchoukal said:
Maybe a different way to look at it: specialty bodies were tasked with coming up with the five most wasteful/least impactful things they do and bill for. Not sure what the ASA come up with, but don’t think TAP blocks should be on that list?
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No i dont. And neither did the ASA

As part of this effort to reduce wasteful or low-value care, the ASA's initial recommendations for things physicians and patients should question include avoiding certain baseline laboratory and cardiac tests for specific low-risk patients and surgeries. They also advise against the routine use of pulmonary artery catheters for low-risk cardiac surgery, administering packed red blood cells to young, healthy patients without persistent blood loss and hemoglobin 6 g/dL or higher (unless symptomatic or unstable), and routinely administering colloid for volume resuscitation without appropriate indications.
 
PpfSuxTube said:
Did you read those trials? A tap block improves your quality of life? For real? Come on...
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Quality of life for the anesthesiologist who bills RVUs. It makes no clinically significant difference in simple lap cases, I'll buy that for large incisions it would have a benefit. One placed I worked it was all PP eat what you kill, everybody got TAP blocks, appys/choles/gyn the anesthesiologists had convinced the staff they were great multi-modal, and they are, but you have to choose wisely
 
Maverikk said:
Quality of life for the anesthesiologist who bills RVUs. It makes no clinically significant difference in simple lap cases, I'll buy that for large incisions it would have a benefit. One placed I worked it was all PP eat what you kill, everybody got TAP blocks, appys/choles/gyn the anesthesiologists had convinced the staff they were great multi-modal, and they are, but you have to choose wisely
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But they work better than local infiltration.

So, then you are also saying that local infiltration isnt clinically significant
 
UscGhost said:
But they work better than local infiltration.

So, then you are also saying that local infiltration isnt clinically significant
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My opinion is they do work better in surgeries that need them, surgeons who can do LTAP I encourage to do them, for appys/choles

TLDR for the below: no difference in opioids or LOS, these are clinical endpoints in my opinion. Their conclusion of 'QOL improvement at one week' may appeal to academics, does it make sense clinically that your local which may last 24 hours at best increased their QOL in one week? This is diving down a rabbit hole but read John Ioannidis work on what people use to get published.

"The LTAP group had significantly lower VAS pain scores at 6 hours (p<0.001), 12 hours (p<0.001) and 24 hours (p=0.002) post-operatively.There was no significant difference in VAS scores at 3 hours post-operatively (p=0.1527), in LOS (p=0.45) or in opioid requirements on the ward (p=0.42). QOL scores were better in LTAP group at 1 week follow up (p=0.043).ConclusionLTAP block significantly improved post-operative analgesia outcomes in patients undergoing laparoscopic appendicectomy and holds promise as part of an effective post-operative analgesic regimen."

The reason I say this is because I'm a choosing wisely proponent: don't do unneeded procedures that drive up healthcare costs. I think blocks are great for the right procedure. But they're also RVUs and I've been at places that used them solely for billing, every 30 min lap chole/appy (yes, surgeons can do this) got a TAP because it was billing based. Yes TAPs are quick to do, are they needed for these? Does it effect clinical endpoints?
 
I've had patients who couldn't get out of PACU for seemingly minor procedures without a rescue TAP block. Surgeon had used local. Not sure why any of us would be clamoring to cut our reimbursement.. it's not a sham procedure. I wonder if the studies are limited by operator technique (not that simple of a block in many patients) or poor patient selection (I've seen people do it for open cholecystectomy or robotic hiatal hernia with high incisions).

I'll say this.. I'm not RVU based and it's really annoying to have to wheel in the ultrasound and perform.. and I still do it when appropriate.
 
Maverikk said:
My opinion is they do work better in surgeries that need them, surgeons who can do LTAP I encourage to do them, for appys/choles

TLDR for the below: no difference in opioids or LOS, these are clinical endpoints in my opinion. Their conclusion of 'QOL improvement at one week' may appeal to academics, does it make sense clinically that your local which may last 24 hours at best increased their QOL in one week? This is diving down a rabbit hole but read John Ioannidis work on what people use to get published.

"The LTAP group had significantly lower VAS pain scores at 6 hours (p<0.001), 12 hours (p<0.001) and 24 hours (p=0.002) post-operatively.There was no significant difference in VAS scores at 3 hours post-operatively (p=0.1527), in LOS (p=0.45) or in opioid requirements on the ward (p=0.42). QOL scores were better in LTAP group at 1 week follow up (p=0.043).ConclusionLTAP block significantly improved post-operative analgesia outcomes in patients undergoing laparoscopic appendicectomy and holds promise as part of an effective post-operative analgesic regimen."

The reason I say this is because I'm a choosing wisely proponent: don't do unneeded procedures that drive up healthcare costs. I think blocks are great for the right procedure. But they're also RVUs and I've been at places that used them solely for billing, every 30 min lap chole/appy (yes, surgeons can do this) got a TAP because it was billing based. Yes TAPs are quick to do, are they needed for these? Does it effect clinical endpoints?
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In total, 138 patients were enrolled in this study: 73 patients allocated to the LA to port sites cohort (52.9%) and 65 patients in the TAP and RS cohort (43.5%). The most common indication for surgery was acute cholecystitis. The average amount of opiate analgesia use was 115.2 mg in the LA group compared to 61.2 mg in the TAP and RS group (p < 0.05).


Time to first analgesic (mean±SD) in Group I and Group T was 292.7 ± 67.03 and 510.3 ± 154.55 min and mean tramadol required was141.8 ± 60.01 mg and 48.69 ± 36.14 mg, respectively (P = 0.001 for both). Mean NRS at 2, 3, 6, 12 and 24 h was significantly lower in Group T.

Conclusion:
Ultrasound-guided bilateral subcostal TAP block provides superior post-operative analgesia after laparoscopic cholecystectomy compared to port-site infiltration.

Thats a big opiod difference
 

Liposomal Bupivacaine, Plain Bupivacaine, and Saline for... : Anesthesiology

h its effectiveness remains unclear. We therefore tested two co-primary hypotheses: first, that opioid consumption during the initial 24 postoperative hours is higher with saline than plain bupivacaine or liposomal bupivacaine; and second, that opioid consumption between 24 to 48 hours...
journals.lww.com journals.lww.com

This study was published 2 days ago and found no difference compared to saline. Granted, I haven’t been able to read the whole article due to not having access right now.
 
Dantrolene FC said:

Liposomal Bupivacaine, Plain Bupivacaine, and Saline for... : Anesthesiology

h its effectiveness remains unclear. We therefore tested two co-primary hypotheses: first, that opioid consumption during the initial 24 postoperative hours is higher with saline than plain bupivacaine or liposomal bupivacaine; and second, that opioid consumption between 24 to 48 hours...
journals.lww.com journals.lww.com

This study was published 2 days ago and found no difference compared to saline. Granted, I haven’t been able to read the whole article due to not having access right now.
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I like that they used saline vs exparel vs bupiv

I wonder how they compare multiple types of different open vs lap procedures. Seems like a lot of variables in there...unless they are separating out each procedure type.
 
UscGhost said:
Seems like a lot of studies disagree with you.
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More studies agree by far not even close. The above study which I also referenced is clear. Many other studies show no differences in complications, length of stay, or anything meaningful.

Insurance companies should stop paying for taps.

Although anesthesia for cataracts is by far the biggest waste in healthcare expenditure
 
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Howard888 said:
More studies agree by far not even close. The above study which I also referenced is clear. Many other studies show no differences in complications, length of stay, or anything meaningful.

Insurance companies should stop paying for taps.

Although anesthesia for cataracts is by far the biggest waste in healthcare expenditure
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Show me more studies.

Interscalene for shoulder arthroscopy dont shorten length of stay or reduced complications. Does that mean they dont work?

Port site infiltration doesnt either.
 

Effect of Transversus Abdominis Plane Block on Postoperative Pain after Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials - PMC

To assess the analgesic efficacy of transversus abdominis plane (TAP) block in patients undergoing colorectal surgery (CRS). The databases of PubMed, ISI Web of Science, and Embase were searched, and randomized controlled studies (RCTs) that ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov

A total of 7 RCTs with 511 patients were included. The results of this study suggested that TAP block significantly relieved postoperative pain during postanesthetic recovery after CRS at rest and during movement (WMDs were −0.98 [95% CI −1.57 to −0.38] and −0.68 [−1.07 to −0.30], respectively), and also decreased pain intensity during movement 24 h after CRS (WMD: −0.57 [95% CI −1.06 to −0.08]). TAP block significantly reduced opioid consumption within 24 h when compared to controls, with a WMD of 15.66 (95% CI −23.93 to −7.39). However, TAP block did not shorten the length of hospital stay
 
gunnershow said:
I've had patients who couldn't get out of PACU for seemingly minor procedures without a rescue TAP block. Surgeon had used local. Not sure why any of us would be clamoring to cut our reimbursement.. it's not a sham procedure. I wonder if the studies are limited by operator technique (not that simple of a block in many patients) or poor patient selection (I've seen people do it for open cholecystectomy or robotic hiatal hernia with high incisions).

I'll say this.. I'm not RVU based and it's really annoying to have to wheel in the ultrasound and perform.. and I still do it when appropriate.
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Agreed, I had a lap chole sobbing and making a fuss in pacu who was much better after a tap block. I don't know why there is so much skepticism regarding blocks in general, I think they are very helpful in general.
 
If it doesn’t change length of stay then it’s not cost effective. 100% interscalenes change length of stay. You wouldn’t be able to do half of rotator cuffs in ASCs. They’d require hospitals or hopds as backup for overnight doubling the cost alone


Worked with a general surgeon yesterday at asc who does lap gallbladders in hour at asc. Did 6. No one stayed over an hour. Zero reason to do a tap block.

I’ll support every insurance company stopping to pay for these unless open procedure. It’s ridiculous
 
Howard888 said:
If it doesn’t change length of stay then it’s not cost effective. 100% interscalenes change length of stay. You wouldn’t be able to do half of rotator cuffs in ASCs. They’d require hospitals or hopds as backup for overnight doubling the cost alone


Worked with a general surgeon yesterday at asc who does lap gallbladders in hour at asc. Did 6. No one stayed over an hour. Zero reason to do a tap block.

I’ll support every insurance company stopping to pay for these unless open procedure. It’s ridiculous
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Im not really in the “pro TAP block for laparoscopic surgery” camp, but I don’t know that length of stay is the only metric that matters.

Do labor epidurals decrease length of stay?
 
Howard888 said:
If it doesn’t change length of stay then it’s not cost effective. 100% interscalenes change length of stay. You wouldn’t be able to do half of rotator cuffs in ASCs. They’d require hospitals or hopds as backup for overnight doubling the cost alone


Worked with a general surgeon yesterday at asc who does lap gallbladders in hour at asc. Did 6. No one stayed over an hour. Zero reason to do a tap block.

I’ll support every insurance company stopping to pay for these unless open procedure. It’s ridiculous
Click to expand...
some surgeons do really bad local and many times its the ones that are really rough with the trocars, i think a tap is possibly better than bad surgeon local and as good as good surgeon local
 
UscGhost said:

Effect of Transversus Abdominis Plane Block on Postoperative Pain after Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials - PMC

To assess the analgesic efficacy of transversus abdominis plane (TAP) block in patients undergoing colorectal surgery (CRS). The databases of PubMed, ISI Web of Science, and Embase were searched, and randomized controlled studies (RCTs) that ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov

A total of 7 RCTs with 511 patients were included. The results of this study suggested that TAP block significantly relieved postoperative pain during postanesthetic recovery after CRS at rest and during movement (WMDs were −0.98 [95% CI −1.57 to −0.38] and −0.68 [−1.07 to −0.30], respectively), and also decreased pain intensity during movement 24 h after CRS (WMD: −0.57 [95% CI −1.06 to −0.08]). TAP block significantly reduced opioid consumption within 24 h when compared to controls, with a WMD of 15.66 (95% CI −23.93 to −7.39). However, TAP block did not shorten the length of hospital stay
Click to expand...
not totally against tap blocks

but i have seen so many studies of "reduced opioid use" and its a barely statistically significant oxycodone or two
 
Hoya11 said:
not totally against tap blocks

but i have seen so many studies of "reduced opioid use" and its a barely statistically significant oxycodone or two
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Thats fine. Same with tylenol, toradol, or any singular aspect of multimodal pain control. Independently, each treatment isnt a miracle. But a 2 minute procedure, with virtually zero complications, that reduces pain and, less oxydocodone, thus leas nausea, happier patients, etc..is certainty worthwhile
 
Howard888 said:
If it doesn’t change length of stay then it’s not cost effective. 100% interscalenes change length of stay. You wouldn’t be able to do half of rotator cuffs in ASCs. They’d require hospitals or hopds as backup for overnight doubling the cost alone


Worked with a general surgeon yesterday at asc who does lap gallbladders in hour at asc. Did 6. No one stayed over an hour. Zero reason to do a tap block.

I’ll support every insurance company stopping to pay for these unless open procedure. It’s ridiculous
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ASCs dont send patients to the hospital for pain control, regardless of regional. So no, they wouldn't be sending RCRs either.

Tylenol, toradol, decadron also dont reduce length of stay.

Thats a ridiculous metric to go by
 
I love them. I'm now doing them for every appy. Instead of 100 fentanyl, now I'm giving 50. The god damn pacu nurses are now giving an extra 50 compared to before.
 
dabears505 said:
I love them. I'm now doing them for every appy. Instead of 100 fentanyl, now I'm giving 50. The god damn pacu nurses are now giving an extra 50 compared to before.
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Except, before you did the blocks, you were giving 100mcg fent intraop, the nurses were adding Dilaudid in pacu while complaining that your patients always seemed more uncomfortable and nauseous compared to other other regional trained docs
 
what makes you think I’m not regional trained. 2007 fellowship. Actually worked at one of few places that started doing TAPs in 2010. Some of first eras protocols. How do you think I know they don’t change outcomes. It’s not the tap blocks, it’s common sense anesthesia. Multimodal. Early ambulating. Patient education. Tap blocks are a scam,

Probably done way more blocks than you have. Can’t say for sure but unless you graduated before me it’s likely. Used to teach for GE and sonosite. I just don’t drink the academic justify my existence nonsense cool aid. Let me know how much you believe in them in 3 years when you aren’t getting paid for them. Because you won’t. And I’ll be there supporting it
 
Howard888 said:
what makes you think I’m not regional trained. 2007 fellowship. Actually worked at one of few places that started doing TAPs in 2010. Some of first eras protocols. How do you think I know they don’t change outcomes. It’s not the tap blocks, it’s common sense anesthesia. Multimodal. Early ambulating. Patient education. Tap blocks are a scam,

Probably done way more blocks than you have. Can’t say for sure but unless you graduated before me it’s likely. Used to teach for GE and sonosite. I just don’t drink the academic justify my existence nonsense cool aid. Let me know how much you believe in them in 3 years when you aren’t getting paid for them. Because you won’t. And I’ll be there supporting it
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If you did, then you certainly should know not to expect a tap block to change length of stay...so it shouldn't be the metric used to justify their use. Local infiltration, tylenol, toradol, tramadol, blocks for ACLs wrist fractures, elbow surgery, ankle surgery...none of which reduce length of stay

The question was, whether they work and whether they work better than local infiltration.

I posted multiple studies, including RCTs, all of which show that they "work" (reduced pain scores, reduced opiod use, etc)

Meanwhile, i will continue to do them, as surgeons continue to request them..and ill continue to get paid to do them.

Edit

Found one anyways

pubmed.ncbi.nlm.nih.gov

Transversus abdominis plane blocks and enhanced recovery pathways: making the 23-h hospital stay a realistic goal after laparoscopic colorectal surgery - PubMed

A bilateral TAP block significantly improved the results of an established ERP for patients undergoing LC. Surgeon-administered TAP blocks may be an economical and efficient method for improving the results of LC.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

). The mean hospital stay was 2 days for the TAP patients and 3 days for the control patients (p = 0.000013). Of the 35 TAP patients, 13 went home on postoperative day (POD) 1 (37 %), 12 on POD 2 (34 %), 8 on POD 3 (23 %), and the remainder on POD 4. Of the 35 control patients, 1 went home on POD 1 (3 %), 10 on POD 2 (29 %), 10 on POD 3 (29 %), 11 on POD 4 (31 %), and the remainder on POD 5 to 8. The TAP patients required fewer narcotics postoperatively than the control patients (respective mean morphine equivalents, 31.08 vs. 85.41; p = 0.01
 
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UscGhost said:
I wouldn't be happy doing it thats for sure
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If you were salaried and your income was completely unrelated to billing or other production measures, would you do them?

I'm not sure why "reduced opioid use" is such a prized metric. I think we've swung too far in the anti-opioid direction because of the opioid epidemic. There ain't nothing at all wrong (or even undesirable!) with the average patient taking a couple extra oxycodone tablets in the first 24h after surgery.
 
pgg said:
If you were salaried and your income was completely unrelated to billing or other production measures, would you do them?

I'm not sure why "reduced opioid use" is such a prized metric. I think we've swung too far in the anti-opioid direction because of the opioid epidemic. There ain't nothing at all wrong (or even undesirable!) with the average patient taking a couple extra oxycodone tablets in the first 24h after surgery.
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I would do them. I dont like salaried models in general. I work fast and efficiently, and do procedures quickly, all things that are disincentivized in a salary model

More opiods causes more sedation, more nausea, and less overall satisfactory pain control.

The downsides of a couple extra oxy are bigger than the downsides of a 3 minute tap block
 
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pgg said:
If you were salaried and your income was completely unrelated to billing or other production measures, would you do them?

I'm not sure why "reduced opioid use" is such a prized metric. I think we've swung too far in the anti-opioid direction because of the opioid epidemic. There ain't nothing at all wrong (or even undesirable!) with the average patient taking a couple extra oxycodone tablets in the first 24h after surgery.
Click to expand...

If I'm not compensated for the risk of the procedure why would I do it
 

TRUMP CANCELS PAYMENT FOR “ANESTHESIOLOGY TAP BLOCKS,” CALLS THEM​

“THE MOST MYSTERIOUS BLOCKS SINCE MINECRAFT”

By Clarissa Pennington, Senior Correspondent for Medical Mysteries & Political Theatre

WASHINGTON, D.C. — In a move that shocked doctors, delighted late-night comedians, and baffled absolutely everyone else, President Donald Trump of the Alternate-Timeline Administration announced Friday that federal reimbursement for Anesthesiology TAP Blocks would be “terminated, revoked, deleted, unfunded, and possibly taken out back and fired.”

The president, speaking from the Rose Garden’s new gold-leaf podium (“because the old one didn’t shine enough”), declared:

“Look, TAP blocks—nobody knows what they do. I asked the doctors. I said, ‘Show me one!’ They couldn’t. Not one! They said it’s inside the body—well, if I can’t see it, how do I know it’s happening? We’re not paying for invisible things anymore.”
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The crowd, consisting largely of interns and three confused tourists, applauded with the restrained enthusiasm of people who weren’t sure whether they were part of a magic show.

MEDICAL COMMUNITY REACTS: “HE THINKS THEY’RE BLOCKS OF TAP WATER”​

Dr. Lenora Hubble, Chief of Anesthesiology at St. Ignatius Hospital of the Fourth Dimension, responded while clutching a stack of medical charts like a life raft:

“We have explained, repeatedly, that a TAP block is a nerve block. It is not a Lego. It is not a piece of pavement. It is not, as the president suggested, ‘a block of tap water.’ We use ultrasound for guidance. He asked if the ultrasound could ‘maybe turn the lights on inside the patient’ so he could watch.”
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Hubble then paused, stared into the middle distance, and requested a personal day.

ECONOMISTS BAFFLED, CONGRESS SHRUGS​

According to the Office of Alternate Budget Realities, the cancellation is expected to save the government “somewhere between $48 and a bag of assorted buttons,” depending on how strictly the new rules are applied.

Congress responded with its usual clarity:
  • Democrats criticized the policy, calling it “anti-science, anti-healthcare, and vaguely anti-common sense.”
  • Republicans praised it for “taking a bold stand against procedures that are difficult to pronounce.”
A bipartisan group briefly attempted to Google “What is a TAP block?” before giving up due to poor Wi-Fi.

THE AFTERMATH: HOSPITALS SCRAMBLE, LATE-NIGHT HOSTS CELEBRATE​

Hospitals across the alternate America are scrambling to adapt. Some are renaming TAP blocks to “Visible Procedures,” hoping it will satisfy the administration’s philosophical concerns.

Meanwhile, late-night host Jace Footman opened his show with:
“TAP blocks reduce pain after surgery. The president would know that if he had ever listened to a doctor for longer than six seconds. But sure—let’s stop paying for them. Can’t wait for next week’s announcement: ‘Gravity is canceled. It’s never done anything for me.’”
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