The TAP Block: A Multimodal Regional Analgesic Approach to Abdominal Surgery

Abstract

Purpose: The purpose of this quality improvement project is to increase the anesthesia providers’ knowledge and willingness to perform transversus abdominis plane (TAP) block as part of a multimodal regional anesthesia approach to abdominal surgery through an in-person educational presentation at Arrowhead Regional Medical Center (ARMC).Background: The TAP block plays a role in minimizing opioid requirements after abdominal surgery, with ample evidence showing the positive analgesic effects, safety, and effectiveness of outcomes. However, many anesthesia providers do not use this block as part of a multimodal regional anesthesia technique for abdominal surgery. Evidence-based education is one strategy to increase knowledge and willingness to use the TAP block as part of the anesthetic plan to manage postoperative abdominal pain. Methods: The design is an in-person educational presentation to increase ARMC anesthesia providers’ knowledge and willingness to use a multimodal regional anesthesia technique for abdominal surgery. After an extensive literature review, the project implementer (PI) created a TAP block educational presentation. The PI will deliver an in-person evidence-based educational training to anesthesia providers via a PowerPoint presentation, assess current knowledge and utilization with a post-pre survey, and evaluate the change in knowledge and willingness to use the TAP block as a multimodal regional anesthesia technique after the education was provided. Results: A total of 24 anesthesia providers attended the educational presentation and completed the post-pre-survey, including three physician anesthesiologists, three certified registered nurse anesthesiologists (CRNA), and 18 resident registered nurse anesthesiologists (RRNA). The knowledge and willingness to utilize the TAP block increased in a statistically significant way after the in-person evidence-based educational presentation (p<0.05). Conclusions: Adequate perioperative surgical pain management after abdominal surgery can be challenging for anesthesia providers as they seek to balance analgesia practice reliant heavily on opioid administration, the potential for opioid misuse and its negative side effects, and multimodal analgesic techniques such as the TAP block. This QI project demonstrated that providing anesthesia providers with an in-person evidence-based TAP block educational presentation increases their knowledge and willingness to implement the TAP block as part of a multimodal regional analgesia postoperative pain management approach for abdominal surgery. However, barriers persist in TAP block utilization, such as a change in department culture to implement a workflow that facilitates performing the TAP block.