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theses

Purpose: The purpose of this review was to examine the evidence on post-operative outcomes associated with patients who receive the Transversus Abdominis Plan (TAP) block for pain management following major abdominal surgery.
Methodology: Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. Papers must have met any 7 out of 10 criteria on the JBI-QARI instrument in order to be included in the review. Also, to be included, papers must have scored a YES answer regarding the reliability of measurement and appropriateness of statistical tests used for analysis.
A three-step search strategy was utilized in this review. An initial limited search of Scopus, PubMed, Web of Science, Cochrane and CINAHL using keywords of TAP Block; abdominal surgery; anesthesia; enhanced recovery after surgery; length of stay was followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe article. An expanded second search using all identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference list of all identified reports and articles was searched for additional studies (footnote chasing). Studies published in English and full text were considered for inclusion in this review as well. A timeframe for studies was not included to increase the sensitivity of findings.
Results: A total of 17 articles of studies were used for this review. In total nine countries and 1,550 participants were represented in the final analysis of eight findings for this study. This Comprehensive Systematic Review examined numerous post-operative outcomes of patients who had major abdominal surgery with the TAP block compared to those who did not have the TAP block. Final synthesis determined that utilizing the TAP block is efficacious in decreasing the length of stay, earlier time to movement, reducing episodes of post-operative nausea and vomiting, earlier time to bowel movement, flatus and may decrease the time to the patient’s first requested dose of narcotics. There was not enough evidence found on time to urination in the literature search, therefore this outcome could not be analyzed.
Implications for Practice:
The results of this study support the use of TAP block in clinical practice, educational and economic implementation. Understanding the influences on opioid addiction along with the fact that the TAP block has only been in use for less than 20 years, allows the opportunity to provide evidence-based practice educational training to health care providers to enhance their knowledge of care for the patient receiving the TAP Block. Knowledge translation of the TAP Block should be provided to staff members caring for the patient who receives the TAP Block.
The development of a comprehensive education module for medical and nursing students/professionals about the assessments of patients receiving the TAP Block can be completed and implemented into the practice setting. It is anticipated that the after implementing use of the educational module, the knowledge of medical and nursing students will be enhanced on assessment of patients who receive the TAP Block.
The opioid epidemic has fiscal implications from legal involvement, healthcare intervention, loss of productivity and treatment for addictions. The medical community has an ethical responsibility to explore ways to prevent the misuse of opioids. With this study’s findings medical efficacy has been supported. The impact this has in terms of cost efficiency, quality and safety should further be explored.
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ETD_10180

DNP

Includes bibliographical references

doi:10.7282/t3-gd5d-rr16

ETD doctoral

The author owns the copyright to this work.