Design: Retrospective, single-institution cohort study

Setting: Academic-affiliated community hospital

Patients or Participants: 2982 patients who underwent minimally invasive total hysterectomy between January 2018 through December 2022. Patients were separated into three groups. 1) No TAP: 1966 patients (65.9%), 2) Preoperative TAP: 854 (28.6%) and 3) Postoperative TAP: 162 patients (5.4%)

Interventions: Summary statistics and mixed-effects regression methods were used to analyze the data

Measurements and Main Results: Comparing patients who received a TAP (either pre or postoperatively) to those who did not, there was a statistically significant lower usage of mean MME of opioids (43.2 vs 53.9, p=0.002). However, when comparing preoperative vs postoperative TAP block patients, there was no statistically significant difference in mean MME used (43.4 vs 42.1, p=0.752).

There were no differences in postoperative pain scores when comparing the same pairings, noting that more MME were required in patients who did not receive a TAP to achieve the same pain scores as patients who received a TAP.

Looking at time between procedure end to discharge home in hours, there was a statistically significant shorter time to discharge in TAP versus no TAP patients (10.28 vs 12.55, p<0.001) as well as preop versus postop TAP patients (9.88 vs 12.4, p=0.003).

Conclusion: Our study is the first of our knowledge to assess if the timing of the TAP block, whether it be preoperatively or postoperatively, has an effect on postoperative MME, pain scores, or time to discharge. Based on our data, the timing of the TAP block did not significantly affect postoperative milliequivalents of morphine use or pain scores, however a preoperative TAP was associated with a significantly shorter time to discharge.