Effect of preoperative versus postoperative use of transversus abdominis plane block with plain 0.25 % bupivacaine on postoperative opioid use: a retrospective study.

BACKGROUND: Enhanced recovery protocols optimize pain control via multimodal approaches that include transversus abdominis plane (TAP) block. The aim of this study was to evaluate the effect of preoperative vs. postoperative plain 0.25 % bupivacaine TAP block on postoperative opioid use after colorectal surgery. METHODS: A retrospective cohort study comparing postoperative opioid use in patients who received preoperative (n = 240) vs. postoperative (n = 22) plain 0.25 % bupivacaine TAP blocks. The study was conducted in a single tertiary care institution and included patients who underwent colorectal resections between August 2018 and January 2020. The primary outcome of the study was postoperative opioid use. Secondary outcomes included operative details, length of stay, reoperation, and readmission rates. RESULTS: Patients who received postoperative plain 0.25 % bupivacaine TAP blocks were less likely to require postoperative patient-controlled analgesia (PCA) (59.1 % vs. 83.3 %; p = 0.012) and opioid medications on discharge (6.4 % vs. 16.9 %; p = 0.004) relative to patients who received preoperative TAP. When needed, a significantly smaller amount of opioid was prescribed to the postoperative group (84.5 vs. 32.0 mg, p = 0.047). No significant differences were noted in the duration of postoperative PCA use, amount of oral opioid use, and length of stay. CONCLUSIONS: Plain 0.25 % bupivacaine TAP block administered postoperatively was associated with significantly lower need for postoperative PCA and discharge opioid medications. The overall hospital length of stay was not affected by the timing of TAP block. Because of the limited sample size in this study, conclusions cannot be generalized, and more research will be required.

Fourteen-year experience of a tertiary hospital transfusion committee in West Africa.

BACKGROUND: Hospital transfusion committees (HTCs) have been established in the United States to link producers and users as well as to ensure appropriate use of blood. The HTC has been little reported in sub-Saharan Africa (SSA), although it has been established in some hospitals. STUDY DESIGN AND METHODS: The minutes of three to four HTC meetings per year in a tertiary hospital hosting its own blood service have been reviewed to examine the HTC role over a period of 14 years. Minutes were broken down into themes and indexes, and incomplete data were reinforced by other information sources. Specific data on progress over time were reviewed. RESULTS: The HTC systematically scrutinized the blood supply, blood safety, donor care, clinical use of blood products, and costs. It operated more as a blood transfusion service supervisory board than the limited function allocated to western HTCs. Clinicians and hospital administration were directly involved in decision making and directing investigations to support potential changes and advances in the role and function of the blood transfusion service. The close relation with a UK major blood center and university laboratory provided the impetus and support for research and investigations preliminary to decision making. Data collected and analyzed were reported in the international literature and contributed to disseminate progress made. CONCLUSIONS: The HTC in a major SSA tertiary hospital inclusive of all sections of hospital organization was critically instrumental in decision making, funding, and implementing measures improving the amount and quality of blood products on the basis of evidence collected despite lack of resources. Steps are taken to ensure sustainability of the HTC.

A pool of repeat blood donors can be generated with little expense to the blood center in sub-Saharan Africa.

BACKGROUND: In sub-Saharan Africa, most collected blood originates from accessible and cheaper replacement donors while recruiting and retaining volunteers requires considerable costs not all countries can afford. The Kumasi Teaching Hospital Blood Center and a local FM radio station developed a partnership calling three times a year for donation at the radio station where music, entertainment, and token gifts were available. STUDY DESIGN AND METHODS: To assess the program's impact, attendance, deferral, age, sex, identification, and viral test results of donors attending 12 consecutive sessions in 2003 through 2006 were analyzed, and this donor population was compared to other types of donors in Kumasi, Ghana. RESULTS: A total of 3801 donors attended the program and 92 percent of the potential FM donors were eligible to donate compared to 85.5 and 70.3 percent of other volunteer and replacement donors, respectively. Ninety percent of donors were male (median, 25 years) and 4.9 percent were hepatitis B surface antigen-positive compared to 11 and 15 percent in other volunteer and replacement donors. This reflected 63.6 percent spontaneous repeat donations from donors responding to the radio appeal compared to 15 to 30 percent in other volunteer donors. CONCLUSIONS: It has been demonstrated that the use of a culturally and socially adapted environment to make the gift of blood a pleasurable and festive experience generated a new pool of blood donors spontaneously repeating donations. This program indicates that retaining Ghanaian blood donors is possible at little extra cost to the blood center and that such an approach may represent a substantial help in the efforts of sub-Saharan Africa to collect volunteer blood.