Evidence map›Paper›PMID 42498863›Full record

ArticleSurgical endoscopy2026

Opioid-sparing multimodal pain regimen in combination with intraoperative transversus abdominis plane block reduces opioid use after laparoscopic paraesophageal hernia repair.

Sophie Lipson, Nicolas Cassata, Sundarachalam Pindicura, Joseph Chronowski, Vladan Obradovic, Osama Shaheen, Ryan Horsley, Alexandra Falvo, Mark Mahan, Anthony T Petrick and 1 more

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Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Sophie LipsonGeisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
Nicolas CassataGeisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
Sundarachalam PindicuraGeisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
Joseph ChronowskiGeisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
Vladan ObradovicGeisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
Osama ShaheenGeisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
Ryan HorsleyGeisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
Alexandra FalvoGeisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
Mark MahanGeisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
Anthony T PetrickGeisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
David M ParkerGeisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA. dparker@geisinger.edu.ORCID http://orcid.org/0000-0002-7722-9079

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThis study evaluated whether a perioperative opioid-sparing multimodal pain regimen with intraoperative transversus abdominis plane (TAP) block reduces opioid use after laparoscopic paraesophageal hernia (PEH) repair while maintaining pain control.

methodsA retrospective chart review identified patients who underwent laparoscopic PEH repair at our institution from January 2010 to April 2025. Patients were grouped before and after implementation of a multimodal regimen with TAP block (July 2017). The regimen included scheduled acetaminophen and celecoxib. Outcomes included inpatient and follow-up pain scores (0-10), inpatient morphine milligram equivalents (MME), and opioid prescriptions at discharge or within 30 days. Statistical analysis included chi-squared, t tests, nonparametric tests, and multivariate analysis.

resultsA total of 2539 patients were included (813 pre-regimen, 1726 post-regimen). Inpatient opioid use decreased from 86% to 67.6% (p < 0.001), and inpatient oral MME was significantly lower post-regimen (p < 0.001). Opioid prescriptions at discharge declined from 94.7% to 20.6% (p < 0.001). Median inpatient and follow-up pain scores were lower in the multimodal group (p < 0.0001 and p = 0.015). After adjusting for demographics, maximum inpatient pain score, and additional procedures at time of surgery, the post-regimen group remained associated with reduced inpatient opioid use (OR 0.36, p < 0.001). Median length of stay decreased from 2 to 1 day (p < 0.001). 30-day ED visits and readmissions were not significantly different (p = 0.116 and p = 0.404).

conclusionImplementation of a multimodal opioid-sparing regimen with intraoperative TAP block reduced inpatient and post-discharge opioid use after laparoscopic PEH repair, with lower pain scores and shorter hospital stays without increased ED visits or readmissions.

Indexed as

Analgesics, OpioidHernia, HiatalHerniorrhaphyLaparoscopyNerve BlockPain ManagementPostoperative PainAbdominal MusclesAgedFemaleHumansMaleMiddle AgedPain MeasurementRetrospective StudiesAnalgesics, OpioidLaparoscopic paraesophageal hernia repairMultimodal analgesiaOpioid-sparing strategyTransversus abdominis plane block

Identifiers

PMID42498863

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.