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Preoperative Transversus Abdominis Plane (TAP) Block with Liposomal Bupivacaine for Bariatric Patients to Reduce the Use of Opioid Analgesics

  • Rena C. Moon
  • Linda Lastrapes
  • Jameson Wier
  • Mark Nakajima
  • Wyatt Gaskins
  • Andre F. Teixeira
  • Muhammad A. JawadEmail author
Original Contributions
  • 43 Downloads

Abstract

Introduction

Postoperative pain remains the most common challenge following inpatient and outpatient surgeries, and, therefore, opioid analgesics are widely used during the perioperative period. The aim of this study is to examine the efficiency of transversus abdominis plane (TAP) block using liposomal bupivacaine in reducing the use of opioid analgesics during the perioperative period of bariatric procedures.

Material and Methods

A retrospective chart review was performed on 191 patients who underwent a laparoscopic bariatric procedure between September 13, 2017, and February 26, 2018. A total of 97 patients received TAP block with liposomal bupivacaine, and 94 patients did not receive TAP block.

Results

Baseline patient characteristics were comparable between the two groups. The mean age was 43.7 and 41.1 years, and the mean preoperative body mass index (BMI) was 45.6 and 46.1 kg/m2 in TAP and non-TAP groups, respectively. In the TAP group, 65 patients (69.2%) received intravenous (IV) hydromorphone or morphine while 93 (95.9%) did in the non-TAP group (p < 0.0001). In the TAP group, 44 (46.8%) received oral opioid analgesic while 73 (75.3%) did in the non-TAP group (p < 0.0001). The odds of receiving IV hydromorphone or morphine for TAP group was about 0.10 times the corresponding odds for non-TAP group, and the odds of receiving oral opioid analgesic for the TAP group was about 0.29 times the corresponding odds for the non-TAP group.

Conclusion

The use of preoperative TAP block with liposomal bupivacaine significantly decreased the use of IV and oral opioid analgesics. A larger prospective study may be needed to further validate the results.

Keywords

Preoperative Transversus abdominis plane block Liposomal bupivacaine Postoperative pain Bariatric Opioid Narcotic 

Notes

Acknowledgements

The authors would like to thank Dr. Kevin Funez, and other anesthesiologists in the Wolverine Anesthesia Consultants Inc. for performing ultrasound-guided TAP for our patients.

Compliance with Ethical Standards

Conflict of Interest

Authors Moon, Lastrapes, Wier, Nakajima, Gaskins, Teixeira, and Jawad have no commercial associations that might be a conflict of interest in relation to this article.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

Does not apply.

References

  1. 1.
    Bartels K, Mayes LM, Dingmann C, et al. Opioid use and storage patterns by patients after hospital discharge following surgery. PLoS One. 2016;11(1):e0147972.CrossRefGoogle Scholar
  2. 2.
    Koepke EJ, Manning EL, Miller TE, et al. The rising tide of opioid use and abuse: the role of the anesthesiologist. Perioper Med (Lond). 2018;7:16.CrossRefGoogle Scholar
  3. 3.
    Beloeil H, Laviolle B, Menard C, et al. POFA trial study protocol: a multicentre, double-blind, randomised, controlled clinical trial comparing opioid-free versus opioid anaesthesia on postoperative opioid-related adverse events after major or intermediate non-cardiac surgery. BMJ Open. 2018;8(6):e020873.CrossRefGoogle Scholar
  4. 4.
    Singh R, Kumar N, Jain A, et al. Addition of clonidine to bupivacaine in transversus abdominis plane block prolongs postoperative analgesia after cesarean section. J Anaesthesiol Clin Pharmacol. 2016;32(4):501–4.CrossRefGoogle Scholar
  5. 5.
    Ma N, Duncan JK, Scarfe AJ, et al. Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis. J Anesth. 2017;31(3):432–52.CrossRefGoogle Scholar
  6. 6.
    Albrecht E, Kirkham KR, Endersby RV, et al. Ultrasound-guided transversus abdominis plane (TAP) block for laparoscopic gastric-bypass surgery: a prospective randomized controlled double-blinded trial. Obes Surg. 2013;23(8):1309–14.CrossRefGoogle Scholar
  7. 7.
    Saber AA, Lee YC, Chandrasekaran A, et al. Efficacy of transversus abdominis plane (TAP) block in pain management after laparoscopic sleeve gastrectomy (LSG): a double-blind randomized controlled trial. Am J Surg. 2019;217:126–32.Google Scholar
  8. 8.
    Wassef M, Lee DY, Levine JL, et al. Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery. J Pain Res. 2013;6:837–41.CrossRefGoogle Scholar
  9. 9.
    Sinha A, Jayaraman L, Punhani D. Efficacy of ultrasound-guided transversus abdominis plane block after laparoscopic bariatric surgery: a double blind, randomized, controlled study. Obes Surg. 2013;23(4):548–53.CrossRefGoogle Scholar
  10. 10.
    Mittal T, Dey A, Siddhartha R, et al. Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic gastric sleeve resection: a randomized single blinded case control study. Surg Endosc. 2018;32:4985–9.CrossRefGoogle Scholar
  11. 11.
    Ruiz-Tovar J, Garcia A, Ferrigni C, et al. Laparoscopic-guided transversus abdominis plane (TAP) block as part of multimodal analgesia in laparoscopic Roux-en-Y gastric bypass within an enhanced recovery after surgery (ERAS) program: a prospective randomized clinical trial. Obes Surg. 2018;28(11):3374–9.CrossRefGoogle Scholar
  12. 12.
    Candiotti K. Liposomal bupivacaine: an innovative nonopioid local analgesic for the management of postsurgical pain. Pharmacotherapy. 2012;32(9 Suppl):19S–26S.CrossRefGoogle Scholar
  13. 13.
    Bhakta A, Glotzer O, Ata A, et al. Analgesic efficacy of laparoscopic-guided transverse abdominis plane block using liposomal bupivacaine in bariatric surgery. Am J Surg. 2018;215(4):643–6.CrossRefGoogle Scholar
  14. 14.
    Said AM, Balamoun HA. Continuous transversus abdominis plane blocks via laparoscopically placed catheters for bariatric surgery. Obes Surg. 2017;27(10):2575–82.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Bariatric SurgeryOrlando Regional Medical Center, Orlando HealthOrlandoUSA
  2. 2.Wolverine Anesthesia Consultants IncOrlandoUSA

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