Analgesic effect of postoperative laparoscopic-guided transversus abdominis plane (TAP) block, associated with preoperative port-site infiltration, within an enhanced recovery after surgery protocol in one-anastomosis gastric bypass: a randomized clinical trial

Abstract

Background

The use of ultrasonography to assist needle placement during transverse abdominal plane (TAP) technique has provided direct visualization of surround anatomical musculature and facial planes. However, the increased girth in patients undergoing bariatric surgery is challenging to visualize via ultrasonography which may lead to poor postoperative analgesia.

Objective

The aim of the study is to investigate whether the addition of postoperative laparoscopic-guided TAP block as part of a multimodal analgesic regimen within the ERAS protocol compared to no block provides better postoperative analgesia in patients undergoing one-anastomosis gastric bypass surgery.

Patients and methods

A prospective clinical trial was performed. Patients were randomized into two groups: patients undergoing postoperative laparoscopic-guided TAP (TAP-lap) and patients not receiving TAP-lap (Control). Multimodal analgesia included preoperative port-site infiltration with Bupivacaine 0.25% in both groups and systemic Acetaminophen. Pain quantification as measured by visual analogic scale (VAS) was assessed at 6 and 24 h after surgery, and 24-h postoperative opioid consumption.

Results

One hundred and forty patients were included, 70 in each group. The mean operation time was 78.5 ± 14.4 min in TAP-lap and 75.9 ± 15.6 min in Control (NS). The mean postoperative pain, as measured by VAS, 6 h after surgery was 23.1 ± 11.3 mm in TAP-lap and 41.8 ± 16.2 mm in Control (p = 0.001).

24 h after surgery was 16.6 ± 11.4 mm in TAP-lap and 35.4 ± 12.7 mm in Control (p = 0.001).

Morphine rescues were necessary in 14.2% in Control and 2.8% in TAP-lap (p = 0.035).

Conclusion

Laparoscopic-guided TAP block as part of a multimodal analgesia regimen can reduce postoperative pain and opioid consumption, without increasing operative time.

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Correspondence to Jaime Ruiz-Tovar.

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Disclosures

Jaime Ruiz-Tovar, MD, PhD; Gilberto Gonzalez, MD; Andrei Sarmiento, MD; Miguel A. Carbajo, MD, PhD; Javier Ortiz-de-Solorzano, MD; Maria Jose Castro, MD, PhD; Jose Maria Jimenez, PhD; and Lorea Zubiaga, MD, PhD have no conflicts of interest or financial ties to disclose.

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Ruiz-Tovar, J., Gonzalez, G., Sarmiento, A. et al. Analgesic effect of postoperative laparoscopic-guided transversus abdominis plane (TAP) block, associated with preoperative port-site infiltration, within an enhanced recovery after surgery protocol in one-anastomosis gastric bypass: a randomized clinical trial. Surg Endosc 34, 5455–5460 (2020). https://doi.org/10.1007/s00464-019-07341-5

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Keywords

  • Transversus abdominis plane block
  • TAP
  • One-anastomosis gastric bypass
  • OAGB
  • Enhanced recovery after surgery
  • ERAS
  • Multimodal analgesia
  • Postoperative pain