Laparoscopic-Assisted Transversus Abdominis Plane (TAP) Block Versus Port-Site Infiltration with Local Anesthetics in Bariatric Surgery: a Double-Blind Randomized Controlled Trial

Overview

Journal Obes Surg

Date 2023 Sep 23

PMID 37740830

Authors

Francesco Mongelli

Michele Marengo

Maria Vittoria Bertoni

Francesco Volonte

Nicola Susan Ledingham

Fabio Garofalo

Affiliations

Soon will be listed here.

Abstract

Background: The transversus abdominis plane (TAP) block has shown great potential usefulness in the management of postoperative pain; however, there is lacking evidence regarding its use in bariatric surgery. This randomized double-blind trial was aimed at comparing the effectiveness of the TAP block and port-site infiltration (PSI) in patients undergoing bariatric surgery.

Methods: We included patients ≥ 18 years old undergoing bariatric surgery. From July 2020 to July 2021, all eligible patients were randomized to receive either laparoscopic-assisted TAP block or PSI. Demographic and clinical data were collected and analyzed.

Results: During the study period, we included 113 patients. Fifty-one were allocated to the TAP block group and 62 to the PSI group. The mean age was 47.9 ± 11.2 years, 88 (77.9%) patients were female, and mean BMI was 40.5 ± 5.9 kg/m. Operative time was 110 ± 42 min vs. 114 ± 41 min in the TAP block and PSI groups (p = 0.658). At 24 h after surgery, pain on the VAS was 2.5 ± 2.6 vs. 2.3 ± 2.1 (p = 0.661). No significant difference between the groups was noted at 3, 6, 12, and 18 h. Also, opioid and antiemetic consumption, the length of stay (3.4 ± 1.5 days vs. 3.2 ± 1.1 days, p = 0.392), and satisfaction score (154 ± 10 pts vs. 154 ± 16 pts, p = 0.828) were similar in the two groups.

Conclusions: Patients undergoing bariatric surgery and receiving either the TAP block or the PSI had similar postoperative pain, nausea, length of stay, and satisfaction. As PSI is technically easier and more reproducible, it might be the first choice for postoperative multimodal analgesia in bariatric surgery.

Citing Articles

Influence of Intraoperative Pain Management on Postoperative Delirium in Elderly Patients: A Prospective Single-Center Randomized Controlled Trial.

Du Y, Cao J, Gao C, He K, Wang S Pain Ther. 2025; 14(1):387-400.

PMID: 39757288 PMC: 11751207. DOI: 10.1007/s40122-024-00702-6.

Laparoscopic-Guided Transversus Abdominis Plane (TAP) Block Combined with Port-Site Infiltration (PSI) for Laparoscopic Sleeve Gastrectomy in an ERABS Pathway: A Randomized, Prospective, Double-Blind, Placebo-Controlled Trial.

Cataldo R, Bruni V, Migliorelli S, Gallo I, Spagnolo G, Gibin G Obes Surg. 2024; 34(7):2475-2482.

PMID: 38764003 DOI: 10.1007/s11695-024-07292-4.

External Oblique Intercostal Plane Block Versus Port-Site Infiltration for Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study.

Doymus O, Ahiskalioglu A, Kaciroglu A, Bedir Z, Tayar S, Yeni M Obes Surg. 2024; 34(5):1826-1833.

PMID: 38565828 PMC: 11031609. DOI: 10.1007/s11695-024-07219-z.

References

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C . Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384(9945):766-81. PMC: 4624264. DOI: 10.1016/S0140-6736(14)60460-8. View

Torre A, Marengo M, Ledingham N, Ajani C, Volonte F, Garofalo F . Opioid-Free Anesthesia in Bariatric Surgery: a Propensity Score-Matched Analysis. Obes Surg. 2022; 32(5):1673-1680. DOI: 10.1007/s11695-022-06012-0. View

Aftab H, Fagerland M, Gondal G, Ghanima W, Olsen M, Nordby T . Gastric sleeve resection as day-case surgery: what affects the discharge time?. Surg Obes Relat Dis. 2019; 15(12):2018-2024. DOI: 10.1016/j.soard.2019.09.070. View

Oderda G, Senagore A, Morland K, Iqbal S, Kugel M, Liu S . Opioid-related respiratory and gastrointestinal adverse events in patients with acute postoperative pain: prevalence, predictors, and burden. J Pain Palliat Care Pharmacother. 2019; 33(3-4):82-97. DOI: 10.1080/15360288.2019.1668902. View

Mongelli F, Treglia G, La Regina D, Di Giuseppe M, Galafassi J, Majno-Hurst P . Pudendal Nerve Block in Hemorrhoid Surgery: A Systematic Review and Meta-analysis. Dis Colon Rectum. 2021; 64(5):617-631. DOI: 10.1097/DCR.0000000000001985. View

Rafi A . Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001; 56(10):1024-6. DOI: 10.1046/j.1365-2044.2001.02279-40.x. View

Seiler J, Chong A, Chen S . Laparoscopic-Assisted Transversus Abdominis Plane Block Is Superior to Port Site Infiltration in Reducing Post-Operative Opioid Use in Laparoscopic Surgery. Am Surg. 2022; 88(9):2094-2099. DOI: 10.1177/00031348221087923. View

Lorenzo N, Antoniou S, Batterham R, Busetto L, Godoroja D, Iossa A . Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surg Endosc. 2020; 34(6):2332-2358. PMC: 7214495. DOI: 10.1007/s00464-020-07555-y. View

Gero D, Vannijvel M, Okkema S, Deleus E, Lloyd A, Lo Menzo E . Defining Global Benchmarks in Elective Secondary Bariatric Surgery Comprising Conversional, Revisional, and Reversal Procedures. Ann Surg. 2021; 274(5):821-828. DOI: 10.1097/SLA.0000000000005117. View

10.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

11.

Caljouw M, van Beuzekom M, Boer F . Patient's satisfaction with perioperative care: development, validation, and application of a questionnaire. Br J Anaesth. 2008; 100(5):637-44. DOI: 10.1093/bja/aen034. View

12.

Ziemann-Gimmel P, Goldfarb A, Koppman J, Marema R . Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis. Br J Anaesth. 2014; 112(5):906-11. DOI: 10.1093/bja/aet551. View

13.

Elamin G, Waters P, Hamid H, OKeeffe H, Waldron R, Duggan M . Efficacy of a Laparoscopically Delivered Transversus Abdominis Plane Block Technique during Elective Laparoscopic Cholecystectomy: A Prospective, Double-Blind Randomized Trial. J Am Coll Surg. 2015; 221(2):335-44. DOI: 10.1016/j.jamcollsurg.2015.03.030. View

14.

Fields A, Gonzalez D, Chin E, Nguyen S, Zhang L, Divino C . Laparoscopic-Assisted Transversus Abdominis Plane Block for Postoperative Pain Control in Laparoscopic Ventral Hernia Repair: A Randomized Controlled Trial. J Am Coll Surg. 2015; 221(2):462-9. DOI: 10.1016/j.jamcollsurg.2015.04.007. View

15.

Rennick A, Atkinson T, Cimino N, Strassels S, McPherson M, Fudin J . Variability in Opioid Equivalence Calculations. Pain Med. 2015; 17(5):892-898. DOI: 10.1111/pme.12920. View

16.

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. DOI: 10.1007/s11695-012-0819-5. View

17.

Ruiz-Tovar J, Albrecht E, MacFarlane A, Coluzzi F . The TAP block in obese patients: pros and cons. Minerva Anestesiol. 2019; 85(9):1024-1031. DOI: 10.23736/S0375-9393.19.13545-6. View

18.

Lissauer J, Mancuso K, Merritt C, Prabhakar A, Kaye A, Urman R . Evolution of the transversus abdominis plane block and its role in postoperative analgesia. Best Pract Res Clin Anaesthesiol. 2014; 28(2):117-26. DOI: 10.1016/j.bpa.2014.04.001. View

19.

Mittal T, Dey A, Siddhartha R, Nali A, Sharma B, Malik V . 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(12):4985-4989. DOI: 10.1007/s00464-018-6261-6. View

20.

Chetwood A, Agrawal S, Hrouda D, Doyle P . Laparoscopic assisted transversus abdominis plane block: a novel insertion technique during laparoscopic nephrectomy. Anaesthesia. 2011; 66(4):317-8. DOI: 10.1111/j.1365-2044.2011.06664.x. View