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Obesity Surgery
Published in: Obesity Surgery 11/2018

01-11-2018 | Original Contributions

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

Authors: Jaime Ruiz-Tovar, Alejandro Garcia, Carlos Ferrigni, Juan Gonzalez, Cesar Levano-Linares, Montiel Jimenez-Fuertes, Carolina Llavero, Manuel Duran

Published in: Obesity Surgery | Issue 11/2018

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Abstract

Background

Despite the ultrasound guidance of transversus abdominis plane (TAP) blocks has allowed greater precision of needle placement in the desired tissue plane, visualization of the abdominal wall muscles can be hindered by morbid obesity and could lead to failed regional anesthesia. The aim of this study was to assess the feasibility and effect of laparoscopic-guided TAP block in patients undergoing Roux-en-Y gastric bypass and to compare it with port-site infiltration.

Patients and Methods

A prospective randomized clinical trial was performed. Patients were randomized into two groups: patients undergoing laparoscopic-guided TAP (TAP-lap) and patients undergoing port-site infiltration (PSI). Pain quantification as measured by visual analogic scale (VAS) and morphine needs during the first 24 h were evaluated.

Results

One hundred and forty patients were included, 70 in each group. The mean operation time was 83.3 + 15.6 min in TAP-lap and 80.5 + 14.4 min in PSI (NS). The mean postoperative pain, as measured by VAS, 24 h after surgery was 16.8 + 11.2 mm in PSI and 10 + 8.1 mm in TAP-lap (p = 0.001). Morphine rescues were necessary in 13.2% in PSI and 2.9% in TAP-lap (p = 0.026). The mean hospital stay was 2.1 + 1.2 days in TAP-lap and 2.9 + 1.3 days in PSI (p = 0.019). Hospital discharge during the first 48 h after surgery was possible in 52.9% of the patients in PSI and 71% in TAP-lap (OR 4.75; 95% CI 2.1–10.8; p = 0.029).

Conclusion

Laparoscopic-guided TAP block can reduce postoperative pain, opioid needs, and hospital stay, when compared with port-site infiltration with the same anesthetic drug, without increasing operation time.

Trial Registration

ClinicalTrials.gov Identifier: NCT03203070
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Metadata
Title
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
Authors
Jaime Ruiz-Tovar
Alejandro Garcia
Carlos Ferrigni
Juan Gonzalez
Cesar Levano-Linares
Montiel Jimenez-Fuertes
Carolina Llavero
Manuel Duran
Publication date
01-11-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 11/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3376-8

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