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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

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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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Authors and Affiliations

  1. Centro de Excelencia para el Estudio y Tratamiento de la Obesidad, Valladolid, Spain

    Jaime Ruiz-Tovar

  2. Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Madrid, Spain

    Jaime Ruiz-Tovar, Alejandro Garcia, Carlos Ferrigni, Juan Gonzalez, Cesar Levano-Linares, Montiel Jimenez-Fuertes & Manuel Duran

  3. Obesity Unit, Garcilaso Clinic, Madrid, Spain

    Jaime Ruiz-Tovar & Carolina Llavero

Authors
  1. Jaime Ruiz-Tovar
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  2. Alejandro Garcia
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  3. Carlos Ferrigni
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  4. Juan Gonzalez
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  5. Cesar Levano-Linares
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  6. Montiel Jimenez-Fuertes
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  7. Carolina Llavero
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  8. Manuel Duran
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Correspondence to Jaime Ruiz-Tovar.

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The authors declare that they have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human Rights

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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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 28, 3374–3379 (2018). https://doi.org/10.1007/s11695-018-3376-8

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  • DOI: https://doi.org/10.1007/s11695-018-3376-8

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