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Can Postoperative Pain Be Prevented in Bariatric Surgery? Efficacy and Usability of Fascial Plane Blocks: a Retrospective Clinical Study

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Abstract

Background

Providing analgesia after bariatric surgery might be challenging due to a high prevalence of obstructive sleep apnea syndrome and the increased sensitivity to respiratory depression triggered by opioid overuse after surgery. Various combination methods with paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and other pain medications such as ketamine or gabapentin have been suggested for reduction of the opioid usage. Regional anesthetic techniques represent a valuable option as they improve patient comfort while reducing opioid-related side effects. In this study, we have evaluated the adjuvant benefits of these various techniques in reduction of the postoperative pain in bariatric surgery.

Methods

After the approval of the IRB Ethics Committee, the records of the patients who had laparoscopic bariatric surgery between January 2019 and December 2021 were reviewed retrospectively.

Results

Records of 120 patients who underwent laparoscopic bariatric surgery between January 2019 and December 2021 were reviewed. In total, 113 patients with full documentation were included in this study. Among these, 74 patients were administered regional analgesia. The main regional analgesia techniques were transversus abdominis plane and rectus sheath block. The pain scores of those receiving regional analgesia were statistically low. The opioid consumption after transversus abdominis plane and rectus sheath block was significantly lower than that of others. External oblique intercostal block alone provides a postoperative opioid consumption similar to those of transversus abdominis plane and rectus sheath block.

Conclusion

The use of fascial plane blocks in bariatric surgery significantly reduces opioid consumption. Transversus abdominis plane and rectus sheath block combination and external oblique intercostal block seem to be the most effective options.

Clinical Trials Number

NCT05284695.

Graphical abstract

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Abbreviations

TAP:

Transversus abdominis plane block

QLBs:

Quadratus lumborum blocks

RB:

Rectus sheath block

ASA:

American Society of Anesthesiologists Physical Status

MAC:

Minimum alveolar concentration

PCA:

Patient controlled analgesia

NRS:

Numeric rating scale

PACU:

Postanesthesia care unit

EOI:

External oblique intercostal block

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Acknowledgements

We are grateful to Deniz Akbay, MD, for the illustrations and Ms. Aslı Baygül for the statistical analysis assistance and supervision.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Clinic, VKV American Hospital, Istanbul, Turkey

    Sami Kaan Coşarcan, Alper Tunga Doğan & Ömür Erçelen

  2. Department of General Surgery – Bariatric and Metabolic Surgery Unit, VKV American Hospital, Istanbul, Turkey

    Yunus Yavuz

  3. Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey

    Yunus Yavuz

  4. Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey

    Ömür Erçelen

Authors
  1. Sami Kaan Coşarcan
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  2. Yunus Yavuz
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  4. Ömür Erçelen
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Contributions

SKC was involved with the conception, planning, and design of the study, study conduct, acquisition of data, review of data, data interpretation, and reporting/preparation of the manuscript. ATD was involved with the study conduct, review of data, and preparation of the manuscript. YY was involved with the acquisition of data, review of data, data interpretation, and review of manuscript. ÖE was involved with the acquisition of data, review of data, data interpretation, and review of the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Sami Kaan Coşarcan.

Ethics declarations

Ethics Approval

The study was approved by Koç University Clinical Research Ethics Committee (2021.466.IRB1.133) on January 02, 2022. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Consent to Participate

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

Conflict of Interest

The authors declare no competing interests.

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Key Points

• The pain scores of those receiving regional analgesia were statistically low.

• The opioid consumption after transversus abdominis plane and rectus sheath block were significantly lower than others.

• External oblique intercostal block alone provides a postoperative opioid consumption similar to those of transversus abdominis plane and rectus sheath block.

• External oblique intercostal block may be the first choice in bariatric surgery because it is easy to apply in patients with obesity and has effective analgesia.

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Cite this article

Coşarcan, S.K., Yavuz, Y., Doğan, A.T. et al. Can Postoperative Pain Be Prevented in Bariatric Surgery? Efficacy and Usability of Fascial Plane Blocks: a Retrospective Clinical Study. OBES SURG 32, 2921–2929 (2022). https://doi.org/10.1007/s11695-022-06184-9

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  • DOI: https://doi.org/10.1007/s11695-022-06184-9

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