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Laparoscopic-guided transversus abdominis plane block following laparoscopic sleeve gastrectomy is associated with an earlier return to activity: a study of 271 patients

  • 2019 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The morbidly obese (MO) patient presents a unique challenge to pain control in the postoperative period due to associated comorbidities and the amplified impact of opiates. In order to reduce potential complications associated with narcotic use in the MO patient, multimodal analgesia has been advocated. In this study, we examined the effect of laparoscopic-guided transversus abdominis plane block (LG TAP) for further optimizing multimodal pain control.

Methods

This is a retrospective analysis of a prospectively collected database of 140 consecutive patients undergoing LSG without TAP block (pre-TAP group) compared to 131 patients undergoing LSG with LGTAP (TAP group). All operations were performed laparoscopically utilizing uniform clinical pathways. Baseline characteristics for both groups were comparable. Both groups received standardized anesthesia. Outcomes included time to postoperative ambulation, pain scores, PCA volume, length of hospital stay, utilization of oral opiate medications, and return to activity (RTA).

Results

Pre-TAP versus TAP groups were comparable, mean age 42 years (p = 0.99), women 81.4% versus 87.8% (p = 0.148), mean BMI (kg/m2) 46 versus 45 (p = 0.394). Most patients ambulated within 2 h after arrival to the floor (87.9% vs. 76.3%, p = 0.013). On postoperative day (POD) 1, mean reported pain score (0–10) was 4.50 vs. 5.06 (p = 0.063) and a mean PCA morphine used for 24 h was 26.3 mL versus 26 mL, p = 0.35. Mean days of postoperative opiate medication were 2.19 versus 1.24 (p < 0.001). Return to activity was 2.81 versus 2.08 days (p < 0.001). When controlled for age, BMI, OR time, PCA volume used, and average pain score, TAP block was an independent predictor of earlier return to activities (p < 0.001).

Conclusions

LGTAP block following LSG is an additional valuable modality of pain control in the perioperative period. Our study shows that TAP block is associated with an earlier RTA and decreased opiate use in patients undergoing LSG.

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References

  1. Hollander SW, Sifft A, Hess S, Klingen HJ, Djalali P, Birk D (2015) Identifying the bariatric patient at risk for pulmonary embolism: prospective Clinical Trial using duplex sonography and blood screening. Obes Surg 25:2011–2017

    Article  Google Scholar 

  2. Ahmad S, Nagle A, McCarthy RJ, Fitzgerald P, Sullivan J, Prystowsky J (2008) Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg 107:138–143

    Article  Google Scholar 

  3. Tao W, Plecka-Ostlund M, Lu Y, Mattsson F, Lagergren J (2015) Causes and risk factors for mortality within 1 year after obesity surgery in a population-based cohort study. Surg Obes Relat Dis 11:399–405

    Article  Google Scholar 

  4. Apfelbaum JL, Ashburn MA, Connis RT, Gan TJ, Nickinovich DG, Caplan RA, Carr DB, Ginsberg B, Green CR, Lema MJ, Rice LJ (2012) Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on acute pain management. Anesthesiology 116:248–273

    Article  Google Scholar 

  5. Rafi AN (2001) Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 56:1024–1026

    Article  CAS  Google Scholar 

  6. Sandeman DJ, Bennett M, Dilley AV, Perczuk A, Lim S, Kelly KJ (2011) Ultrasound-guided transversus abdominis plane blocks for laparoscopic appendicectomy in children: a prospective randomized trial. Br J Anaesth. https://doi.org/10.1093/bja/aer069

    Article  PubMed  Google Scholar 

  7. Ganapathy S, Sondekoppam RV, Terlecki M, Brookes J, Das Adhikary S, Subramanian L (2015) Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery. Eur J Anaesthesiol. https://doi.org/10.1097/EJA.0000000000000345

    Article  PubMed  Google Scholar 

  8. Ruiz-Tovar J, Garcia A, Ferrigni C, Gonzalez J, Levano-Linares C, Jimenez-Fuertes M, Llavero C, Duran M (2018) 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

    Article  Google Scholar 

  9. Keller DS, Delaney CP, Senagore AJ, Feldman LS, Force SST (2016) Uptake of enhanced recovery practices by SAGES members: a survey. Surg Endosc 31(9):3519–3526

    Article  Google Scholar 

  10. Bhakta A, Glotzer O, Ata A, Tafen M, Stain SC, Singh PT (2018) Analgesic efficacy of laparoscopic-guided transverse abdominis plane block using liposomal bupivacaine in bariatric surgery. Am J Surg 215:643–646

    Article  Google Scholar 

  11. Chetwood A, Agrawal S, Hrouda D, Doyle P (2011) Laparoscopic assisted transversus abdominis plane block: a novel insertion technique during laparoscopic nephrectomy. Anaesthesia 66(4):317–318

    Article  CAS  Google Scholar 

  12. Tihan D, Totoz T, Tokocin M, Ercan G, Koc TC, Vartanoglu T et al (2016) Efficacy of laparoscopic transversus abdominis plane block for elective laparoscopic cholecystectomy in elderly patients. Bosn J Basic Med Sci 16(2):139–144

    PubMed  PubMed Central  Google Scholar 

  13. Finucane MM, Stevens GA, Cowan MJ, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN, Farzadfar F, Riley LM, Ezzati M (2011) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9 1 million participants. Lancet 377:557–567

    Article  Google Scholar 

  14. Flegal KM, Carroll MD, Kit BK, Ogden CL (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 307:491–497

    Article  Google Scholar 

  15. Sherry B, Blanck HM, Galuska DA, Pan L, Dietz WH, Balluz L (2010) Vital signs: state-specific obesity prevalence among adults—United States, 2009. MMWR Morb Mortal Wkly Rep 6(59):951–955

    Google Scholar 

  16. Koepke EJ, Manning EL, Miller TE, Ganesh A, Williams DGA, Manning MW (2018) The rising tide of opioid use and abuse: the role of the anesthesiologist. Perioper Med (Lond). https://doi.org/10.1186/s13741-018-0097-4

    Article  Google Scholar 

  17. Lee JS, Hu HM, Edelman AL, Brummett CM, Englesbe MJ, Waljee JF, Smerage JB, Griggs JJ, Nathan H, Jeruss JS, Dossett LA (2017) New persistent opioid use among patients with cancer after curative-intent surgery. J Clin Oncol. https://doi.org/10.1200/JCO.2017.74.1363

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gagner M, Hutchinson C, Rosenthal R (2018) Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis 12:750–756

    Article  Google Scholar 

  19. Ponce J, DeMaria EJ, Nguyen NT et al (2016) American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis 12:1637–1639

    Article  Google Scholar 

  20. Mittal T, Dey A, Siddhartha R, Nali A, Sharma B, Malik V (2018) 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 32:4985–4989

    Article  Google Scholar 

  21. Wassef M, Lee DY, Levine JL, Ross RE, Guend H, Vandepitte C, Hadzic A, Teixeira J (2013) Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery. J Pain Res 6:837–841

    Article  Google Scholar 

  22. Park SY, Park JS, Choi GS, Kim HJ, Moon S, Yeo J (2017) Comparison of analgesic efficacy of laparoscope-assisted and ultrasound-guided transversus abdominis plane block after laparoscopic colorectal operation: a Randomized, Single-Blind, Non-Inferiority Trial. J Am Coll Surg 225:403–410

    Article  Google Scholar 

  23. Lancaster P, Chadwick M (2010) Liver trauma secondary to ultrasound-guided transversus abdominis plane block. Br J Anaesth 104:509–510

    Article  CAS  Google Scholar 

  24. Paller CJ et al (2009) Sex-based differences in pain perception and treatment. Pain Med 10(2):289–299

    Article  Google Scholar 

  25. Granot M, Ferber SG (2005) The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: a prospective study. Clin J Pain 21(5):439–445

    Article  Google Scholar 

  26. Wiech K, Ploner M, Tracey I (2008) Neurocognitive aspects of pain perception. Trends Cogn Sci 12(8):306–313

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA

    Ziyad Nasrawi, Toni Beninato, Krystyna Kabata, Stella Iskandarian, Michael E. Zenilman & Piotr Gorecki

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  1. Ziyad Nasrawi
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  2. Toni Beninato
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  3. Krystyna Kabata
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  4. Stella Iskandarian
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Correspondence to Ziyad Nasrawi.

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Disclosures

Ziyad Nasrawi, Toni Beninato, Krystyna Kabata, Stella Iskandarian, Michael E. Zenilman, and Piotr Gorecki have no conflicts of interest or financial ties to disclose.

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Nasrawi, Z., Beninato, T., Kabata, K. et al. Laparoscopic-guided transversus abdominis plane block following laparoscopic sleeve gastrectomy is associated with an earlier return to activity: a study of 271 patients. Surg Endosc 34, 2197–2203 (2020). https://doi.org/10.1007/s00464-019-07008-1

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  • DOI: https://doi.org/10.1007/s00464-019-07008-1

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